Géraud Dautzenberg

Summary and general discussion 7 179 is partly due to the reciprocal nature of the demand for care for the psychiatric complaint (Houtjes et al., 2011). There is also considerable evidence in the literature regarding the need for functional, social, and personal recovery. In doing so, ‘there is no hierarchy or imperative order’ (stel van der, 2015) between the different aspects of recovery. Even if it is not one’s competency or primary mandate to address the ‘other’ or ‘all’ areas of recovery, the clinician must be aware of them and therefore can refer the patient to a facility or staff member where there is such a possibility, for example, social psychiatry. The treatment or treatment setting can then better match the treatment demand. For example, treatments with a clinical focus that is inappropriate for social or functional recovery due to an underlying social need can be reduced. This results in reductions in the number needed to treat by reducing the number of aforementioned misdiagnosed patients and the associated number of unnecessary treatments (Stel van der, 2015), thus reducing the cost impact. In addition, the number of unmet needs can be reduced, and the quality of life improved. We want to highlight the apparent watershed between the reported needs being met or not on the basis of the CANE between patients and staff. This seems to be the same partition as a realistic or daily practice versus theoretical or idealistic psychiatric treatment. As one can debate whether all CANE items belong to the primary goal of psychiatric care (clinical recovery), one cannot debate whether these unmet CANE items will influence the wellbeing of patients and play a part in functional and social recovery. This is a clear message not only for clinicians, but also for policymakers and insurance companies, and they should be aware of this. There is also an increasing tendency to assess the needs of patients (Thornicroft and Slade, 2014). The CANE has been used to assess the needs of older psychiatric patients and those in general practice. In the UK, both the Department of Health and the Royal College of Psychiatrists recommend CAN(E) as an ‘outcome measure’ to be used by mental health professionals who wish to make sure their clinical practice is effective (http://www.kcl.ac.uk/ioppn/about/difference/ The-Camberwell-Assessment-of-Need.aspx). In the Netherlands, it is one of the core instruments that comprise CNCM, the cumulative needs for care monitoring, used to plan treatment for individuals, and conduct research (Drukker et al., 2007). The CAN(E) is often used as an aid during the history of complaints interviews, which follows the demandoriented care in the mental health sector (HOI or herstelondersteunende intake). As the CANE is used in multiple studies using different inclusion criteria, we raise the question of what could be learned from these results.

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