Unspoken needs: an essential perspective in the treatment of schizophrenia

Despite increasing attention to patient-centered care, the treatment of schizophrenia remains predominantly clinician-driven, with limited integration of patients' subjective needs. This paper critically examines the concept of unmet needs in schizophrenia. While structured tools exist, they are rarely used in routine care, and even less frequently from the patient's perspective. Drawing on international literature and Italian service data, this paper examines the systemic, clinical, and ethical implications of unmet needs, highlighting neglected domains including family support, physical health, and sexual well-being. Comparing mental health systems in Italy, Northern Europe, and the UK reveals systemic differences in the inclusion of patient voice in care planning. Finally, we address the issue of clinician training, proposing a reframing of professional competencies to include active listening, shared decision-making, and coproduction. Integrating patients' voices into need assessment is not optional; it is a prerequisite for meaningful, effective, and equitable care in schizophrenia.