J. K. Wing

PRINCIPLES AND PRACTICE OF MEASURING NEEDS IN THE LONG-TERM MENTALLY-ILL - THE MRC NEEDS FOR CARE ASSESSMENT

We report the development of a new procedure for assessing the needs for treatment and care of the long-term mentally ill. This procedure covers 21 areas of clinical and social functioning, and in each of these specifies appropriate interventions. Decision rules are described which permit problems in functioning to be primarily classified as a met need, an unmet need, or as involving no need, and which allow the identification of various secondary needs. We report preliminary data on the reliability and validity of this procedure and discuss its potential applications in the care of the long-term mentally ill.

Needs for care among the long-term mentally ill: a report from the Camberwell high contact survey

We report the results of a survey of the needs for items of care of 145 long-term users of psychiatric day-hospitals and day-centres in Camberwell. The overall ratio of met to unmet need was almost exactly 5:1. Need was shown to vary according to chronicity, degree of participation, and placement in day-hospital or day-centre. Specific areas of functioning and specific types of care were identified in which there was significant overprovision or underprovision. The utility of our measures, and their ability to identify clinically significant unmet need, are discussed.

The relationship of social network deficits with deficits in social functioning in long-term psychiatric disorders

SummaryIt has been suggested that deficits or impairments in social functioning may explain the depleted support networks of the mentally ill. With this in mind, 145 long-term users of day care psychiatric facilities, 57% of whom had a life-time diagnosis of schizophrenia, were examined to determine whether deficits in social and survival skills explained deficits in their social networks. Compared with patients with acute depression, long-term patients had smaller social networks. There was a very small but statistically significant association between observer ratings of deficits in social functioning (daily social and living skills) and self-reported family social networks size. Behavioural problems were also associated with smaller family networks. Among the long-term patients, duration of service contact and type of disorder (affective vs nonaffective psychosis) were not related to network size. These preliminary findings are discussed.

The problems of people in long-term psychiatric day care; An introduction to the Camberwell High Contact Survey

The aims of the Camberwell High Contract Survey (CHCS) were to develop and test a systematic needs assessment procedure and use it to evaluate the services provided to long-term users of day centres and sheltered residential accommodation (excluding hospital wards). This paper describes the background to the study, the sample of 145 attenders and their characteristics, their clinical and social problems and the care provided for them.

Differential diagnosis of schizophrenia

The way that the phenomena of the major psychoses have been classified and conceptualized has fluctuated markedly during the past 150 years. Kraepelin’s formulation, and Eugen Bleuler’s extension of it, have been clinically influential and scientifically fruitful although alternative models have always been available. The negative symptoms, for example, are well-known to neurologists in the form of akinetic mutism, catatonia and abulia. They occur in a wide range of psychiatric conditions, including dementia, the autistic spectrum, schizophrenia and bipolar disorders, in an approximate dimension of severity. The positive symptoms appear clinically to lie near the top of an approximate hierarchy. Symptoms of conditions lower down, such as the affective psychoses and neuroses, are commonly associated.