Chapter 2 58 because of severe psychiatric symptoms. Although we found no significant differences between the fully participating (N=78) and partially participating (N=23) patients in demographic and clinical characteristics, the patients participating in the CANE had higher GAF score (65 (SD=11.15) versus 58 (SD 9.94) for patients not participating in the interviews (Mann Whitney U test (Z=-2.671, p=0.008) (data not shown)). This is a possible limitation, as we found a negative correlation with the total number of needs. In our study we only included patients using specialised mental health services. Stable older patients with bipolar disorder may be treated by their family doctor or psychiatrist in a private practice (ten Have M. et al. 2002), and these patients probably have less complex disorders with fewer needs. On the other end of the spectrum, patients who refuse care are likely to be the most seriously ill. Despite these limitations, it must be noted that our findings are probably indicative for the large majority of older bipolar patients, as our institution is the sole mental health institution in these two districts and there are no financial barriers to receive health care. 2.5 Conclusions Current mood symptoms, smaller network size, less social participation and lower cognitive functioning were associated with a higher number of needs reported by both patients and staff. It is striking that only social functioning correlated with unmet needs. A plausible explanation is that staff are aware of the correlations between needs and psychiatric symptoms but seem to fail to recognize or anticipate on needs in social functioning. Even though one can dispute if the social domain is the primary territory of psychiatric care, it seems indisputable that unmet needs in social functioning affect psychiatric health. It is therefore recommended that, psychiatric services acknowledge the patient ‘s needs in the social domain and evaluate if aid in this domain can be provided.
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