Assessing need in mental illness

Alyson Buck, Senior Lecturer in Mental Health at Anglia Ruskin University, Essex, UK, reviews Camberwell assessment of need for mothers: a needs-based assessment for pregnant women and mothers with severe mental illness by Louise Howard et al. 2008, London, Royal College of Psychiatrists. ISBN 978 1 904671 54 1

Cover image CAN-M

CAN-M: Does exactly what it says on the tin. At first sight it seems a fairly daunting document; an A4 spiral bound book of approximately 150 pages and lots of different versions of the assessment tools. Flicking through it you might be forgiven for initially wondering how this might be applied. By persevering, however, you find that it really is 'a needs-based assessment for pregnant women and mothers with severe mental illness (SMI)' and should ultimately improve the care for this vulnerable service user group.

The Camberwell assessment of need (CAN) was developed in 1999 as a tool for assessing the needs of adults of working age who have a severe and enduring mental illness. Camberwell assessment of need for mothers: a needs-based assessment for pregnant women and mothers with severe mental illness (CAN-M) is the fourth modification of this now familiar document. The credentials of the contributors are impressive and represent leading figures in the field of perinatal mental healthcare so one can be assured that the assessment tools have been rigorously tested.

Please note that understanding of the term SMI is assumed in the resource, which does not explicitly outline what mental health problems come under this heading.

What does CAN-M contain?

The first section of the document consists of chapters which set the scene both for definition and understanding of what needs assessment is and identification of the needs of women with mental health problems during pregnancy and the postnatal period. There are also important chapters on the needs of severely mentally ill mothers with children and the impact of maternal mental illness on the developing child. Don't be tempted to skip through this information as it all feeds into understanding why and how the CAN-M was developed, which is then discussed in chapter 5.

Guidance on rating and scoring the CAN-M follows, information to help with training for CAN-M and then three versions of the tool itself: CAN-M (C), the clinical version; CAN-M (R), the research version; and CAN-M (S), the short appraisal schedule version. At first, it is a bit confusing to be faced with all these versions, but a read through the document clarifies things. Completing the assessment apparently takes between five and 25 minutes, depending on which version you use. Service users of working age (18–65 years), who are pregnant and/or have given birth to a child who is 16 years or younger can be assessed.

Who can use CAN-M?

The tools themselves are devoid of any medical or professional jargon so ideally any healthcare professional should be able to use them, and the document contains some well planned training information to introduce people to it. The authors state that midwives, nurses, social workers, psychologists, occupational therapists, psychiatrists, mental health workers, obstetricians and health visitors can all use the CAN-M. However, in chapter 6 (Guidance on rating), the authors recommend that the interviewer should be 'a professional who has knowledge and experience of working with pregnant women and mothers with SMI'. This will therefore exclude a lot of healthcare professionals and most midwives unless they have specific responsibilities for women with mental health problems.

Overall then, once you wade through all the preliminary information and understand why there are so many versions of the CAN-M, the assessment of the 26 identified health and social care problems should result in a much improved assessment which can then be used to plan more appropriate care. In the field of perinatal mental health, this is one CAN that's long overdue and I hope professionals will open the lid and get stuck in.

First published DPPI Journal, Issue 65: Spring 2009

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