The association between the assessment of need by staff and by severely mentally ill patients was examined using a new needs assessment instrument, the Camberwell Assessment of Need (CAN). In all, 49 staff patient pairs were interviewed separately using the CAN as part of a larger reliability study. For each of 22 areas of need, we assessed agreement on (1) the presence of need, (2) the informal and formal help currently being given, (3) the formal help needed and (4) satisfaction with the type of help being received. Staff and patients rated a similar number of needs, but not in the same areas. There was better agreement between staff and patients regarding needs that have a specific service intervention. Agreement between staff and patient ratings of help received, help given and service satisfaction was low. We concluded that needs are very often assessed differently by staff and patients, which has implications for how needs are assessed in clinical practice.

The Audit Commission recently highlighted the need for health services to plan language services to help the problems of poor communication facing non-English speaking patients. Doctors and other health workers need to know how to work effectively when interviewing patients with an interpreter. This article describes the different options for helping non-English speaking patients; explains how interviews should be conducted with a trained interpreter, including those using sign language; and outlines the extent of interpreting services currently available in the United Kingdom, complete with a list of addresses of organisations offering interpreting services.

Promoting independence ' is a central theme of recent United Kindgdom health and social care policy development but is rarely defined. Instead it is generally assumed that we know what independence means. Based on a review of the literature on independence in older age, this paper examines the terms and meanings. While the most common conceptualisation equates independence with the absence of reliance on others, for older people themselves independence is a broader concept that encompasses not only self-reliance but also self-esteem, selfdetermination, purpose in life, personal growth and continuity of the self. Drawing on previous work in the field of health promotion, we therefore put forward a model that takes older people's views into account and that reconceptualises independence as two intersecting dimensions representing levels of dependence and levels of independence. While dependence equates with reliance on others, independence can be seen as subjectively self-assessed lived experience. Thus it becomes possible to combine high levels of dependence with high levels of experienced or felt independence, a particularly pertinent combination for service providers. Finally we examine the ways in which independence thus conceptualised can be promoted at the individual, institutional, community and societal levels.

Patients' ratings of satisfaction with mental health services are significantly worse for UK-born Black Caribbean than other patients with psychotic disorder in South London.

Both services were reasonably successful, with little difference from the user perspective. The intensive service provided benefits in terms of met needs, but this has to be balanced against a possible increase in unmet needs.