Staff and patient assessments of need in an epidemiologically representative sample of patients with psychosis--staff and patient assessments of need

The present study aimed to assess, in an epidemiologically representative sample of patients with psychosis, the relationship between patient and staff perception of need and to investigate the association between unmet need and study variables when assessed by patients and staff, respectively. Of 474 cases of functional psychosis identified in the locality, 225 were assessed using the Camberwell Assessment of Need Short Appraisal Schedule (CANSAS) to rate staff and patients' perceptions of need. Unmet need was rated most highly in social/relationship domains by patients and keyworkers. Levels of total met and unmet need were rated similarly as aggregate scores and in differing domains, by staff and patients. Levels of staff agreement between patient and staff ratings were "substantial" in all domains except safety to others, where agreement was "fair" and in which staff appeared to perceive higher risk than patients. Staff, but not patients, rated significantly more unmet need in non-Caucasian groups. No other variable studied was associated with unmet need. The levels of agreement between patient and staff ratings were significantly higher in the present study than previously reported. Possible reasons for the higher concordance found in this study were the use of keyworkers who knew patients well. Further, keyworkers may have been influenced in their assessment of need by awareness of patients' perceived need. Joint needs assessment may strengthen the therapeutic alliance, improve our understanding of priority needs and aid in service development. Work is needed to ensure that care is targeted explicitly towards unmet need.