Assessment of needs for mental health care Professor Norman Sartorius Geneva, Switzerland

Professor Norman Sartorius, 2005 Traditional definition of needs Number of individuals with a disease X Number of interventions considered optimal

Professor Norman Sartorius, 2005 Traditional definition of needs: problems Diseases are often ill defined Many individuals refuse treatment or undertake it themselves There is no consensus about « optimal » treatment among those concerned The prevalence of diseases changes over time The efficacy and cost of interventions change over time

Professor Norman Sartorius, 2005 Definition of needs Demands Effective interventions Disease

Professor Norman Sartorius, 2005 A definition of needs for 2005 Needs are equal to demands related to a disease for which the service has or could have an effective and acceptable intervention

Professor Norman Sartorius, 2005 Corollaries of the 2005 definition Demands for which there is no adequate response are not needs Needs are not necessarily proportional to prevalence of a disease Needs vary between and within individuals Needs are different in different cultures, times and social groups

Professor Norman Sartorius, 2005 Overlap of needs Health staff needs Patient needs Community needs Common needs Family needs Society needs

Professor Norman Sartorius, 2005 Society’s needs Reduce cost Reduce numbers of impaired/diseased Reduce problems unpleasant for government Use health action to promote ideology of society

Professor Norman Sartorius, 2005 Family needs Help the sick member Avoid shame and stigma Receive compensation for care Harmonize care with other family roles Be informed

Professor Norman Sartorius, 2005 Health staff needs Avoid litigation Prevent burn-out Reduce work burden Harmonize care and personal careers Avoid danger

Professor Norman Sartorius, 2005 Community health needs Reduce nuisances Obtain government’s support Participate in decisions about communities Reduce problems due to « different » people (« U » shaped curve of tolerance)

Professor Norman Sartorius, 2005 Tolerance of the proportion of people who are different Tolerane % of people who are different

Professor Norman Sartorius, 2005 Needs of people with mental illness Obtain or retain respect from staff, family, social agents Reduce suffering Understand (or label) illness Obtain subsistence support Avoid impairment and disability Avoid relapse

Professor Norman Sartorius, 2005 Needs of people with mental illness (2) Prevent disease in offspring Increase self confidence Have opportunity to use assets

Professor Norman Sartorius, 2005 Needs assessment Comparative Corporate Epidemiological Ethnographic Ideological