Abstract
This is a sobering book. It endeavours to explain the place of ‘needs assessment’ in current mental health policy in the United Kingdom. The authors provide the context of such assessment by describing developments in health policy over recent decades, including the innumerable reports and working documents (one notes all the ‘ing’ titles – so much potential activity for all concerned!) and apparent shifts in direction, no doubt to the confusion and befuddlement of the hapless clinician. The authors express caution regarding the meaning and use of a term that seems to imply appropriate and beneficial results, yet must always be read within a political and economic context. It is difficult not to approach the area with a degree of cynical realism, in which the ‘needs assessment’ must lead to the answer that is within the government's means and acceptable to the community. This is especially so when it is the needs of mentally disordered offenders (MDO) that are being considered.
Having set the scene of changing health policy in the UK in the last decade, the authors move to attempt to tie down a definition of need – no easy task given the many influences brought to bear. The bulk of the book then goes on to describe the approaches to needs assessment: (1) survey methods which consistently demonstrate a high level of need and the limited impact of efforts to address this to date; (2) a rates-under-treatment method which illustrates who does access services, but provides little information on unmet need; (3) the social indicator approach which assesses need indirectly; and (4) the key informant and community opinion approach which rates need on what community groups with differing levels of expertise think is needed. The authors then examine attempts to evaluate services for the MDO – a task so complex and with so many competing interests that the authors rightly conclude that in this area outcome measurement is simply inadequate. The book concludes by highlighting the potential dangers of needs assessment in this area. The recent push towards a separate policy approach to the dangerous severe personality disordered (DSPD) in the UK is a cogent reminder that the needs assessed are not always those of the patient.
The book is clearly written, well researched and is not only relevant to MDO service development, but also to the wider health sphere. It is not easy to read, and is very much UK-centred, but will be of interest to those who wonder how it is that we get the services we do, and how government attempts to respond to multiple conflicting interests in times of limited resources.