Focus of methods

Normally the assessment will focus on the presented or referred patient. However, it may be necessary to either focus on a family member (or all family members) or on formal or informal direct carers of the patient. Platt,(8) for example, reviewed five rating scales measuring the burden of psychiatric illness on the family, completed on the basis of an interview with one or more family members, and pointed out the distinction between objective and subjective burden as well as the need for such scales to be adequate psychometrically. Another example is the Camberwell Family Interview, which is a combined interview-based rating scale and observation rating, focusing on family reactions to the identified patient.

Another potential focus is the patient's environment. The range of behaviour a patient can display may be limited by the physical size or area of the environment, by the range of equipment available to the patient, and by the institutional rules of the setting (such as rules against smoking). In a small space or in a deprived environment the patient may be unable to exhibit the range of skills they possess. It may then be helpful to assess characteristics of both the physical or social environment, looking at the range of therapeutic materials available in a day room, for example. A measure of environmental restrictiveness would survey both the range of formal regulations and those informal rules followed by care staff, which might cover whether visitors can stay overnight, when lights have to be turned off, and whether residents can cook their own food.

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