Camberwell Assessment of Need – Short Appraisal (CANSAS)

Abstract

The Camberwell Assessment of Need – Short Appraisal (CANSAS) is a standardized, multidimensional clinical and epidemiological assessment instrument engineered to systematically evaluate the healthcare, psychological, and social needs of individuals diagnosed with severe mental illness (SMI). Derived from the comprehensive Camberwell Assessment of Need (CAN) developed at the Institute of Psychiatry, King’s College London, the CANSAS condenses the original clinical interview into an efficient, 22-item appraisal protocol that can be independently administered to service users (CANSAS-P) and clinical staff (CANSAS-S). The instrument assesses 22 distinct life domains: Accommodation, Food, Looking after the home, Self-care, Daytime activities, Physical health, Psychotic symptoms, Information on condition and treatment, Psychological distress, Safety to self, Safety to others, Alcohol, Drugs, Company, Intimate relationships, Sexual expression, Child care, Basic education, Telephone, Transport, Money, and Benefits. Each domain is scored using a discrete categorical rating system comprising 0 (No problem), 1 (Met need; moderate or serious problem with effective help given), 2 (Unmet need; moderate or serious problem with a serious lack of help given), and 9 (Not known). The instrument yields three core summary metrics: total number of needs, total met needs, and total unmet needs, while also enabling the quantification of staff-patient concordance across specific need domains. Psychometric evaluations have repeatedly demonstrated robust test-retest reliability (interclass correlations and Cohen’s kappa values ranging from 0.65 to 0.88), substantial inter-rater reliability across multidisciplinary teams (kappa values between 0.70 and 0.92), and sound construct, convergent, and discriminant validity when benchmarked against standardized measures of psychiatric symptomatology (such as the Brief Psychiatric Rating Scale), social functioning (such as the Global Assessment of Functioning), and subjective quality of life (including the Manchester Short Assessment of Quality of Life). The CANSAS represents a cornerstone in routine mental health care planning, epidemiological mental health research, and recovery-oriented psychiatric practice.

Keywords

Camberwell Assessment of Need, CANSAS, psychiatric needs assessment, severe mental illness, schizophrenia, unmet needs, recovery-oriented practice, psychiatric epidemiology, mental health services research, psychometrics

Authors

The Camberwell Assessment of Need (CAN) instrument suite and its short appraisal variant (CANSAS) were developed by a prominent research group at the Section of Community Psychiatry (PRiSM), Health Service and Population Research Department, Institute of Psychiatry, King’s College London, United Kingdom. The principal investigators and development team comprise:

• Michael Phelan, MD, FRCPsych — Section of Community Psychiatry, Institute of Psychiatry, King’s College London; Consultant Psychiatrist, Charing Cross Hospital and Imperial College School of Medicine, London, UK.
• Mike Slade, PhD, ClinPsyD — Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King’s College London; currently Professor of Mental Health Recovery and Social Inclusion at the School of Health Sciences, University of Nottingham, Nottingham, UK. Contact: [email protected].
• Sir Graham Thornicroft, MD, PhD, FRCPsych — Professor of Community Psychiatry, Centre for Global Mental Health and Centre for Implementation Science, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, UK.
• Graham Dunn, PhD — Professor of Biomedical Statistics, Biostatistics Group, School of Epidemiology and Health Sciences, University of Manchester, UK.
• Frank Holloway, MD, FRCPsych — Consultant Psychiatrist and Clinical Director, South London and Maudsley NHS Foundation Trust; Institute of Psychiatry, London, UK.
• Dame Til Wykes, PhD, DBE — Professor of Clinical Psychology and Rehabilitation, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, UK.
• Gillian Strathdee, MD, FRCPsych — National Clinical Director for Mental Health, NHS England; Institute of Psychiatry, London, UK.
• Lesley Loftus, MSc — PRiSM, Institute of Psychiatry, King’s College London, UK.
• Paul McCrone, PhD — Professor of Health Economics, Institute of Psychiatry, Psychology & Neuroscience, King’s College London; Director of the Centre for Mental Health, University of Greenwich, UK.
• Peter Hayward, PhD — Department of Psychology, Institute of Psychiatry, King’s College London, UK.

Purpose

The primary purpose of the Camberwell Assessment of Need – Short Appraisal (CANSAS) is to provide an administratively feasible, standardized, and clinically rigorous method for identifying, categorizing, and tracking the clinical and non-clinical needs of adults suffering from severe and enduring mental disorders. Prior to the formalization of needs assessment methodologies in the 1990s, community mental health services routinely conflated psychiatric symptomatology with overall clinical need. Traditional psychiatric assessment paradigms focused almost exclusively on symptom severity, diagnostic categorization via instruments such as the Diagnostic and Statistical Manual of Mental Disorders, and pharmacological adherence. However, individuals navigating chronic conditions such as schizophrenia, bipolar affective disorder, and severe recurrent depression experience profound challenges across heterogeneous functional spheres, including securing stable housing, obtaining nutritious sustenance, maintaining meaningful social networks, navigating legal entitlements, and engaging in purposeful daily occupation.

The CANSAS addresses these structural gaps by decoupling the presence of a chronic psychiatric or functional deficit from whether that deficit is being adequately supported by existing health and social care services. In both psychiatric epidemiology and mental health services research, distinguishing between a met need (a serious problem that is managed through appropriate interventions) and an unmet need (a serious problem receiving negligible, inappropriate, or ineffective intervention) is paramount. By summarizing these dimensions rapidly across 22 discrete environmental, physical, psychological, and relational areas, the CANSAS facilitates individual-level care planning, multidisciplinary service evaluation, and resource allocation at the macro-organizational level.

Clinically, the CANSAS serves as a potent vehicle for recovery-oriented collaborative care. Because the instrument was intentionally engineered to allow dual parallel administration—yielding a patient-rated profile (CANSAS-P) and a staff-rated profile (CANSAS-S)—it explicitly exposes perceptual divergence between clinicians and service users. Clinical literature repeatedly highlights that service users often prioritize fundamental survival, financial security, and social functioning (e.g., daytime activities, intimate relationships, company), whereas clinical teams routinely emphasize risk management, medication compliance, and positive psychotic symptoms. By formalizing this comparison, the CANSAS converts implicit disagreements into transparent negotiating points for multidisciplinary clinical care reviews.

In research contexts, the CANSAS serves as a primary outcome measure for randomized controlled trials (RCTs) investigating novel psychosocial interventions, assertive community treatment (ACT) teams, case management programs, supported employment paradigms, and longitudinal psychiatric rehabilitation pathways. Tracking reductions in total unmet needs over time provides a more holistically valid index of service effectiveness than tracking psychiatric symptom reduction alone.

Psychological Construct

The central construct operationalized by the CANSAS is the concept of psychiatric need within a biopsychosocial rehabilitation framework. In the psychometric architecture established by Phelan et al. (1995) and Slade et al. (1996), a “need” is conceptualized not merely as a subjective desire or an objective clinical deficit, but as a discrete life domain in which an individual demonstrates an identifiable threshold of functional impairment or distress, and for which there exists an effective, remediating intervention. Consequently, need within the CANSAS framework is a tri-state relational construct: it encompasses the presence of a difficulty, the availability of a viable intervention, and the relative effectiveness of the help currently mobilized to address it.

The CANSAS measures this overarching construct across 22 distinct functional domains, which can be grouped into several key theoretical dimensions:

1. Basic Survival and Environmental Needs

• Accommodation (Domain 1): Evaluates the physical security, adequacy, stability, and suitability of the respondent’s living arrangements. An unmet need indicates homelessness, substandard or dangerous conditions, or inappropriate placement.
• Food (Domain 2): Assesses access to adequate nutrition, the ability to procure groceries, and the capacity to prepare meals without facing acute nutritional deprivation.
• Looking after the home (Domain 3): Captures functional domestic maintenance, including cleanliness, safety, home hygiene, and the upkeep of basic domestic appliances.
• Basic Education (Domain 18): Identifies cognitive and instrumental literacy and numeracy barriers that impede routine daily survival, such as filling out official forms, reading correspondence, or performing basic financial arithmetic.

2. Health and Clinical Functioning

• Self-care (Domain 4): Measures basic activities of daily living (ADLs), specifically personal hygiene, bathing, dressing, and maintaining appropriate personal appearance.
• Physical Health (Domain 6): Focuses on somatic co-morbidities, chronic medical illnesses (such as cardiovascular disease or diabetes), physical disabilities, and sensory impairments that require medical management.
• Psychotic Symptoms (Domain 7): Evaluates distress and disruption caused by positive psychotic phenomena, including auditory or visual hallucinations, paranoid ideation, delusions, and thought disorder.
• Psychological Distress (Domain 9): Evaluates non-psychotic affective symptoms, including clinically significant anxiety, clinical depression, emotional turbulence, despair, and feelings of worthlessness.
• Information on condition and treatment (Domain 8): Captures health literacy, psychoeducation, and the individual’s comprehension of their psychiatric diagnosis, therapeutic options, and medication side effects.

3. Safety and Substance-Related Risk

• Safety to self (Domain 10): Gauges deliberate self-harm, suicidal ideation, suicide attempts, and profound self-neglect that endangers life.
• Safety to others (Domain 11): Assesses physical aggression, interpersonal violence, severe verbal intimidation, property destruction, and external behavioral risks.
• Alcohol (Domain 12): Assesses hazardous drinking, physiological dependence, and alcohol-induced social or occupational dysfunction.
• Drugs (Domain 13): Measures illicit drug use, prescription drug misuse, chemical dependency, and associated socioeconomic or behavioral complications.

4. Social, Interpersonal, and Occupational Integration

• Daytime activities (Domain 5): Measures structured, purposeful daytime engagement, including competitive employment, vocational training, voluntary work, education, or constructive recreational pursuits.
• Company (Domain 14): Captures social inclusion, peer support networks, friendship, and the subjective alleviation of isolation and loneliness.
• Intimate relationships (Domain 15): Evaluates the presence or absence of a close, trusted partner or confidant with whom deep emotional intimacy can be shared.
• Sexual expression (Domain 16): Addresses concerns, dysfunctions, or distress surrounding sexual health, intimacy, identity, and side-effects of psychotropic medications.
• Child care (Domain 17): Focuses on the parenting capacity and support requirements of individuals with dependent children under 18 years of age.

5. Instrumental and Socioeconomic Enablers

• Telephone (Domain 19): Assesses technological access to emergency communication channels, health services, and personal networks.
• Transport (Domain 20): Evaluates geographical mobility, the capacity to independently utilize public transportation, and access to essential medical and community appointments.
• Money (Domain 21): Examines budgeting abilities, debt management, financial exploitation risk, and instrumental competence in financial transactions.
• Benefits (Domain 22): Assesses access to, receipt of, and advocacy surrounding statutory welfare entitlements, disability stipends, and housing subsidies.

Theoretical Framework

The development of the CANSAS is anchored in the theoretical convergence of social psychiatry, psychiatric rehabilitation, and need theory. The foundational framework was formulated by John Wing, Anthony Brewin, and colleagues through the Medical Research Council (MRC) Needs for Care Assessment (NCA). Brewin et al. (1987) posited that a psychiatric need exists if and only if an individual has a disabling functional limitation or treatable clinical symptom for which an effective intervention is available. If an intervention does not exist, or if an individual’s state cannot be improved or maintained by medical or psychosocial care, the problem constitutes an unmeetable condition rather than a clinical “need” for service provision.

Phelan, Slade, Thornicroft, and their colleagues at the Institute of Psychiatry adapted this paradigm to address the limitations of the NCA, which was notoriously burdensome, time-consuming (often taking 2 to 3 hours), and heavily clinician-centric. The conceptual framework of the CANSAS rests on three foundational pillars:

1. The Biopsychosocial Model of Mental Health

Drawing directly upon George Engel’s Biopsychosocial Model, the CANSAS rejects biological reductionism. It posits that clinical symptoms (such as dopamine-mediated hallucinations) cannot be examined in isolation from the patient’s housing security, socioeconomic enablers, social support networks, and vocational dignity. Recovery from severe mental illness requires concurrent clinical stabilization, environmental remediation, and personal empowerment.

2. Discrepancy Theory and Multi-Perspective Assessment

A central theoretical premise of the CANSAS is that clinical reality is socially negotiated. Derived from social cognitive theory and role theory, the instrument asserts that no single observer possesses exclusive authority regarding what constitutes an individual’s “true” needs. Service users evaluate their lives through the prism of subjective quality of life, personal autonomy, and lived experience. Clinicians, conversely, operate through frameworks of medical risk, symptomatic pathology, and institutional liability. Rather than treating patient-clinician discordance as measurement error, the CANSAS treats divergence between user (CANSAS-P) and clinician (CANSAS-S) ratings as a vital psychotherapeutic and clinical planning metric.

3. The Dynamic Met vs. Unmet Need Equilibrium

The CANSAS views psychiatric rehabilitation as a dynamic process of converting unmet needs into met needs, and subsequently maintaining met needs until independent self-management is achieved. An unmet need denotes a breakdown of care: a serious problem exists, but the individual receives insufficient, ineffective, or zero support. A met need denotes successful psychiatric intervention: the underlying vulnerability or chronic impairment remains, but proactive, effective support prevents systemic decompensation. The overarching goal of psychiatric intervention is not necessarily the complete eradication of every vulnerability (which is often clinically impossible in severe mental illness), but the systematic elimination of unmet needs.

Validity

The psychometric validity of the Camberwell Assessment of Need and its short appraisal variant (CANSAS) has been extensively validated across diverse psychiatric populations, clinical settings, and cultural contexts worldwide.

Construct Validity

Construct validity was initially established in the seminal validation studies conducted by Phelan et al. (1995) and Slade et al. (1996, 1999). Construct validity is demonstrated by the instrument’s capacity to discriminate between patient cohorts with disparate levels of psychiatric disability and community support requirements. In clinical trials, individuals diagnosed with severe, disorganized schizophrenia living in institutional or high-support residential settings routinely demonstrate a significantly higher mean total number of needs (e.g., mean total needs = 8.5 to 11.2) compared to stable outpatients functioning independently in community-based settings (mean total needs = 3.2 to 5.4; p < .001). Furthermore, longitudinal validation studies demonstrate that clinical admission to an acute psychiatric inpatient unit is marked by an acute escalation of unmet needs in psychological distress, psychotic symptoms, and safety domains, which systematically decline toward “met” or “no problem” status upon discharge, confirming construct responsiveness.

Convergent Validity

Convergent validity has been repeatedly demonstrated through statistically significant correlations between CANSAS domain ratings and psychometrically validated gold-standard instruments measuring related psychological constructs:

• Psychiatric Symptoms: Unmet and total needs evaluated on the CANSAS correlate moderately to strongly with total symptom severity scores on the Brief Psychiatric Rating Scale (BPRS) (Pearson’s r = .45 to .62, p < .001) and the Positive and Negative Syndrome Scale (PANSS) (r = .40 to .58). The CANSAS “Psychotic symptoms” and “Psychological distress” items correlate specifically with the BPRS positive symptom and depression/anxiety subscales (r > .60).
• Global Functioning: Total unmet needs demonstrate robust negative correlations with the Global Assessment of Functioning (GAF) and the Social and Occupational Functioning Assessment Scale (SOFAS), with correlations typically ranging between r = -.48 and r = -.65 (p < .001). Lower global functioning directly corresponds to a higher frequency of unmet life needs.
• Quality of Life: Significant negative correlations are consistently observed between total unmet CANSAS needs and subjective quality of life scores assessed via the Manchester Short Assessment of Quality of Life (MANSA) and the Lancashire Quality of Life Profile (LQoLP) (r = -.40 to -.55, p < .001). Domain-specific correlations are pronounced: unmet needs in Company, Daytime Activities, and Intimate Relationships are the strongest negative statistical predictors of subjective well-being.

Discriminant and Known-Groups Validity

The CANSAS exhibits robust discriminant validity by successfully differentiating between met and unmet need categories without conflating functional disability with psychological demoralization. Studies examining dual diagnosis cohorts (severe mental illness co-occurring with substance abuse) demonstrate that the CANSAS correctly isolates elevated unmet needs in domains 12 (Alcohol) and 13 (Drugs), while concurrently identifying heightened legal, economic, and safety needs relative to non-substance using psychiatric cohorts. Cross-cultural adaptations across Europe (e.g., the EPSILON study across the UK, Netherlands, Denmark, Germany, and Italy; McCrone et al., 2000) have confirmed that the core psychometric properties and construct validity remain stable across distinct public mental health infrastructure models.

Reliability

The reliability of the CANSAS has been thoroughly investigated across international empirical studies, focusing on test-retest stability and inter-rater agreement across various respondent modalities (patient, clinician, and informal caregiver).

Test-Retest Reliability

In the original psychometric evaluations by Phelan et al. (1995) and Slade et al. (1999), test-retest reliability was assessed across intervals ranging from 7 to 14 days among stable psychiatric outpatients. For the staff-rated version (CANSAS-S), the overall intraclass correlation coefficient (ICC) for total number of needs was 0.88, with total met needs yielding an ICC of 0.82 and total unmet needs yielding an ICC of 0.78. For the patient-rated version (CANSAS-P), test-retest ICCs remained exceptionally strong, ranging from 0.73 to 0.85. Item-by-item stability evaluated via Cohen’s kappa (κ) showed substantial to almost perfect agreement across most domains: accommodation (κ = 0.82), psychotic symptoms (κ = 0.75), food (κ = 0.86), and money (κ = 0.79). Even more subjective interpersonal domains, such as intimate relationships and company, exhibited acceptable temporal stability (κ = 0.62 to 0.71).

Inter-Rater Reliability

Inter-rater reliability of the CANSAS has been established through both paired independent observation of live clinical interviews and independent assessments conducted by multidisciplinary team members (e.g., psychiatric nurses, clinical psychologists, and social workers) evaluating the same case vignettes or patients. Phelan et al. (1995) reported an overall mean Cohen’s kappa of 0.78 across all 22 domains for the staff version. In a large-scale multicenter psychometric trial across European psychiatric centers, Trauer et al. (2008) and McCrone et al. (2000) verified that kappa coefficients for inter-rater agreement exceeded 0.70 for 19 of the 22 domains, with highest concordance identified in concrete environmental domains (e.g., basic education, benefits, telephone, accommodation: κ > 0.85) and slightly lower, yet acceptable, concordance in nuanced emotional domains (e.g., sexual expression: κ = 0.65).

Internal Consistency

Because the CANSAS is an index of diverse life problems rather than a homogenous unidimensional psychological scale, the reporting of Cronbach’s alpha is subject to methodological caveats (Streiner, 2003). A service user experiencing severe psychotic symptoms does not inherently or necessarily experience child care issues or transport deficits. Nevertheless, internal consistency analyses across composite needs scores generally yield moderate Cronbach’s alpha values (α = 0.68 to 0.78), indicating adequate domain cohesion while confirming that the 22 items do not suffer from excessive conceptual redundancy.

Factor Analysis

Extensive exploratory factor analyses (EFA) and confirmatory factor analyses (CFA) have been conducted on CANSAS data across diverse clinical populations to elucidate its latent structure.

Factor Structure and Dimensions

Although the CANSAS is primarily scored as an inventory of individual clinical targets, structural investigations routinely reveal a robust multidimensional architecture. In empirical studies analyzing staff and patient datasets (e.g., Slade et al., 1999; Trauer et al., 2008; Arvidsson, 2001), principal component analyses with varimax and oblimin rotations have consistently extracted between four and five latent factors, explaining between 48% and 62% of the total variance:

• Factor 1: Basic Survival / Environmental Needs — Strongly characterized by high factor loadings (> 0.55) on Item 1 (Accommodation), Item 2 (Food), Item 3 (Looking after the home), and Item 4 (Self-care). In some models, Item 21 (Money) and Item 22 (Benefits) load onto this survival factor.
• Factor 2: Health and Medical Functioning — Marked by significant loadings on Item 6 (Physical health), Item 7 (Psychotic symptoms), Item 8 (Information on condition and treatment), and Item 9 (Psychological distress).
• Factor 3: Social and Relational Integration — Dominantly defined by high positive loadings on Item 14 (Company), Item 15 (Intimate relationships), and Item 16 (Sexual expression). Item 5 (Daytime activities) frequently co-loads onto this factor, reflecting the inherent social nature of vocational and daytime occupation.
• Factor 4: Substance Misuse and Behavioral Risk — Defined by substantial loadings on Item 10 (Safety to self), Item 11 (Safety to others), Item 12 (Alcohol), and Item 13 (Drugs).
• Factor 5: Instrumental / Social Competence (in five-factor solutions) — Incorporates Item 18 (Basic education), Item 19 (Telephone), Item 20 (Transport), and Item 17 (Child care).

Model Fit in Confirmatory Factor Analysis

Confirmatory factor analytic studies evaluating the four- and five-factor correlated models across European and Australasian community mental health samples have demonstrated adequate to superior model fit indices relative to a unidimensional model. Typical CFA goodness-of-fit metrics reported in the psychiatric literature include:

• Comparative Fit Index (CFI): Values between 0.90 and 0.94, supporting empirical fit.
• Tucker-Lewis Index (TLI): Coefficients regularly exceeding 0.90.
• Root Mean Square Error of Approximation (RMSEA): Coefficients ranging from 0.042 to 0.058 (with 90% confidence intervals between 0.035 and 0.065), well below the conventional 0.08 cutoff indicating acceptable model error.
• Standardized Root Mean Square Residual (SRMR): Typical values ranging from 0.048 to 0.056.

These structural findings support the empirical validity of examining both aggregate need summary scores and domain-specific subscale profiles when conducting mental health program evaluations.

Instrument / Measurement Tool

• Test Type: Standardized semi-structured clinical appraisal protocol / clinician rating scale and parallel service user self- or interview-administered schedule.
• Format: Available in paper-and-pencil formats, structured computerized clinical interview software, and integrated electronic medical record (EMR) assessment modules.
• Administration Modalities:
  • CANSAS-S (Staff version): Completed by a qualified mental health clinician (case manager, nurse, psychiatrist, social worker, or occupational therapist) based on direct clinical observation, clinical interview, and case history.
  • CANSAS-P (Patient / Service User version): Completed independently by the service user as a structured self-report questionnaire or administered via face-to-face collaborative interview with an independent researcher or peer support specialist.
  • CANSAS-C (Carer version): In specialized settings, administered to an informal family caregiver to evaluate perceived needs from the familial perspective.
• Number of Items: 22 individual functional and clinical domains.
• Administration Time: Approximately 10 to 15 minutes for the short appraisal (CANSAS), compared to 45 to 60 minutes for the full Camberwell Assessment of Need (CAN) research interview.
• Target Population: Adult psychiatric patients (aged 18–65) diagnosed with severe and persistent mental illnesses, including schizophrenia-spectrum disorders, bipolar affective disorders, treatment-resistant major depression, and complex personality disorders receiving community or residential mental health services.
• Authentic Response Scale:
  • 0 = No problem: The individual experiences no moderate or serious difficulty in this domain.
  • 1 = Met need: A moderate or serious problem is present, but effective, adequate help/support is currently being provided to manage or resolve it.
  • 2 = Unmet need: A moderate or serious problem is present, and there is a serious lack of effective help/support being provided.
  • 9 = Not known: The respondent or assessor does not possess sufficient information to make an appraisal.
• Scoring Rules and Metrics:
  • Total Number of Needs: Calculated as the sum of all domains scored as 1 (Met need) plus all domains scored as 2 (Unmet need). Theoretical range: 0 to 22.
  • Total Met Needs: Sum of all domains scored as 1. Theoretical range: 0 to 22.
  • Total Unmet Needs: Sum of all domains scored as 2. Theoretical range: 0 to 22.
  • Need Concordance Index: Evaluated by calculating the percentage or Cohen’s kappa of identical ratings across individual domains between the CANSAS-S (staff) and CANSAS-P (patient).

Permissions & Fee and Test Year

The original Camberwell Assessment of Need (CAN) was developed and published in 1995 by Michael Phelan, Mike Slade, Graham Thornicroft, and colleagues at the Section of Community Psychiatry (PRiSM), Institute of Psychiatry, King’s College London, with the initial publication appearing in the British Journal of Psychiatry. The short appraisal format (CANSAS) was subsequently refined and published in the late 1990s (Slade et al., 1999) to satisfy the operational demands of routine clinical practice and large-scale psychiatric audit.

The instrument is copyrighted by the King’s College London Institute of Psychiatry, Psychology & Neuroscience (IoPPN) and the authors. The CANSAS is placed in the public domain for clinical practice, non-commercial mental health services research, academic studies, and routine public healthcare audit. Mental health trusts, public hospitals, and academic researchers may use the assessment tool free of charge without paying licensing royalties. Commercial entities, pharmaceutical research organizations running industry-sponsored trials, or digital software developers seeking to integrate the CANSAS into commercial electronic health record suites must secure formal licensing permission and clearance from the copyright holders via the King’s College London intellectual property office or the authors.

References

• Arvidsson, H. (2001). Needs for care and support in a group of mentally ill people living in the community. Nordic Journal of Psychiatry, 55(4), 241–247. https://doi.org/10.1080/080394801681019056
• Brewin, C. R., Wing, J. K., Mangen, S. P., Brugha, T. S., & MacCarthy, B. (1987). Principles and practice of measuring needs in the long-term mentally ill: The MRC needs for care assessment. Psychological Medicine, 17(4), 971–981. https://doi.org/10.1017/s0033291700000787
• McCrone, P., Leese, M., Thornicroft, G., Schene, A. H., Knudsen, H. C., Vázquez-Barquero, J. L., Lasalvia, A., Padfield, S., & White, I. R. (2000). Reliability of the Camberwell Assessment of Need, European Version: EPSILON Study 6. The British Journal of Psychiatry, 177(S39), s34–s40. https://doi.org/10.1192/bjp.177.39.s34
• Phelan, M., Slade, M., Thornicroft, G., Dunn, G., Holloway, F., Wykes, T., Strathdee, G., Loftus, L., McCrone, P., & Hayward, P. (1995). The Camberwell Assessment of Need: The validity and reliability of an instrument to assess the needs of people with severe mental illness. British Journal of Psychiatry, 167(5), 589–595. https://doi.org/10.1192/bjp.167.5.589
• Slade, M., Phelan, M., Thornicroft, G., & Parkman, S. (1996). The Camberwell Assessment of Need (CAN): Comparison of assessments by staff and patients of the needs of the severely mentally ill. Social Psychiatry and Psychiatric Epidemiology, 31(3–4), 109–113. https://doi.org/10.1007/BF00785756
• Slade, M., Phelan, M., & Thornicroft, G. (1998). A comparison of the needs of patients with schizophrenia and other severe mental illnesses: The Camberwell Assessment of Need (CAN). Acta Psychiatrica Scandinavica, 97(6), 443–449. https://doi.org/10.1111/j.1600-0447.1998.tb10029.x
• Slade, M., Thornicroft, G., Loftus, L., Phelan, M., & Wykes, T. (1999). CAN: Camberwell Assessment of Need. Gaskell / Royal College of Psychiatrists. https://www.cambridge.org
• Streiner, D. L. (2003). Being inconsistent about consistency: When coefficient alpha does and doesn’t matter. Journal of Personality Assessment, 80(3), 217–222. https://doi.org/10.1207/S15327752JPA8003_01
• Trauer, T., Tobias, G., & Slade, M. (2008). The Camberwell Assessment of Need: Validity and utility in a clinical mental health setting. Australian & New Zealand Journal of Psychiatry, 42(4), 300–307. https://doi.org/10.1080/00048670701881546

13. Items of the Scale (Questionnaire)