BACKGROUND Needs for care in service users with schizophrenia are often defined by professionals and focus on basic needs for health and social care rather than broader existential issues. OBJECTIVE To examine the perceptions of users and formal and informal carers of the needs of people with non-affective psychosis. METHODS A qualitative study was conducted involving focus groups of service users and informal and formal carers in a major Brazilian city. RESULTS Existential needs were the most important theme for people with psychotic disorders. Informal and formal carers mainly regarded such needs as secondary to needs for health, housing, leisure and work. Carers usually reduced the existential questioning of the ill person to symptoms or the result of a privation such as lack or failure of medication and its consequences. CONCLUSIONS We require an approach to service users wherein respect and understanding are prized as the first needs from which all others will naturally follow. We also need to give greater priority to existential issues in validated schedules that measure needs in clinical work and research.