A neurobiological hypothesis is proposed to account for his symptoms, and recent discoveries in the basic sciences used to inform his management.

Need assessment is an important component in planning, prioritizing and evaluating care provision. Old age psychiatry is an expanding community-based speciality. It is important for community mental health services to be need-led (McCrone and Strathdee, 1994), since this ensures better targeting of the limited resources. The available needs assessment instruments are either those problem-oriented methods that have limited applicability in health service planning or methods that are too complicated and cumbersome to be used in the community. Some of these instruments have been standardized on adult general psychiatry patients and might not be appropriate for old age psychiatry services. There is thus an opportunity for the development of a needs assessment method that is standardized on old age psychiatry patients and measures need for the range of interventions offered by old age psychiatry services.KEY woms-health care needs; social disablement; needs for psychiatric services; needs of the elderly; old age psychiatry services Assessment of individual needs is an important component of proposed community care plans (Department of Health, 1991). The multidisciplinary nature and community-based emphasis of old age psychiatry services would make a need assessment procedure a very useful tool for targeting and evaluating services. The assessment of need is an essential prerequisite to setting up health care programmes (Abramson, 1984) and an important part of the evaluation of health services and establishing priorities for services (Donabedian, 1974). Cassel (1994), in a recent editorial, has emphasized the particular importance of assessing health care needs in the elderly with the current climate of health care rationing. Furthermore, a recent study has shown that a needs-led health care provision for the elderly can reduce the cost and the length of stay in hospital (McLean et al., 1994). NEEDS FOR HEALTH CARENeed for health care is defined as the requirement for preventative, curative and rehabilitative care

Aims and MethodThere is a lack of tools to assess the needs of older people with enduring mental illness who have ‘graduated’ from adult mental health services and little is known about this population. the Elderly Psychiatric Needs Schedule (EPNS) was developed and applied to older people with enduring mental illness in contact with the old age and general adult components of an inner-city mental health service.ResultsThe EPNS proved reliable (mean agreement 96%, mean Kappa κ=0.90). the mean number of needs identified was 7.6, of which 4.3 were unmet and 3.3 were met.Clinical ImplicationsThe EPNS provided a reliable method of needs assessment in this population. the authors offer the EPNS as a tool to assess service needs of older adults with functional psychiatric disorders having ‘graduated’ from adult mental health services.

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