The concept of mental health needs is often ambiguously defined, frequently used to justify the creation of mental health services or programs. It may refer to the care required by individuals with mental disorders, the contributions mental health sciences could or should make towards a more humane socio-economic development, or actions necessary to foster more cordial, supportive, and respectful interpersonal relationships.1 The World Health Organization (WHO) defined health in 1948 as "a state of complete physical, mental, and social well-being, not merely the absence of disease or infirmity".2,3 Although this definition is comprehensive—albeit somewhat idealistic and ambitious—it underscores the ultimate goal of healthcare interventions. Despite this, medical professionals often adopt a narrower focus aligned with the medical model, emphasizing history-taking, examination, investigation, treatment, and measurable clinical outcomes.

Defining the scope of mental health services requires clarity on three aspects: (i) identifying what constitutes a mental disorder, (ii) determining the availability and proven effectiveness of treatments through appropriate trials, and (iii) understanding public expectations regarding conditions that mental health services can address (1). Need is defined as "the requirements of individuals to enable them to achieve, maintain, or restore an acceptable level of social independence or quality of life".4 Addressing needs is crucial, as unmet needs correlate with poorer health outcomes, reduced quality of life, and higher healthcare costs.5

The importance of needs assessment is widely acknowledged for ensuring holistic and high-quality care for individuals with mental illnesses. It serves as a bridge between identifying problems, implementing solutions, and evaluating outcomes, forming a vital component in healthcare planning and development.6 Meeting needs and reducing symptoms are central to effective mental health treatment. Unmet or partially met needs can hinder patients' ability to adapt, leading to maladaptive coping mechanisms and increased reliance on healthcare services. Consequently, the prevalence of unmet needs should be a key criterion for evaluating the efficacy of mental health services.7

Listening to patients' needs is essential for addressing self-perceived social requirements beyond symptom reduction and enhancing the quality of life for individuals with mental disorders. Studies reveal significant levels of unmet needs among those with severe mental illnesses. Integrating standardized need assessments into care planning can help address these needs and improve outcomes.7 Modern medicine increasingly acknowledges the value of the patient's perspective, but further research is needed to explore the interconnections between health needs, satisfaction, and quality of life.8

According to the Department of Health Social Service Inspectorate, need assessments should be comprehensive, encompassing both health and social needs, while also being reliable and valid.9 As a critical indicator for evaluating healthcare, need assessment plays a pivotal role in managing psychiatric patients and reforming treatments. The shift from hospital-centered to community-focused care has redefined how care is evaluated. The ultimate goal extends beyond achieving clinical results to meeting a broader range of needs, fostering successful social interactions, and improving overall quality of life.10

There is growing agreement on the critical role of mental health services in accurately assessing the needs of individual patients.(11) Precise need assessment enables tailored treatment choices, particularly for those with severe mental illness, who are among the most in need within mental health services. The concept of severe mental illness is complex and encompasses a broad spectrum of disorders. According to the International Classification of Diseases (ICD), severe mental illnesses include five major groups: schizophrenic and delusional disorders, mood (affective) disorders such as depressive, manic, and bipolar forms, as well as neuroses and obsessive-compulsive disorders.11

The significance of this study lies in highlighting the multifaceted challenges faced by individuals with severe mental illnesses. These challenges range from difficulty in securing or maintaining employment and earning a sustainable income to struggles in forming and maintaining stable relationships. Additionally, they often face disparities in accessing both mental and physical healthcare, including timely evidence-based treatments. Patients with major mental illnesses are also at elevated risk for poor nutrition, obesity, smoking-related diseases, and other physical illnesses, all of which diminish quality of life and contribute to premature mortality.12

According to the Camberwell Assessment of Need Short Appraisal Schedule (CANSAS), common unmet needs include financial assistance, welfare benefits, transportation, information about illness and treatment, relief from psychological distress, companionship, and household skills.13 Among met needs, the most frequently addressed were relief of psychological distress, provision of information about illness and treatment, transportation, companionship, household skills, and intimate relationships.14 Hence, present study aimed to assess the unmet and met needs in patients with major mental illness. 

This cross-sectional study was conducted at a tertiary care center in North Kerala over period of one year. The study included 428 patients diagnosed with major mental illnesses, such as schizophrenia, bipolar disorder, recurrent depressive disorder, major depressive disorder, or obsessive-compulsive disorder (OCD), based on ICD-10 criteria. Inclusion criteria required patients aged 18–75 years, with a duration of illness of at least one year, in remission, and attending the department. Patients with intellectual or psychiatric comorbidities, seizure disorders, dementia, delirium, or those not meeting the inclusion criteria were excluded. Convenient sampling was employed for selection.

Patients underwent clinical interviews and evaluations using MINI Plus 5.0, with diagnoses confirmed as per ICD-10. Socio-demographic details were assessed using the Modified Kuppuswamy’s Socio-Economic Scale. Remission was evaluated using established criteria for specific mental disorders, and symptom severity was measured using PANSS, YMRS, HDRS, and Y-BOCS scales. Needs assessment was conducted using the Camberwell Assessment of Need Short Appraisal Schedule (CANSAS), with data analyzed using SPSS software.

The tools utilized included structured scales for psychiatric assessment, socio-economic classification, and needs analysis, such as the PANSS for psychotic symptoms, YMRS for mania, HDRS for depression, and Y-BOCS for OCD. Statistical analysis involved descriptive statistics, independent t-tests, and Chi-square tests for comparisons, with significance set at p<0.01. Results were presented through tables, charts, and graphs, focusing on met and unmet needs among the study population.

Present study included total of 428 participants, among them 50.9% were male (n=218) and 49.1% were female (n=210), with mean age of 42.16±2.68yrs ranging from 18 to 75 years.

The comparison of mean MET&UNMET needs values among the patients of all mentioned diseases are found to be statistically highly significant.(p<0.05) Mean CANSAS score found to be significantly different regarding needs (met and unmet needs) in each diagnosis.

This cross-sectional study assessed the needs of 428 patients with severe mental disorders at a tertiary care center in North Kerala, India. The Camberwell Assessment of Need Short Appraisal Schedule (CANSAS), which evaluates 21 domains of need, was used to categorize each domain as "No need," "Met need," or "Unmet need" based on patient input. The sample included slightly more males than females, aligning with findings from the Indian Psychiatric Society multicenter study by Grover S et al., which also reported male predominance in mental health care needs.15

The mean age of participants was 42.16 ± 2.68 years, higher than the averages reported in studies by Grover S et al.,15. This discrepancy may stem from factors such as poor awareness, stigma surrounding mental illness, and limited access to mental health professionals. Socio-economically, most participants belonged to the middle class (both upper and lower tiers), consistent with the general profile of the region. Additionally, the majority of participants were married, reflecting societal norms of the area.

In this study, the marital status distribution showed that 295 participants (68.9%) were married, 107 (25%) were unmarried, and 27 (6.1%) were divorced. This aligns with findings from Indian studies,15 which suggest that married individuals generally have a better prognosis than those who are unmarried or divorced.16,17 In contrast, Western studies often report a predominance of single individuals, likely reflecting cultural differences and earlier disease detection due to better mental health services in those regions.10,18

The most common diagnostic category was affective disorders (n = 229; 53.4%), followed by schizophrenia (n = 176; 41.1%), with obsessive-compulsive disorder (OCD) forming a smaller proportion (n = 28; 5.5%). Among individual diagnoses, schizophrenia was the most frequent, while bipolar disorder (n = 148; 34.5%) emerged as the predominant affective disorder, followed by recurrent depressive disorder (n = 45; 10.5%) and major depressive disorder (n = 36; 8.4%). These patterns align with the diagnostic trends reported in Indian Psychiatric Society multicentre studies by Sandeep Grover S et al.15

Unmet needs were most frequently observed in domains such as welfare benefits, financial assistance, information, and transportation. On the other hand, met needs were highest in the domains of information, relief from psychological distress, transportation, and intimate relationships, consistent with findings from other studies. Western studies have consistently reported unmet needs in areas like daytime activities,14,19,20 companionship (15, 58, 82), intimate relationships,14,19–21 information,22 relief from psychological distress, management of psychotic symptoms, and welfare benefits.16,20

In the present study, the most frequently reported unmet needs were related to welfare benefits, money, information about illness, and transport, consistent with findings from previous research. A prior Indian study similarly identified welfare needs, psychotic symptoms, information about illness, and financial support as common unmet needs.23 While many studies have reported higher unmet needs in the domain of psychotic symptoms,24 the current study found fewer unmet needs in this area (10.2%), likely due to the study population's lower diagnostic severity scores and consistent medication and follow-up. The emphasis on unmet needs related to money, transport, and welfare benefits highlights the lack of social security for patients. These findings suggest that patients prioritize basic needs, and the unmet need for welfare benefits may reflect inadequate treatment resources and insufficient awareness of government mental health policies.

In the present study, treatment-related needs commonly reported by patients included the need for information and relief from psychological distress, aligning with findings from many Western studies, emphasizing the global impact of mental illness. The reported need for companionship is also consistent with Western research,14,20–22 highlighting the social exclusion and isolation experienced by individuals with major mental illnesses. However, unlike Western studies, needs such as food, house upkeep, daytime activities, and intimate relationships were not prominent in this study. This difference may be attributed to the significant role of family in managing mental illness in India, where families often provide food, housing, and home care, alleviating these burdens on patients.

The mean total number of needs reported was 8.20 ± 2.28, consistent with other Indian studies reporting a mean of 7.6. The mean of met needs was 5.35 ± 1.96, while unmet needs averaged 2.85 ± 1, indicating that about two-thirds of the needs were met, and one-third remained unmet. This distribution of met and unmet needs is corroborated by several studies from both India and the West.20,22,24,25

In patients with schizophrenia assessed using the CANSAS scale, the most frequently reported needs included money, welfare benefits, telephone access, psychological distress relief, information about their condition, house upkeep, and companionship. Among met needs, child care, sexual expression, self-safety, accommodation, and psychological distress relief were noted as most common. Conversely, the most reported unmet needs were related to psychotic symptoms, self-care, daytime activities, intimate relationships, and education. Consistently, studies on schizophrenia patients highlight needs in managing psychotic symptoms,26,27 companionship, food, information, house upkeep, daytime activities, psychological distress relief, and intimate relationships.28,29 Indian studies corroborate findings from the present research, identifying welfare benefits, psychological distress relief, information about the condition, money, and companionship as primary needs.23

Western studies emphasize unmet needs in domains like daytime activities, companionship, intimate relationships, information, relief from psychological distress, management of psychotic symptoms, and welfare benefits. Indian studies also align, reporting welfare needs, psychotic symptom management, information about illness, and financial support as major unmet needs.29 The findings of the present study align with previous research, though a lower number of needs were reported in the area of psychotic symptoms. This discrepancy could be attributed to the diagnostic heterogeneity in the study population, with most patients in remission and adhering to regular medication and follow-ups. For instance, a study by S. Ochoa et al. on schizophrenia patients in Spain identified psychotic symptoms, house upkeep, food, and information as the most frequently detected needs.20 However, in the present study, food was not consistently reported as a need, likely due to the participants’ predominantly upper-middle-class background and the effectiveness of government food security measures in India.

The mean number of needs reported by schizophrenia patients in the present study was 5.34 ± 1.23, which is consistent with Indian studies and comparable to findings from Western studies using CAN-R. Western studies have reported mean needs ranging from 5.3 to 7.9, while Indian studies reported 6.84 to 8.12 needs.23 Mohebbi F et al., found higher met needs in areas such as psychotic symptoms, house upkeep, food, and money, while unmet needs were most prevalent in domains like information, companionship, intimate relationships, physical health, daytime activities, and psychological distress.30

In the current study, psychotic symptoms were frequently identified as an unmet need, reflecting the limitations in mental health service performance in addressing these issues. The needs assessment of patients with bipolar affective disorder (BPAD), major depressive disorder (MDD), and recurrent depressive disorder (RDD) using the CANSAS scale revealed distinct patterns of met and unmet needs. In BPAD patients, the most consistently reported needs included money, welfare benefits, accommodation, psychological distress, looking after home, information, company, and telephone. Unmet needs were highest in domains such as intimate relations, transport, physical health, safety to others, and food, while met needs were predominantly in areas of information, accommodation, psychological distress, and safety to self. Previous studies, noted that 91.7% of BPAD patients did not require accommodation as most lived in their own homes, aligning with preferences for independent living reported by Carling and supported by Tanzman in a review of mental health consumer preferences.31–34

For MDD patients, commonly reported needs were related to psychological distress, money, welfare benefits, information, telephone, and alcohol. Met needs were highest in domains like safety to self, accommodation, physical health, money, and company, while unmet needs were prominent in areas of looking after home, self-care, psychotic symptoms, daytime activities, and information. Similarly, RDD patients frequently reported needs in domains of money, welfare benefits, accommodation, psychological distress, looking after home, daytime activities, and telephone. Their met needs were highest in psychological distress, company, information, physical health, and childcare, while unmet needs centered on benefits, daytime activities, safety to self, intimate relations, food, and education. These findings underscore the universal importance of addressing both social and clinical needs to enhance patient care and well-being, with observations aligning broadly with both Indian and international studies. 31–34

In patients with obsessive-compulsive disorder (OCD), the CANSAS scale revealed consistently reported needs in areas such as money, welfare benefits, psychological distress, looking after home, company, and telephone. Previous studies on need assessment in OCD patients have highlighted higher needs in domains of money, psychological distress, intimate relations, company, and household skills, findings that align with the current study.35–37 However, telephone was not identified in earlier studies as a need due to its exclusion during those periods of evaluation. The significant differences in mean CANSAS scores for met and unmet needs across diagnostic groups emphasize the substantial impact of major mental illnesses on an individual’s ability to fulfill basic needs compared to the general population. This highlights the necessity for targeted interventions to address these needs effectively.

Limitation: This hospital-based cross-sectional study has limitations that affect the generalizability of its findings to the broader community. The study focused solely on patients attending the outpatient department (OPD), which does not fully capture the needs of individuals with major mental disorders in the community. Additionally, only a few correlates of needs were analyzed, and the assessment relied exclusively on patients’ self-reported perspectives. The views of healthcare providers or family members regarding patient needs were not included. Furthermore, the study was limited to identifying needs and did not evaluate the availability of services or interventions to address met or unmet needs. While the CANSAS tool was utilized, it functions more as an inventory of specific needs rather than an instrument for measuring the overall level of need.

In the total study population, the most commonly reported needs were in the areas of psychological distress, money, information, welfare benefits, transportation, intimate relations, company, and looking after the home. Unmet needs were highest in welfare benefits, money, information, and transportation, while met needs were more prevalent in domains such as information, psychological distress, transportation, and intimate relations. The findings suggest that major mental illnesses significantly hinder individuals from meeting their basic needs compared to the general population. Additionally, there has been a noticeable shift in the services provided to patients with severe mental disorders. Addressing the needs of patients with major mental illnesses is crucial for improving their outcomes. Initiatives such as self-help groups, community mental health care, daycare centers, and rehabilitation facilities for skill development can enable patients to function more independently and fulfill many of their unmet needs. Moreover, the government should play a more active role by offering free treatment, medical reimbursements, and financial assistance to individuals with mental illnesses, as practiced in many Western countries.

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