OBJECTIVE:Previous work suggests that psychiatric patients are more satisfied with community-based than with hospital-based services, but it is not clear how far these findings can be generalized to routine services. The aim of this study was to compare the satisfaction of patients with psychosis between a hospital-based service in London, UK and a community-based service in Verona, Italy.METHOD:The Verona Service Satisfaction Scale (VSSS) was used to measure satisfaction among patients with psychosis in Nunhead (London) and South Verona.RESULTS:Satisfaction across all dimensions was higher in South Verona than in Nunhead. Sociodemographic and service use differences between the two groups were insufficient to explain this difference.CONCLUSION:This study suggests that experimental findings that patients prefer community-based to hospital psychiatric services can be generalized to routine services.

Community support workers have become a common feature of mental health services. They work mainly with people with severe mental illness and offer intense support. Their need for training should be considered.

Background The prevalence of schizophrenia is known to be greater in urban than in rural areas. less studied are differences between the patients themselves and, more specifically, their use of psychiatric services.Method The prevalence of schizophrenia was determined in rural Nithsdale in Scotland and urban Nunhead and Norwood in South London. information about patients' psychiatric history, use of services during the study year and global assessment of functioning were obtained from case records and staff.Results There were no significant differences in prevalence rates between Nithsdale patients, all White (2.78 per 1000 general population), Nunhead (3.46 per 1000) and Norwood (2.24 per 1000) Whites, rates were significantly higher among the non-Whites in Nunhead (7.36 per 1000) and Norwood (5.53 per 1000), who were mainly Black Caribbeans. Nithsdale patients were at a higher level of functioning and made substantially more use of psychiatric services. During the study year, 42% of Nithsdale patients used more than one of three principal community services, namely day, out-patient and community psychiatric nursing care.Conclusions The prevalence of schizophrenia is no different in rural Nithsdale and inner-city Nunhead and Norwood, when only White patients are considered. Nithsdale patients were at a higher level of functioning and made more use of available psychiatric services.

Previous work examining how individuals enter mental health treatment comes either from the health services utilization tradition, which implicitly assumes that clients make decisions to seek care, or from the socio-legal perspective, which examines how clients are forced into care. This paper draws from the Network-Episode Model to systematically consider the different social processes through which people come to enter psychiatric treatment by exploring the “stories” told by individuals making their first major contact with the mental health system. We combine the use of qualitative and quantitative methods to examine data from the Indianapolis Network Mental Health Study, a longitudinal study of individuals in treatment at the largest public and voluntary facilities in the city. We analyze detailed self-reports of how they came to use mental health services, classifying these stories as “choice,” “coercion,” or “muddling through.” Using multinomial logit analyses, we examine how factors such as gender, race and diagnosis shape the types of stories that individuals tell. The preliminary results indicate that fewer than half of the stories (45.9%) match the notion of choice underlying the dominant utilization theories. Almost a quarter of respondents (22.9%) report coercion and nearly one-third (31.2%) tell stories that lack a clear agent. Diagnosis and social networks tap differences in how individuals experience entry into care. Individuals diagnosed with bipolar disorder or who have larger, closer social networks are more likely to tell stories of coercion. We discuss the theoretical, methodological, and clinical implications of findings drawn from this examination of clients' stories

BackgroundPeople with severe mental illness often have a complex mixture of clinical and social needs. The Camberwell Assessment of Need (CAN) is a new instrument which has been designed to provide a comprehensive assessment of these needs. There are two versions of the instrument: the clinical version has been designed to be used by staff to plan patients' care; whereas the research version is primarily a mental health service evaluation tool. The CAN has been designed to assist local authorities to fulfil their statutory obligations under the National Health Service and Community Care Act 1990 to assess needs for community services.MethodA draft version of the instrument was designed by the authors. Modifications were made following comments from mental health experts and a patient survey. Patients (n= 49) and staff (n= 60) were then interviewed, using the amended version, to assess the inter-rater and test-retest reliability of the instrument.ResultsThe mean number of needs identified per patient ranged from 7.55 to 8.64. Correlations of the inter-rater and test-retest reliability of the total number of needs identified by staff were 0.99 and 0.78 respectively. The percentage of complete agreement on individual items ranged from 100–81.6% (inter-rater) and 100–58.1% (test-retest).ConclusionsThe study suggests that the CAN is a valid and reliable instrument for assessing the needs of people with severe mental illness. It is easily learnt by staff from a range of professional backgrounds, and a complete assessment took, on average, around 25 minutes.

EDITOR,--The problem of non-random under-enumeration in the 1991 census has recently been highlighted in the BMJ.1 2 This problem may be substantial for certain groups in the population. Glover pointed out that the population figures for black Caribbeans, especially young men, may be substantially underestimated.3 Such issues are important for those concerned with estimating the differential prevalence of diseases among minority groups. We, for example, are estimating the prevalence of psychosis among different ethnic groups in two inner …

A new community multidisciplinary team based in primary care is described and the experience of the first year discussed. The effect the team has had on the use of psychiatric services in its first year was studied. There was a threefold increase in the rate of inception to care, leading to a doubling in the prevalence of treated psychiatric disorder. There has been a reduction in the demands made on the hospital out-patient services, but no change in the use of in-patient resources or emergency contacts.