Hans Arvidsson

Test-retest reliability of the Camberwell Assessment of Need (CAN).

The Camberwell Assessment of Need (the CAN) is a widely used instrument in several countries to assess needs for the severely mentally ill. The instrument consists of ratings of needs made by patient and staff. This paper reports test-retest reliability for staff ratings in the Swedish version. Fifty-six patients, most of them with a diagnosis of schizophrenia, were interviewed by one person from the social services and by one from the psychiatric clinic. Afterwards the ratings were discussed and negotiated in order to arrive at one unanimous rating. The same procedure was replicated after 2-4 weeks. The intraclass correlation coefficient for the sum of needs was 0.93, and for the sum of unmet needs and met needs 0.80 for both. There were no means differences between the first and second rating. An analysis was also made of the test-retest scores of individual needs and subscales. The results in this study suggest that the summary scores of the CAN generally are reliable over time when using the method applied here. General conclusions about test-retest reliability for individual needs and subscales are more difficult to make and demand larger samples.

Met and unmet needs of severely mentally ill persons--the Psychiatric Care Reform in Sweden.

Abstract.Background: There has been a process of deinstitutionalisation and mental health care reforms in most countries in Europe. The objective of this study was to discuss the effects of the Psychiatric Care Reform in Sweden in 1995 on the development of needs of severely mentally ill persons and to analyse whether the efforts made by social services and psychiatric care have been more adequate since the reform. Method: Two hundred and eighteen persons who were considered to be severely mentally ill both in 1995/96 and 2000/2001, using the same criteria of definition, were interviewed using the same form of interview and their needs were assessed according to Camberwell Assessment of Need on both occasions. Results: The results were in the expected direction. The total sum of unmet needs and unmet needs in important need-domains had decreased on the occasion of the second interview. The degree of effort by psychiatric care and social services had increased. Conclusions: The target group had made some progress. Due to methodological difficulties, it was not possible to ascribe these results to the reform, but the often negative picture of the reform deserves to be more nuanced.

The development of needs in a group of severely mentally ill. A 10-year follow-up study after the 1995 Swedish mental health care reform.

BackgroundThe objective of this study was to follow the development of met and unmet needs in a sample of severely mentally ill after the 1995 Swedish mental health care reform and to analyse whether the efforts made by social services and mental health care have been more adequate since the reform.MethodInventories were made in 1995/1996, 2000/2001 and 2006 in an area of Sweden. A total of 171 persons who were considered to be severely mentally ill both in 1995/1996 and 2006, using the same criteria of definition, were interviewed using the same form of interview and their needs were assessed according to Camberwell Assessment of Need on all three occasions.ResultsThe number of met needs had increased between 2006 and 1995/1996 and unmet needs in important need-domains had decreased. The changes in needs mostly referred to needs in the factor ‘functional disability’. The degree of effort by psychiatric care and social services had increased. The number of wage-earners in the group had decreased to almost zero and the degree of social isolation had increased in 2006.ConclusionsThe target group had made some progress referring to their functional disability and the efforts from services had increased. However, the integration in society had decreased in fundamental aspects.

The development of psychiatric care after the mental health care reform in Sweden. A case register study

A process of deinstitutionalization and a series of mental health care reforms targeting severely mentally ill persons have taken place worldwide. The objective of this study was to follow-up the volume of psychiatric care after the 1995 Swedish reform and to study if the intended efforts of the reform were fulfilled. In a municipality, during the time-period 1994–2003, the development of number of days of inpatient care, inpatient care episodes, visits to outpatient facilities and the number of unique patients were studied using case registers. The number of persons staying in group homes and nursery homes was also studied. The number of days of inpatient care for persons given a diagnosis of schizophrenia was drastically reduced, but this reduction was quantitatively substituted by the persons staying in different kind of group homes. The implementation of new psychiatric field teams directed towards persons with psychosis and new social service field teams targeting this same group were reflected in the registers. Data supported that the intended efforts of the mental health care reform were in fact carried out, but the prioritizing of the target group of the reform may have influenced the care of persons with other kinds of psychiatric problems negatively.

Reliability of a functioning scale (GAF) among psychiatric ward staff

This study investigated the reliability of the Global Assessment of Functioning Scale (GAF) when used by psychiatric staff from acute psychiatric wards. A special focus was attributed to factors predicting the reliability of the GAF.101 raters from six acute psychiatric wards assessed six GAF-vignettes. Intraclasscorrelation (ICC) with a model of absolute agreement was used as the overall reliability measure.An overall ICC of 0.79 was obtained. There were no significant differences found between the different occupational groups or psychiatric wards according to reliability. None of the predictive factors in the regression model yielded a significant contribution to reliability.The present study supports prior results of a reliability coefficient to be found mainly in the good to excellent range. There is supporting evidence that GAF ratings performed by trained psychiatric ward staff comprise a satisfactory reliability. The present study adds to prior research showing no consistent results between studies according to reliability factors. Further studies focusing on factors related to reliability are needed.

Severely and persistently mentally ill—A changing group. Ten years after the 1995 Swedish mental health care reform

Aim: A mental health care reform was implemented in Sweden in 1995. The target group of the reform was persons considered severely and persistently mentally ill (SMI). The aim of this article was to study changes in the target group 10 years after the reform, i.e. changes in the group of persons defined as SMI. Methods: Inventories of persons considered SMI were made in a municipality of Sweden in 1995/96, 2000/2001 and 2006 based on the same definition. The invented persons were interviewed. The same interview procedures, questionnaires and need assessments were used on all three occasions. The results were based on comparing the new groups considered SMI in 2000/2001 and 2006. Results: In 2006, the group of persons considered SMI was younger. Fewer persons with a diagnosis of schizophrenia and more persons with a diagnosis of mood disorders or addictive problems were included. Problems concerning relations and physical health were more evident. A greater part had all their income from social security in 2006, and fewer persons were occupied in some kind of salaried employment, full-time or half-time, regular or sheltered. Conclusion: The target group of the reform had changed and other groups of persons were considered SMI in 2006. These new groups require other strategies of care.

Core components in the care of immigrants with psychoses: a Delphi survey of patients, families, and health-care staff.

The aim of the present study was to identify core components in the care of immigrants with psychosis in Sweden. Experts (n=43) from different perspectives (immigrants, families, and health-care staff) were assembled and used to score the importance of statements regarding components in the care for a person with psychosis in three questionnaire rounds. After each round, the opinions were consolidated and compared to identify whether consensus was reached. Consensus was reached about the importance of being treated on equal terms, regardless of country of birth. Staff interest and respect, shown in different ways of understanding, was valued. Consensus could not be reached on approximately half of the statements, of which four tended to be ranked towards unimportant. Those included that staff should have specific cultural knowledge or that the patient should be allowed to decide whether to be cared for by male or female staff. Nor was it regarded as important to identify a persons religious or ethnic background. The results illustrate the importance of fundamental psychiatric nursing, which should enable nurses to identify and meet the basic needs of all patients, regardless of country of origin. Areas for which consensus was not reached illustrate a future challenge for health-care staff to identify situations when cultural clashes could appear. Staff should have strategies to accomplish cultural negotiations to build an effective treatment alliance with the patient, as well as the family, to meet individual needs.

Gender Differences in Needs and Care of Severely Mentally Ill Persons: Findings From a Swedish Cross-Sectional and Longitudinal Study

Background: A great amount of research has been done in the area of gender and severe mental illness. However, there is an apparent lack of studies on gender differences concerning needs and care. Aim: To analyze differences in needs and care between men and women considered to be severely mentally ill (SMI) after the 1995 Swedish mental health care reform. Method: In one area of Sweden, surveys were made in 1995/96 and 2006 of persons considered to be SMI. These persons were interviewed and their needs assessed. In a cross-sectional study in 2006, the needs and care of men and women were compared. In a longitudinal study, men and women interviewed in both 1995/96 and 2006 were compared concerning the development of needs and care. Results: The structure of needs differed between men and women. Men had more needs concerning functional disability and those needs seemed possible to meet in the existing service structure. Women’s needs concerning physical health, information about health and own security, seemed to be more difficult to meet. Only a few gender differences were found in satisfaction with services and service utilization. Conclusion: It seems urgent to have a gender perspective in a needs-led mental healthcare service.

Recovery from Severe Mental Illness: a 5-Year Follow-Up Study After the 1995 Swedish Mental Health Care Reform

The aim of this study was to follow up the target group of the 1995 Swedish Mental Health Care Reform, focusing on recovery. In 1995–96, in one area of Sweden, 602 people were surveyed and judged to be severely mentally ill. Five years later the number of people who had recovered was estimated and compared with the group still judged to be severely mentally ill. A sample of recovered people was interviewed in order to gain an understanding of the recovery process. Of those surveyed, 14% were estimated to have recovered to the degree that they were no longer considered to be severely mentally ill. Support from others, medication and healthcare contributed to recovery, sometimes in a complex and contradictory way. It was also found to be important that the person took an active role in his/her own process of recovery. The recovered persons locus of control could be internal as well as external.

A Swedish sample of 45 adolescent males who have sexually offended

This study describes the background, individual characteristics, and offending behavior of 45 adolescent males who have sexually offended. This group was also compared to adolescents from the general population. The data sources were intake assessment information and questionnaires. Family problems and neglect were common. Having separated parents and growing up in large families or foster-homes discriminated the group from the general population of Swedish adolescent males. The group scored higher than norm data regarding anger, depression, and disruptive behavior. They showed a wish to present themselves in a positive way and they were less open concerning sexuality than a comparison group. There were overall few significant differences between the target group and the comparison groups. Future studies need to explore offender sub-groups; specifically how and why problematic backgrounds affect children differently.