Needs for care of chronic schizophrenic patients in long-term community treatment

Background Specific problems of long-term community care of chronic schizophrenic patients are an under-researched area interesting for the provision of regional mental health care. Methods This study focuses on a 41/2-year prospective assessment of normative needs for care in a cohort (initially N=115) living in the Dresden care region (Germany).At six time-points, normative needs for care were assessed with the Needs for Care Assessment (NFCAS). Results The total number of problems did not change significantly over the study period. The average number of met needs was lower at the longer-term follow-up assessments,due particularly to a decrease in the social section. This trend is also demonstrated for the average number of unmet needs. In contrast, the mean number of “unmeetable needs” increased. Consistently, 70–80% of the patients exhibit problems in positive psychotic and negative symptoms, household affairs and recreational activities.Communication, occupation and recreational activities constitute a trio of social needs not met for nearly one-third of the patients disabled in these respects. Logistic analyses of regression could not identify a predictive model for the total needs development within the 41/2-year community treatment. Conclusion The rather stable pattern of needs for care seems to define clear long-lasting tasks for community mental health services. For chronic schizophrenic patients, services should especially focus on social skills training and psychoeducational approaches. Due to a wide range of possible factors of influence, however, planning long-term context-dependent processes of care in the community lacks a clear evidence base.