The nature of needs assessment in community mental health

Confusion in defining needs assessment is discussed. A tripartite model of needs assessment is proposed: an identification of a problem; a statement about priorities; and a chosen solution. The parts can be used independently or linked together to plan new or altered services. Various needs assessment techniques are examined for their usefulness in each area. Two examples of needs assessment processes are given.     

The uses and misuses of data in assessing mental health needs

Relatively little attention has been directed to the need-assessment procedures stipulated by the 1964 Federal Regulations for the Community Mental Health Centers Act. This paper considers the implications of the assumptions contained in these procedures and their significance for planners. It is concluded that in spite of inherent theoretical difficulties and methodological limitations the Federal Regulations ultimately will considerably broaden the planners' definition of community need. He was formerly Director of Research for the Massachusetts Mental Health Planning Project.     

School-based mental health services in the united states: History,current models and needs

Children's mental health needs continue to be largely unmet, even when community services are provided. On-site mental health services in schools address unmet needs by improving access to, and relevance of services. As schools have increasingly been mandated to serve the needs of all children (including those who are emotionally disturbed) general health and mental health services have been increasingly placed in them. Although the provision of basic health care in schools began in the early part of the century, the concept of providing comprehensive services, in which mental health services are integrated into primary medical care, has only been implemented recently. We review the background of school-based mental health services, compare various models of service delivery, and highlight issues important to the future development and advancement of these services.     

The mental health needs of the severely physically disabled

Severely physically disabled individuals, advocates for the disabled, and rehabilitation and mental health professionals were surveyed to determine their perceptions of the need for services for 12 mental health problems encountered by persons with physical disability and the kinds of services needed. All groups surveyed agreed that vocational, social-interpersonal, personal-emotional, self-concept, and marital-family problems were in greatest need of services, but their perceptions of the extent of service need for each of the 12 problems differed significantly. The groups unanimously perceived rehabilitation counseling as the most needed service but differed significantly in their perception of the extent of service need for other services that were also highly rated, such as family, group, and individual therapy; peer counseling; respite care; and social skills training. The groups unanimously agreed that services designed to treat major mental illness were the least needed.     

Adult mental health needs and expenditure in Australia

BACKGROUND: Relatively little international work has examined whether mental health resource allocation matches need. This study aimed to determine whether adult mental health resources in Australia are being distributed equitably. METHOD: Individual measures of need were extrapolated to Australian Areas, and Area-based proxies of need were considered. Particular attention was paid to the prevalence of mental health problems, since this is arguably the most objective measure of need. The extent to which these measures predicted public sector, private sector and total adult mental health expenditure at an Area level was examined. RESULTS: In the public sector, 41.6% of expenditure variation was explained by the prevalence of affective disorders, personality disorders, cognitive impairment and psychosis, as well as the Area's level of economic resources and State/Territory effects. In the private sector, 72.4% of expenditure variation was explained by service use and State/Territory effects (with an alternative model incorporating service use and State/Territory supply of private psychiatrists explaining 69.4% of expenditure variation). A relatively high proportion (58.7%) of total expenditure variation could be explained by service utilisation and State/Territory effects. CONCLUSIONS: For services to be delivered equitably, the majority of variation in expenditure would have to be accounted for by appropriate measures of need. The best model for public sector expenditure included an appropriate measure of need but had relatively poor explanatory power. The models for private sector and total expenditure had greater explanatory power, but relied on less appropriate measures of need. It is concluded that mental health services in Australia are not yet being delivered equitably.     

Responsibilities and training needs of mental health administrators

This paper reports findings of a needs assessment in the area of training programs for senior mental health administrators. Questionnaires (N=530) were sent; 169 to county and regional state mental health administrators; 331 went to community mental health administrators. The response rate was 43%. Thirty-four percent of the public sector respondents listed general administration as their first topic; fiscal issues were listed by 19%; 18% listed personnel administration first. Second topics chosen for training by the public sector administrators were general administration (17%), financial management (24%), and personnel (20%). As their first topics of choice for future training, 37% of the community mental health administrators selected general administration areas, 27% selected financial management, and 10% personnel. Training for mental health administrators has the potential for substantial enrichment through the design and implementation of carefully planned programs. Results from this needs assessment show the continued strong need for such training.     

The current state of adult mental health care in France

Since the 1960s, French public mental health services are organised in “sectors”, each sector catering for a mean population of 54,000 inhabitants. Although this organisation was aimed at insuring equal access to care whatever the place of residence, there are still huge disparities in number of staff and bed resources from one sector to another. The reduction in the number of hospital beds started later in France than in most other European countries, and was really effective in the 1990s. In 2000, there were 9.4 beds for 10,000 inhabitants aged over 20 years. Hospital-based care has still an overwhelming importance, and is associated with a marked under-development of community services and lack of sheltered housing for the most disabled patients. With more than 13,000 registered psychiatrists in France, the density of psychiatrists is one of the highest in the world. However, French psychiatry has currently to face a structural crisis due to the reduction in public health budgets, as well as to the reduction of 30% in the number of French psychiatrists over the next two decades. The numerous national programmes aimed at renovating French mental health services, published over the last decade, have not yet kept their promises.     

A needs index for mental health care

The study aimed to develop a mental illness needs index to help local managers, district purchasers and national policy makers in allocating resources. Formulae were developed by regression analysis using 1991 census data to predict the period prevalence of acute psychiatric admission from electoral wards. Census variables used were chosen on the basis of an established association with mental illness rates. Data from one English Health Service region were analysed for patterns common to wards at hospital catchment area level and patterns common to district health authorities at regional level. The North East Thames region was chosen as the setting for the study, with 7096 patients being admitted during 1991. In most, but not all, catchment areas reasonable prediction of the pattern of admission prevalence was possible using the variables chosen. However, different population characteristics predicted admission prevalence in rural and urban areas. Prediction methods based on one or two variables are thus unlikely to work in both settings. A Mental Illness Needs Index (MINI) based on social isolation, poverty, unemployment, permanent sickness and temporary and insecure housing predicted differences in admission prevalence between wards at catchment area level better than Jarman's Underprivileged Area (UPA) score [1] and between districts at regional level better than the UPA score and comparably to the York Psychiatric Index [2] (adjusted r ² at regional level (MINI 0.82, UPA 0.53, York index 0.70). District admission prevalence rates vary by a factor of three between rural and inner city areas; this difference may not fully reflect the variation in the cost of providing care. It did not prove possible to incorporate factors related to bed availability in the models used; reasons for this are discussed. Data covering other aspects of mental health care in addition to hospital admission are needed for more satisfactory modelling. Accepted: 20 June 1997     

Denver American Indian mental health needs survey

American Indians are at higher risk for mental health problems than other ethnic groups in the United States (Nelson, McCoy, Stetter, & Vanderwagen, 1992). Little attention has been directed towards assessing mental health problems among urban American Indians. In response to an Indian Health Service (IHS) call for proposals, this survey addressed the mental health needs of Denver urban American Indians. The purpose of the survey was to gather data from Denver American Indian adults and adolescents as well as service providers in the Denver area who work, to one degree or the other, with members of the American Indian community. These data were to provide a general idea of the breadth of mental health and other associated problems among the Denver American Indian population.     

A multi-perspective survey of mental health consumer needs

Conclusions There is extensive evidence that perspectives on mental health consumer needs vary widely between consumers and other stakeholders-administrators, practitioners, and family members. Traditional methods of determining mental health consumer needs, based on professional input only, have inhibited program development. While progress has been achieved when shared goals have been identified, it has also been inhibited by a lack of known areas of consensus between stakeholder groups.Surveys provide a cost-effective step toward documenting shared views from stakeholders who have the greatest stake in influencing the size and direction of the mental health service system. Identifying shared views is necessary to coordinate stakeholder efforts. The most encouraging result of the surveys is that there are many areas of consensus and thus the potential exists for the stakeholders to coordinate their efforts toward shared goals to better meet important consumer needs by prioritizing services, improving practitioner training, and coordinating advocacy.     

Administrative issues and current mental health research

During the last decade there has been a shift in the focus of mental health research and an increased number of publications in professional journals describing research efforts. There is an increase in the proportion of investigations devoted to biological factors and into the etiology of psychiatric disorders and a decreased emphasis on psycho-behavioral research and research concerning management of psychiatric disorders. There is a significant increase in the sophistication of mental health research. These changes have important and encouraging implications for administrations of mental health programs.Dr. Keill is Chief of Psychiatry at the Buffalo VA Medical Center and Clinical Professor of Psychiatry at the State University of New York at Buffalo. Requests for reprints should be sent to Dr. Keill at the Dept. of Psychiatry, 3495 Bailey Avenue, Buffalo, New York, 14215.     

Training in geriatric mental health: needs and strategies.

This paper examines current numbers of U.S. mental health care professionals in psychiatry, psychology, social work, and nursing who are trained to treat late-life mental disorders and presents estimates of the increased numbers that will be needed by 2010. Strategies that may be effective in increasing the supply of geriatric mental health specialists are expanding incentives, such as fellowship stipends, loan forgiveness programs, and clinical reimbursement, to attract more clinicians to the field; encouraging professional organizations to offer certification in aging to highlight increased knowledge among professionals; and increasing core curricula in late-life mental disorders, or at least in aging, in all health professions. Other strategies are to diversify the range of training opportunities available by establishing short-term training initiatives to meet specific demands; use new technology to provide education to both professionals and the public; and establish "centers of excellence" to advance research training and clinical care in late-life mental disorders.     

Governing boards in mental health: Roles and training needs

This paper emphasizes the importance of a mental health center board's assuming responsibility for directing its effort to objectives that are different from that of the staff and suggests a framework for such differentiation. The authors describe a study on boards and its implications for the training of board members.     

Staff development needs in a community mental health center

Staff training and development needs in a community mental health center were determined using a methodology that analyzed data from three different sources: survey data, psychiatric diagnoses of client population, and individual staff development plans. Findings support the rationale that validation of training and development needs is important.