Study of coercive measures in prisons and secure psychiatric hospitals: the views of inmates and caregivers.

AIM: The aim of the study was to ascertain the opinions of both inmates and staff of prison establishments about the use of coercive measures justified for clinical reasons for people with mental health problems and about the need to create protocols to regulate the application of these measures. METHOD: These opinions were gathered in a Qualitative Study with Focus Groups (prison inmates and prison staff) from the Granada Penitentiary Centre and the Alicante Penitentiary Psychiatric Hospital, both in Spain. RESULTS: The results showed that forced medication is the most commonly used coercive measure in these institutions. The inmates did not understand and rejected the use of this measure, above all because they were poorly informed about their illness and the medication required to treat it. The staff however defended the benefits of psychiatric medicine, even when administered without the patient's consent. CONCLUSIONS: Both inmates and staff agreed that it would be useful to have a protocol regulating the use of coercive measures. The study has also identified a number of important factors that could help to reduce the need for coercive measures or make their use unnecessary.

Variables associated with the use of coercive measures on psychiatric patients in Spanish penitentiary centers.

We have studied the use of coercive medical measures (forced medication, isolation, and mechanical restraint) in mentally ill inmates within two secure psychiatric hospitals (SPH) and three regular prisons (RP) in Spain. Variables related to adopted coercive measures were analyzed, such as type of measure, causes of indication, opinion of patient inmate, opinion of medical staff, and more frequent morbidity. A total of 209 patients (108 from SPH and 101 from RP) were studied. Isolation (41.35%) was the most frequent coercive measure, followed by mechanical restraint (33.17%) and forced medication (25.48%). The type of center has some influence; specifically in RP there is less risk of isolation and restraint than in SPH. Not having had any previous imprisonment reduces isolation and restraint risk while increases the risk of forced medication, as well as previous admissions to psychiatric inpatient units does. Finally, the fact of having lived with a partner before imprisonment reduces the risk of forced medication and communication with the family decreases the risk of isolation. Patients subjected to a coercive measure exhibited a pronounced psychopathology and most of them had been subjected to such measures on previous occasions. The mere fact of external assessment of compliance with human rights slows down the incidence of coercive measures.

Estudio de las medidas coercitivas en centros penitenciarios y hospitales psiquiátricos penitenciarios: opiniones de internos y profesionales / Study of coercive measures in prisons and secure psychiatric hospitals: the views of inmates and caregivers

Objetivos: El estudio ha pretendido conocer por un lado la opinión de personas internas en establecimientos penitenciarios, y por otro lado, la opinión de los funcionarios de estas instituciones sobre el uso de medidas coercitivas por indicación clínica en personas con problemas de salud mental y sobre la necesidad de creación de protocolos de actuación para la aplicación de estas medidas. Metodología: Estudio cualitativo que ha utilizado la técnica de Grupos Focales llevados a cabo con internos y funcionarios del Centro Penitenciario de Granada y del Hospital Psiquiátrico Penitenciario de Alicante, España. Resultados: Los resultados demuestran que la medida coercitiva más utilizada en estas instituciones es la medicación forzosa. Las personas internas no comprenden y rechazan la utilización de esta medida, sobre todo porque están mal informadas sobre su enfermedad y su tratamiento farmacológico, pero los profesionales abogan por los beneficios de la medicación psiquiátrica, aunque sea de forma involuntaria. Conclusiones: Tanto usuarios como profesionales están de acuerdo con la utilidad de la existencia de un protocolo de actuación para la aplicación de medidas coercitivas. Este estudio ha hallado importantes factores que podrían ayudar a disminuir la utilización de medidas coercitivas o incluso evitarlas (AU)

Aim: The aim of the study was to ascertain the opinions of both inmates and staff of prison establishments about the use of coercive measures justified for clinical reasons for people with mental health problems and about the need to create protocols to regulate the application of these measures. Method: These opinions were gathered in a Qualitative Study with Focus Groups (prison inmates and prison staff) from the Granada Penitentiary Centre and the Alicante Penitentiary Psychiatric Hospital, both in Spain. Results: The results showed that forced medication is the most commonly used coercive measure in these institutions. The inmates did not understand and rejected the use of this measure, above all because they were poorly informed about their illness and the medication required to treat it. The staff however defended the benefits of psychiatric medicine, even when administered without the patient's consent. Conclusions: Both inmates and staff agreed that it would be useful to have a protocol regulating the use of coercive measures. The study has also identified a number of important factors that could help to reduce the need for coercive measures or make their use unnecessary (AU)

Standardization of the Maristán Scale of Informal Care in people with schizophrenia and other psychoses.

OBJECTIVE: No instrument has been developed and validated across cultures to measure the degree of support provided by informal carers to people with schizophrenia. We aimed to develop such a measure. METHOD: The Maristán Scale of Informal Care was developed directly from the views of patients with schizophrenia in six countries. Face-to-face interviews were carried out with participants and 103 were repeated after 30 days. Principal Axis Factoring followed by Promax rotation evaluated the structure of the scale. Horn's parallel combined with bootstrapping determined the number of factors. Cronbach's alpha estimated the scale's internal consistency and intra-class correlation its test-retest reliability. RESULTS: A total of 164 interviews were undertaken, 103 with re-test. The Horn's Parallel Analysis and the analysis of the Promax rotation revealed one factor. Cronbach's alpha was 0.89. Intra-class correlation coefficient was 0.56 (95% CI 0.42-0.68) and this increased to 0.64 (95% CI 0.51-0.75) after removing two outlying values. Patients from Argentina recorded the lowest scores (poor informal support/care). CONCLUSION: The Maristán Scale of Informal Care is a reliable instrument to assess the degree of support provided by informal carers to people with schizophrenia across cultures. A confirmatory factor analysis is needed to evaluate the stability of its factor structure.

Predicting onset of major depression in general practice attendees in Europe: extending the application of the predictD risk algorithm from 12 to 24 months.

BACKGROUND: PredictD is a risk algorithm that was developed to predict risk of onset of major depression over 12 months in general practice attendees in Europe and validated in a similar population in Chile. It was the first risk algorithm to be developed in the field of mental disorders. Our objective was to extend predictD as an algorithm to detect people at risk of major depression over 24 months. Method Participants were 4190 adult attendees to general practices in the UK, Spain, Slovenia and Portugal, who were not depressed at baseline and were followed up for 24 months. The original predictD risk algorithm for onset of DSM-IV major depression had already been developed in data arising from the first 12 months of follow-up. In this analysis we fitted predictD to the longer period of follow-up, first by examining only the second year (12-24 months) and then the whole period of follow-up (0-24 months). RESULTS: The instrument performed well for prediction of major depression from 12 to 24 months [c-index 0.728, 95% confidence interval (CI) 0.675-0.781], or over the whole 24 months (c-index 0.783, 95% CI 0.757-0.809). CONCLUSIONS: The predictD risk algorithm for major depression is accurate over 24 months, extending it current use of prediction over 12 months. This strengthens its use in prevention efforts in general medical settings.

Spiritual and religious beliefs as risk factors for the onset of major depression: an international cohort study.

BACKGROUND: Several studies have reported weak associations between religious or spiritual belief and psychological health. However, most have been cross-sectional surveys in the U.S.A., limiting inference about generalizability. An international longitudinal study of incidence of major depression gave us the opportunity to investigate this relationship further. METHOD: Data were collected in a prospective cohort study of adult general practice attendees across seven countries. Participants were followed at 6 and 12 months. Spiritual and religious beliefs were assessed using a standardized questionnaire, and DSM-IV diagnosis of major depression was made using the Composite International Diagnostic Interview (CIDI). Logistic regression was used to estimate incidence rates and odds ratios (ORs), after multiple imputation of missing data. RESULTS: The analyses included 8318 attendees. Of participants reporting a spiritual understanding of life at baseline, 10.5% had an episode of depression in the following year compared to 10.3% of religious participants and 7.0% of the secular group (p<0.001). However, the findings varied significantly across countries, with the difference being significant only in the U.K., where spiritual participants were nearly three times more likely to experience an episode of depression than the secular group [OR 2.73, 95% confidence interval (CI) 1.59­4.68]. The strength of belief also had an effect, with participants with strong belief having twice the risk of participants with weak belief. There was no evidence of religion acting as a buffer to prevent depression after a serious life event. CONCLUSIONS: These results do not support the notion that religious and spiritual life views enhance psychological well-being.

Predicting the onset of major depression in primary care: international validation of a risk prediction algorithm from Spain.

BACKGROUND: The different incidence rates of, and risk factors for, depression in different countries argue for the need to have a specific risk algorithm for each country or a supranational risk algorithm. We aimed to develop and validate a predictD-Spain risk algorithm (PSRA) for the onset of major depression and to compare the performance of the PSRA with the predictD-Europe risk algorithm (PERA) in Spanish primary care. METHOD: A prospective cohort study with evaluations at baseline, 6 and 12 months. We measured 39 known risk factors and used multi-level logistic regression and inverse probability weighting to build the PSRA. In Spain (4574), Chile (2133) and another five European countries (5184), 11 891 non-depressed adult primary care attendees formed our at-risk population. The main outcome was DSM-IV major depression (CIDI). RESULTS: Six variables were patient characteristics or past events (sex, age, sex×age interaction, education, physical child abuse, and lifetime depression) and six were current status [Short Form 12 (SF-12) physical score, SF-12 mental score, dissatisfaction with unpaid work, number of serious problems in very close persons, dissatisfaction with living together at home, and taking medication for stress, anxiety or depression]. The C-index of the PSRA was 0.82 [95% confidence interval (CI) 0.79-0.84]. The Integrated Discrimination Improvement (IDI) was 0.0558 [standard error (s.e.)=0.0071, Zexp=7.88, p<0.0001] mainly due to the increase in sensitivity. Both the IDI and calibration plots showed that the PSRA functioned better than the PERA in Spain. CONCLUSIONS: The PSRA included new variables and afforded an improved performance over the PERA for predicting the onset of major depression in Spain. However, the PERA is still the best option in other European countries.

An international risk prediction algorithm for the onset of generalized anxiety and panic syndromes in general practice attendees: predictA.

BACKGROUND: There are no risk models for the prediction of anxiety that may help in prevention. We aimed to develop a risk algorithm for the onset of generalized anxiety and panic syndromes. METHOD: Family practice attendees were recruited between April 2003 and February 2005 and followed over 24 months in the UK, Spain, Portugal and Slovenia (Europe4 countries) and over 6 months in The Netherlands, Estonia and Chile. Our main outcome was generalized anxiety and panic syndromes as measured by the Patient Health Questionnaire. We entered 38 variables into a risk model using stepwise logistic regression in Europe4 data, corrected for over-fitting and tested it in The Netherlands, Estonia and Chile. RESULTS: There were 4905 attendees in Europe4, 1094 in Estonia, 1221 in The Netherlands and 2825 in Chile. In the algorithm four variables were fixed characteristics (sex, age, lifetime depression screen, family history of psychological difficulties); three current status (Short Form 12 physical health subscale and mental health subscale scores, and unsupported difficulties in paid and/or unpaid work); one concerned country; and one time of follow-up. The overall C-index in Europe4 was 0.752 [95% confidence interval (CI) 0.724-0.780]. The effect size for difference in predicted log odds between developing and not developing anxiety was 0.972 (95% CI 0.837-1.107). The validation of predictA resulted in C-indices of 0.731 (95% CI 0.654-0.809) in Estonia, 0.811 (95% CI 0.736-0.886) in The Netherlands and 0.707 (95% CI 0.671-0.742) in Chile. CONCLUSIONS: PredictA accurately predicts the risk of anxiety syndromes. The algorithm is strikingly similar to the predictD algorithm for major depression, suggesting considerable overlap in the concepts of anxiety and depression.

The risk for depression conferred by stressful life events is modified by variation at the serotonin transporter 5HTTLPR genotype: evidence from the Spanish PREDICT-Gene cohort.

We report results from the PREDICT-Gene case-control study nested in a prospective cohort designed to identify predictors of the onset of depression among adult primary-care attendees. We tested the potential gene-by-environment interaction between 5HTTLPR genotype at the serotonin transporter gene and previous exposure to threatening life events (TLEs) in depression. A total of 737 consecutively recruited participants were genotyped. Additional information was gathered on exposure to TLEs over a 6-month period, socio-demographic data and family history of psychological problems among first-degree relatives. Diagnoses of depression were ascertained using the Composite International Diagnostic Interview (CIDI) by trained interviewers. Two different depressive outcomes were used (ICD-10 depressive episode and ICD-10 severe depressive episode). Both the s/s genotype and exposure to increasing number of TLEs were significantly associated with depression. Moreover, the 5HTTLPR s/s genotype significantly modified the risk conferred by TLEs for both depressive outcomes. Thus, s/s homozygous participants required minimal exposure to TLE (1 TLE) to acquire a level of risk for depression that was only found among l/s or l/l individuals after significantly higher exposure to TLEs (two or more TLEs). The interaction was more apparent when applied to the diagnosis of ICD-10 severe depressive episode and after adjusting for gender, age and family history of psychological problems. Likelihood ratios tests for the interaction were statistically significant for both depressive outcomes (ICD-10 depressive episode: LR X(2)=4.7, P=0.09 (crude), LR-X(2)=6.4, P=0.04 (adjusted); ICD-10 severe depressive episode: LR X(2)=6.9, P=0.032 (crude), LR-X(2)=8.1, P=0.017 (adjusted)).

Estimación de unidades de costes de atención sanitaria a pacientes con esquizofrenia / Estimation of mental health care cost units for patients with schizophrenia

Introducción. Llevar a cabo estudios de coste de la enfermedad siguiendo cohortes de pacientes en su recorrido por los dispositivos de atención requiere contar con información lo más precisa posible acerca de los costes unitarios de las diferentes intervenciones. Sin embargo, la carencia de procedimientos estandarizados limita la validez externa de los resultados obtenidos. Disponer de información metodológica acerca de los procedimientos seguidos permite contrastar la validez interna y conocer los supuestos bajo los cuales operan las estimaciones realizadas.Métodos. Se estimaron unidades de coste de la atención sanitaria que reciben los pacientes con diagnóstico de esquizofrenia atendidos por un equipo de salud mental de la Comunidad Autónoma de Andalucía. Se optó por datos de fuentes primarias, trabajando por separado la atención ambulatoria y la hospitalaria. Se llevó a cabo un análisis de sensibilidad con algunas variables sometidas a incertidumbre.Resultados. Tanto en los cuidados ambulatorios como hospitalarios el mayor peso de los costes recae en el capítulo de personal, siendo esta proporción más alta en los cuidados ambulatorios. Por categoría laboral, el mayor coste recae en la atención de los psiquiatras. Las cargas horarias, excepto en psiquiatría, son similares entre los diferentes profesionales.Conclusiones. La magnitud de los costes estimados está por debajo de lo publicado en estudios internacionales, que incluyen estudios españoles. Sin embargo, los hallazgos deben ser cuidadosamente analizados por la influencia que pueden tener las opciones metodológicas realizadas

Introduction. The disease-cost study, based on the study of cohorts of patients through their visits to the mental health system, requires knowledge on the cost of each health care unit. However, lack of standardized procedures limits the external validity of the results obtained. When methodological information regarding the procedures applied is available, it makes it possible to compare the internal validity and to understand the suppositions on which the cost estimations have been made.Methods. Cost-units for the health care received by a cohort of patients diagnosed of schizophrenia were estimated. The study was performed by a community-based team and at several hospital premises belonging to the Andalusia Health Service. A sensitivity analysis was conducted whenever necessary.Results. Both in inpatients and outpatients care, personnel represents the biggest cost, this proportion being higher within the outpatient care. Among the professional categories the care given by the psychiatrists is the most expensive. Time load is similar for the different categories except for the psychiatrist.Conclusions. Cost unit estimates are lower than that which has been published internationally and within Spain. However, the findings must be carefully considered due to the influence that the different methodological options may have

Estimation of mental health care cost units for patients with schizophrenia.

INTRODUCTION: The disease-cost study, based on the study of cohorts of patients through their visits to the mental health system, requires knowledge on the cost of each health care unit. However, lack of standardized procedures limits the external validity of the results obtained. When methodological information regarding the procedures applied is available, it makes it possible to compare the internal validity and to understand the suppositions on which the cost estimations have been made. METHODS: Cost-units for the health care received by a cohort of patients diagnosed of schizophrenia were estimated. The study was performed by a community-based team and at several hospital premises belonging to the Andalusia Health Service. A sensitivity analysis was conducted whenever necessary. RESULTS: Both in inpatients and outpatients care, personnel represents the biggest cost, this proportion being higher within the outpatient care. Among the professional categories the care given by the psychiatrists is the most expensive. Time load is similar for the different categories except for the psychiatrist. CONCLUSIONS: Cost unit estimates are lower than that which has been published internationally and within Spain. However, the findings must be carefully considered due to the influence that the different methodological options may have.

[Assessment of needs for care of a schizophrenic patient sample from the Granada Sur Mental Health Care Area]. / Evaluación de las necesidades asistenciales de una muestra de pacientes esquizofrénicos del Area de Salud Mental Granada Sur.

INTRODUCTION: The assessment of the needs for care for long term severe ill patients has been one of the areas of greatest interest since the community mental health system was established. OBJECTIVE: This study has aimed to describe the needs for care of a group of schizophrenic patients and to know if these needs are met by the public mental health network. METHODS: A cohort of 83 schizophrenic patients was selected. The diagnosis was confirmed by the SCAN method. The Needs for Care Assessment instrument was used to assess the needs for care of the patients. RESULTS: The positive psychotic symptoms (98%) followed by slowness and underactivity (71%) are the most common clinical problems between the patients of the cohort. In regards to skills and abilities, the most common are those related with work (49%) and house keeping (domestic work, getting meal and domestic shopping, with 42, 41 and 41%, respectively). In regards to the state of the need, 81% of the clinical problems are covered while this is only 40% in the social area. CONCLUSIONS: The clinical needs of the schizophrenic patients can be met by the mental health services established, oriented to the community care. However, attending social needs requires more rehabilitation, occupational and residential resources to be developed.

Evaluación de las necesidades asistenciales de una muestra de pacientes esquizofrénicos del Área de Salud Mental Granada Sur / Assessment of needs for care of a schizophrenic patient sample from the Granada Sur Mental Health Care Area

Introducción. La evaluación de las necesidades asistenciales de las personas con una enfermedad mental de larga evolución es una de las áreas de mayor interés desde que se instauró el modelo comunitario de atención a la salud mental. Objetivo. El objetivo de este estudio es describir las necesidades asistenciales que presentan un grupo de pacientes esquizofrénicos y determinar si dichas necesidades están cubiertas por la red pública de servicios de salud mental. Métodos. Se ha seleccionado una muestra de 83 pacientes con diagnóstico de esquizofrenia confirmado según el método SCAN. Para la evaluación de las necesidades asistenciales se ha utilizado el instrumento Needs for Care Assessment (NCA).Resultados. Los problemas clínicos que se presentan más frecuentemente entre los pacientes de la cohorte son los síntomas psicóticos positivos (98 por ciento), seguidos de lentitud y baja actividad (71 por ciento). Respecto a los problemas presentes en la sección de destrezas y habilidades, los más frecuentes son los relacionados con la ocupación (49 por ciento) y el mantenimiento del hogar (tareas domésticas, conseguir alimentos y compras domésticas, con 42, 41 y 41 por ciento, respectivamente). Respecto al estado de la necesidad, el 81 por ciento de los problemas clínicos están cubiertos, mientras que en el área social este porcentaje desciende hasta el 40 por ciento. Conclusiones. Las necesidades clínicas de los pacientes esquizofrénicos pueden ser atendidas con los servicios de atención ya establecidos, orientados a la intervención en la comunidad. Sin embargo, la atención a las necesidades sociales requiere de forma específica del desarrollo de más recursos rehabilitadores, ocupacionales y residenciales (AU)

Características sociodemográficas de una cohortede pacientes esquizofrénicos del Área SaludMental Granada Sur / Sociodemographics characteristics of patients with schizophrenia in Granada South Area

Las variables sociodemográficas juegan un papel importante en el pronóstico de la esquizofrenia. Si se conocen dichas características se pueden planificar servicios más adaptados a las necesidades de los pacientes. El objetivo de este trabajo es presentar el perfil sociodemográfico de una cohorte de 83 pacientes esquizofrénicos que está recibiendo atención de los servicios de salud mental del área Granada Sur. Los resultados muestran que se trata de un varón (75 por ciento), de 35 años de edad, soltero (82 por ciento), que vive con su familia de origen (79 por ciento), con un nivel de estudios primarios (65 por ciento), sin trabajo (73 por ciento), y que recibe una pensión de jubilación (66 por ciento). Llama la atención el alto porcentaje de varones que acude a demandar atención (AU)

[Predictors for hospitalization rates of patients with schizophrenia]. / Variables predictoras de los ingresos hospitalarios en pacientes con esquizofrenia.

INTRODUCTION: For clinicians and care providers, the use of hospital facilities by patients with schizophrenia is one of the areas of most concern in the field of mental health studies. The objective of this study is to determine those characteristics which relate to hospital admissions for this group of patients. METHOD: A one year follow up study for a group of 83 patients with schizophrenia in contact with mental health services was carried out to identify the socio-demographic, clinical and care needs' variables related to hospital admissions. RESULTS: As a result of the multivariate models applied, male patients presenting hyperactivity, thought disturbance, deliria and exaggerated interpretation, socially embarrassing behaviour and use of drugs were shown to be those with a greater probability of hospital admission.

[Mental health services evaluation]. / Evaluación de Servicios de Salud Mental en el ámbito de la atención comunitaria.

The evaluation of the community mental health services to the chronic mental health patients is one of the areas of more interest since the psychiatric reform began. To carry out an evaluation of the attention in depth it is necessary to keep in mind many different aspects. The new conception of the mental health services has implied a change in the whole system. The evaluation process can be divide in three levels: structures, processes and results which are interrelated to each other. For each one of these levels specific indicators exist and all should complete a minimum requirements as being valid, objectives, sensitive and specific. For a good evaluation and planning of mental health services is necessary to know what type of services are implied in the attention, which are the patients that go to the services and which are the changes that have taken place in this patients.

Variables predictoras de los ingresos hospitalarios en pacientes con esquizofrenia / Predictors for hospitalization rates of patients with schizophrenia

Introduccion. El uso de servicios hospitalarios que realizan los pacientes con esquizofrenia es uno de los temas de preocupación más frecuente en el campo de la salud mental por parte de los clínicos y los gestores de los recursos asistenciales. El objetivo de este trabajo es determinar aquellas variables que están relacionadas con los ingresos hospitalarios en este grupo de pacientes. Método. Para ello se ha realizado un seguimiento, durante un año, a un grupo de 83 pacientes con esquizofrenia, en contacto con los servicios de salud mental, para identificar las variables sociodemográficas, psicopatológicas y de necesidades asistenciales relacionadas con los ingresos hospitalarios. Resultados. Como resultado de los modelos multivariantes aplicados, los pacientes que son varones, que presentan hiperactividad, experiencias de distorsión de la forma del pensamiento, delirios e interpretaciones extravagantes, comportamiento socialmente embarazoso y uso de drogas son los que tienen una probabilidad mayor de ser ingresados (AU)

[Assessment of needs in schizophrenia patients]. / Evaluación de necesidades de personas con enfermedad esquizofrénica (CAN).

BACKGROUND: To optimise appropriate planning of services, the care needs in patients with chronic mental illness, the organisms or individuals that cover these needs, and the relationships between specific needs and sociodemographic variables should be identified. This study was designed to assess needs in a population of persons with mental illness. METHODS: The Camberwell Assessment of Need (CAN) questionnaire was used to obtain and report quantitative information on needs. A total of 246 patients diagnosed as having schizophrenic disorder and 246 staff members of public mental health services, all living and working in the province of Granada (southern Spain, n = 187) or the city of Madrid (central Spain, n = 56), completed the questionnaire. Regression analysis was used to identify correlations between needs and sociodemographic variables. RESULTS: Mean needs score was 6.5; the most frequent needs were those related with daytime activities, company, psychotic symptoms, psychological distress, basic education and money management. The sociodemographic variables most closely associated with these needs were: not living with a life partner, low educational level, and receiving state benefits. The type of help these patients received was mainly from the family (informal help); public services (formal help) covered mainly clinical needs. CONCLUSIONS: The needs of persons with schizophrenic disorder do not differ from those of members of the more marginalised groups in Spanish society. Care provided by family members often represents a considerable burden on relatives.

Evaluación de Servicios de Salud Mental en el ámbito de la atención comunitaria / Mental Health Services Evaluation

La evaluación de la atención comunitaria en salud mental a los pacientes mentales crónicos es una de las áreas de mayor interés desde que comenzó la reforma psiquiátrica. Para realizar una evaluación de la atención en profundidad es necesario tener en cuenta tanto aspectos organizativos como del propio individuo, ya que la nueva concepción de la atención a la salud mental ha implicado un cambio en todo el sistema de servicios de salud mental. El proceso de evaluación se puede dividir en tres niveles: estructura, procesos y resultados, los cuales se encuentran interrelacionados entre sí. Para cada uno de estos niveles existen indicadores específicos que ayudan en el proceso de evaluación de los mismos, y todos ellos deben cumplir unos requisitos mínimos tales como ser válidos, objetivos, sensibles y específicos. La principal aportación que se deriva a partir de este trabajo de revisión es que para una buena evaluación y planificación de servicios es necesario conocer qué tipo de servicios están implicados en la atención, cuáles son los pacientes que acuden a los servicios y qué cambios se han producido en dichos pacientes (AU)

[Reliability of the Spanish version of the Camberwell Assessment of Needs (CAN) (Spanish version of CAN Reliability Study)]. / Fiabilidad del instrumento de Evaluación de Necesidades de Camberwell (CAN) (Versión española del CAN Estudio de fiabilidad).

UNLABELLED: The Camberwell Assessment of Needs questionnaire (CAN) was developed in the Institute of Psychiatry (London) in the 1990's and constitutes one of the most widely accepted instruments to assess needs of people suffering from long term psychotic disorders. This assessment instrument was translated into Spanish by the Andalusian Group of Research in Mental Health. This paper describes both the methods and most significant results on the reliability of the Spanish version of the CAN. METHODS: 246 patients with a diagnosis of schizophrenia were interviewed as well as staff involved in their care. Kappa index was used to study concordance among the results obtained from interviews to the patients and those obtained from the staff. We calculated both inter-rater reliability and test-retest reliability. RESULTS: the mean score of needs was 6.47 in the patients sample and 6.49 in the staff sample. The level of agreement amongst patients and staff interviewed was moderate/strong. Inter-rater agreement was high (r=0.986 (patients) / 0.976 (staff), p<0.01). Similarly, test-retest agreement was r=0.791 in the patients group and r=0.766 in the staff sample (p<0.01). CONCLUSIONS: this study suggests that the Spanish version of the CAN is a highly reliable instrument to evaluate needs of people suffering from long-term psychotic disorders. It also is easy and fast to administer. However, we believe it may have some transcultural difficulties in certain areas as responses might be dependent on socio-cultural context.