A needs-led approach to mental healthcare
A needs-led approach to the provision of mental healthcare has been one of the most consistent themes to emerge within evolving community mental healthcare services. In England this was first expressed in the provisions of the National Health Service and Community Care Act 1990. The central tenet of a needs-led approach is that assessment of the needs of patients should be on the basis of their individual circumstances, problems and personal goals. Assessment should not be undertaken in terms of or on the basis of existing services, that is, assessment should not be service based. This means that assessment of need is a separate process from decisions about what care or treatment to provide.
Needs-led assessment should, for example, look at whether people have access to enough activities which are meaningful (to them) each day, rather than whether they need to attend a day centre. If the assessment indicates that there is a problem with daytime activities, one service response might be a place at a day centre. Another, however, might be support in undertaking voluntary work. Needs-led assessments have two advantages over service-based assessments: first, they point to the most appropriate form of service response (in terms of treatment or care) for the individual's difficulties; and second, they have the potential to indicate needs for which there is currently no service provision, which a service-based assessment by definition would not identify.
What is a need?
People with severe mental illness usually have a wide range of clinical and social needs. A variety of approaches to defining need have been proposed. The American psychologist Maslow (1954) established a hierarchy of need when attempting to formulate a theory of human motivation. In Maslow's model, fundamental physiological needs (such as the need for food) underpin the higher needs of safety, love, self-esteem and self-actualisation. He proposed that people are motivated by the requirement to meet these needs, and that higher needs could be met only after the lower and more fundamental needs were met. This approach can be illustrated by the example of a homeless man, who is not concerned about his lack of friends while he is cold and hungry. However, once these physiological needs have been met he may express more interest in having the company of other people.