ORIGINAL ARTICLE Comparison of user assessed needs for care between psychiatric inpatients and supported community residents D. Brunt 1 RN and L. Hansson 2 1 University Lecturer, Doctoral student, School of Health Sciences and Social Work, Va ¨xjo ¨ University, Sweden and 2 Associate Professor, Department of Clinical Neuroscience, Division of Psychiatry, University of Lund, Sweden Scand J Caring Sci; 2002; 16; 406–413 Comparison of user assessed needs for care between psychiatric inpatients and supported community residents The aim of the present study was to compare user assessed needs for care for psychiatric patients in inpatient settings with that of residents in supported community residences. The Camberwell Assessment of Need was administered to 75 patients and residents in different housing settings. Residents in supported community settings had more needs for care (8.1), than patients in inpatient settings (5.8), partly because of differences in duration of illness. A greater proportion of those living in supported community residences reported needs in the areas of psychotic symptoms, accommodation, food, daytime activities, sex- ual expression and looking after the home. There were no differences in numbers of unmet needs. Relatives and friends provided emotional and social support predomin- antly in the areas of company and psychological distress. In conclusion, living in supported community residences does not imply more unmet needs, or less adequate response to needs from services, despite a greater number of needs being reported. In some areas of need, relatives and friends play an important role in the provision of support. Keywords: need assessment, psychiatric inpatients, community residences, unmet needs. Submitted 26 November 2001, Accepted 28 June 2002 Introduction The plight of patients living in mental hospitals was highlighted in the middle of the 20th century (1, 2) and the process of deinstitutionalization of psychiatric services started in earnest in the western world. Two important areas of concern for persons with severe mental illness have been housing and needs for care in the community. The latter part of the century saw the growth of various residential solutions to meet the needs of discharged mental patients. Housing in combination with treatment was followed by supported housing models and small group homes without treatment facilities (3–5). In Sweden a parliamentary commission in 1992 reported on the state of the mental health system (6). The report laid bare the problems and unmet needs of individuals suffering from severe mental illness in the hospital and in the community. Specific interest was attached to the question of housing as this was considered to be the single factor that had the greatest effect on the circum- stances of the mentally ill. A lack of suitable housing alternatives and appropriate individually planned housing support was noted. The resulting mental health reform stimulated the rapid increase of supported residential alternatives for persons with severe mental illness. These residential solutions were provided by the local authorities and were mainly in the form of small congregate residences and independent living with support. The local authorities were also stimulated to carry out inventories to identify the people with psychiatric disabilities and their needs. The inventories showed a great need for support programmes in areas such as work, daily activities, social contacts and recreation (7). The concept of need has not been clearly defined. Maslow (8) saw need as a way to understand human actions. Bradshaw (9), using a sociological perspective, distinguished between normative, felt, expressed and comparative needs. Stevens and Gabbay (10), however, saw need as being what people benefit from, and con- trasted this with demand – what people ask for. The assessment of needs generated methodological challenges (11) and needs assessment measures for the mental health field have, according to Brewin (12), covered three dif- ferent areas: lack of health, lack of access to services and lack of action by lay or professional workers. Furthermore, Correspondence to: David Brunt, School of Health Sciences and Social Work, Va ¨xjo ¨ University, 351 95 Va ¨xjo ¨ , Sweden. E-mail: david.brunt@ivosa.vxu.se 406 Ó 2002 Nordic College of Caring Sciences, Scand J Caring Sci