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Background: The importance of needs assessment for service development has been widely recognised. Several studies have focused on the associations between ratings of needs by patients and staff and have found clear differences, especially concerning the unmet needs., Methods: The present study is part of a Nordic Multicentre study that investigates the life and care of outpatients with a schizophrenia group illness in all the Nordic countries. The aim of this paper is to study the patterns of needs as identified by patients and staff according to the Camberwell Assessment of Needs (CAN). Quality of life, level of functioning, and psychiatric symptoms were assessed., Results: The sample includes 300 patients, 194 (65%) men and 106 (35%) women. The factor analysis identified five factors for patients and four factors for staff in the questionnaire on ratings of needs. In four of the five patient-related factors a meaningful interpretation was possible, and the factors were named skills, illness, coping, and substance abuse. The staff-related factors were named skills, impairment, symptom, and substance abuse. There were significant associations between the sum scores constructed from the factors and measures of functioning level and symptoms., Conclusions: It seems that the sum factor reflecting secondary needs was the most important of the identified factors among both patient and staff ratings. The item-by-item comparisons in previous studies have emphasised differences between patient and staff ratings, but our analysis of the structure of needs also found similarities in the structures and in the associations between the identified sum scores and measures of symptoms, functioning level, and quality of life.

Psychiatric patients' awareness of treatments options and their possibilities to influence their care has increased. For the clinicians, the management of evidence-based care, as well as organizational and resource aspects, set different goals for the clinical encounter. In this article we are focusing on the clinicians' experiences and ask: How do the clinicians view situations in which there is a conflict between patients' individual needs and goals and other aspects in decision-making? We implemented a qualitative study of 13 thematic semi-structured interviews with clinicians working in psychiatry. We used discourse analysis to investigate how the clinician view the doctor–patient interaction. We identified three discources which were termed the medical standpoint, the psychodynamic standpoint and the standpoint of the patient's experience. In their talk, the clinicians use the three discources to make sense of the diverse expectations from both the patient and the mental health care system. The three discources also reflect different aspects in psychiatric treatment cultures, such as evidence-based medicine, the ideal of patient-centeredness, therapeutic interaction and organizational requirements. [ABSTRACT FROM AUTHOR]

Background: Current categorical classification of personality disorders has been criticized for overlooking the dimensional nature of personality and that it may miss some sub-threshold personality disturbances of clinical significance. We aimed to evaluate the clinical importance of these conditions. For this, we used a simple four-level dimensional categorization based on the severity of personality disturbance. Methods: The sample consisted of 352 patients admitted to mental health services. All underwent diagnostic assessments (SCID-I and SCID-II) and filled in questionnaires concerning their social situation and childhood adversities, and other validated tools, including the Beck Depression Inventory (BDI), Alcohol Use Disorders Identification Test (AUDIT), health-related quality of life (15D), and the five-item Mental Health Index (MHI-5). The patients were categorized into four groups according to the level of personality disturbance: 0 = No personality disturbance, 1 = Personality difficulty (one criterion less than threshold for one or more personality disorders), 2 = Simple personality disorder (one personality disorder), and 3 = Complex/Severe personality disorder (two or more personality disorders or any borderline and antisocial personality disorder). Results: The proportions of the groups were as follows: no personality disturbance 38.4% (n = 135), personality difficulty 14.5% (n = 51), simple personality disorder 19.9% (n = 70), and complex/severe personality disorder 24.4% (n = 86). Patients with no personality disturbance were significantly differentiated (p < 0.05) from the other groups regarding the BDI, 15D, and MHI-5 scores as well as the number of Axis I diagnoses. Patients with complex/severe personality disorders stood out as being worst off. Social dysfunction was related to the severity of the personality disturbance. Patients with a personality difficulty or a simple personality disorder had prominent symptoms and difficulties, but the differences between these groups were mostly non-significant. Conclusions: An elevated severity level of personality disturbance is associated with an increase in psychiatric morbidity and social dysfunction. Diagnostically sub-threshold personality difficulties are of clinical significance and the degree of impairment corresponds to actual personality disorders. Since these two groups did not significantly differ from each other, our findings also highlight the complexity related to the use of diagnostic thresholds for separate personality disorders. [ABSTRACT FROM AUTHOR]

This study set out to evaluate overall patient satisfaction with psychiatric community care and to study the factors predicting level of satisfaction with the services. The level of overall satisfaction was fairly high and at the same level as in some other studies. There did not seem to be great difficulties in accessing the community care. Our results indicate that patients would prefer receiving more information about their disorder and its treatment. The stepwise logistic regression model indicated that the odds were 6.8-fold that the problems of mental health would become easier if the views of the patient were taken into consideration (P<0.05). The odds were 12.8-fold that the patient would recommend community care if he/her had felt him/herself understood and cared for (P<0.05). The odds were 5.9-fold that the patient experienced community care as effective if the therapist had understood the patient in the discussions (P=0.01). Evaluating the satisfaction of the patients should become routine practice throughout the services. Consequently, the views of the service users would be brought into decision-making procedures, and the services could be better modified on the basis of such views. [ABSTRACT FROM AUTHOR]

To assess the availability and flexibility of psychiatric services as seen by primary care physicians, a questionnaire was mailed to 190 general practitioners working in public health centers in two Finnish university towns with populations of 180,000 and 160,000. The response rate of the GPs was 64%. The primary care physicians were dissatisfied with the amount of psychiatric services and found problems in transferring information from specialist care to primary care. Admission to psychiatric hospital was considered difficult to arrange even when found necessary by primary care, and the delay between referral and entering specialist-level services was seen as too long. Satisfaction was expressed about special teams that respond quickly to crisis situations. In improving collaboration between primary care and specialized care, better transfer of information and flexible consultations are needed. [ABSTRACT FROM AUTHOR]