A Model of Needs Assessment: Why are There Differences Between Assessments of Need Made by Staff and by Psychotic Patients?

Objectives: This study investigated why there are differences between staff and patient assessments of need for people with a diagnosis of functional psychosis. A model to account for these differences was proposed and tested. Design The needs of psychotic patients were assessed cross-sectionally by patients and staff, and the staff-patient discrepancies were compared with measures of attributional style, standards and expectations completed by the patients. Setting: 3 catchment area Community Mental Health Teams in South London. Subjects: 35 out-patients aged over 18 and with a clinical diagnosis of a functional psychotic disorder, and their formal carers (staff). Measures: The Camberwell Assessment of Need: Short Appraisal Schedule, the Internal, Personal and Situational Attributions Questionnaire, and the Expectations of Self questionnaire. Results: Patients rated on average 2.0 needs (out of 22) more than staff, a significant difference which was substantially accounted for by discrepancies between staff and patient ratings of unmet need. 44% of the discrepancy between staff and patient ratings of unmet need was accounted for by variables relating to psychiatric history, intensity of contact with staff, standards and expectations. Conclusions: This study provides some evidence that the standards and expectations held by patients impact on how they assess their needs. Further refinement of the proposed model is necessary, but the identification of patient characteristics which impact on how they assess needs will inform negotiations between staff and patient when there is disagreement about needs