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Relevant training for case managers in severe mental illness

School of Nursing and Midwifery, The Queen's University of Belfast, Medical Biology Centre, 97 Lisburn Road, Belfast BT9 7BL

The UK700 Group (2000) case management trial demonstrated that there were "no clear beneficial effects on costs, clinical outcome or cost effectiveness" by reducing the case-loads of case managers working with patients with psychotic disorders. However, they went on to advise that the policy of intensive case management for patients with severe psychosis is not justified. The findings of this study do not support such a conclusion. The key issue studied (i.e. intensive case management) was determined purely by numbers of patients on the manager's case-load. No attempt is made to describe the level of training of the case managers in techniques and skills needed for effective working with patients who have a severe mental illness. The need for relevant training for case managers in severe mental illness has been addressed in the Clinical Standards Advisory Group report on schizophrenia (Gournay & Beadsmore, 1995). An alternative explanation for the findings of this study may be that without specific training in severe mental illness, purely reducing case manager's case-loads is not effective. It is most disappointing and surprising that this issue has neither been addressed in a study of this magnitude nor referred to in the discussion.

EDITED BY MATTHEW HOTOPF

REFERENCES

Gournay, K. & Beadsmore, A. (1995) The report of the Clinical Standards Advisory Group: standards of care for people with schizophrenia in the UK and implications for mental health nursing. Journal of Psychiatric and Mental Health Nursing, 2, 359-364.[Medline]

UK700 Group (2000) Cost-effectiveness of intensive v. standard case management for severe psychotic illness. UK700 case management trial. British Journal of Psychiatry, 176, 537-543.[Abstract/Free Full Text]

Authors' reply

Centre for Health Economics, University of York, Heslington, York YO1 5DD

M. Fiander and T. Burns

St George's Hospital Medical School, Cranmer Terrace, Tooting, London SW17 0RE

T. Fahy

South London & Maudsley NHS Trust, Denmark Hill, London SE5 8AZ

EDITED BY MATTHEW HOTOPF

The training and expertise of the case managers involved in the UK700 case management trial have been described in a previous publication (UK700 Group, 1999) and discussed in subsequent correspondence (Burns et al, 1999). The clinical staff providing both intensive and standard case management were equally experienced in terms of training and skills, had considerable expertise in working with severe mental illness, and were representative of the staff working in community mental health teams throughout the UK. All staff received courses in case management, and intensive case managers additionally received training in out-reach practice from a team leader in assertive community treatment.

The recommendations made by Gournay & Beadsmore (1995), such as implementation of the Care Programme Approach and emphasis on post-qualification training, are ones we would agree with, and were in place in the collaborating sites during the period of the trial. They are, however, general recommendations and there is currently no research or strong clinical consensus to suggest which specific skills or training components are required for effective or cost-effective care in this area.

Although we agree that the skills of case managers working with people who have severe mental illness are an important issue in need of research, Martin has misunderstood the purpose of the UK700 case management trial. We aimed to test rigorously one component of intensive case management - reduced case-load size - in a pragmatic situation representative of clinical services within the UK. We stand by the conclusions of our paper, which relate to the cost-effectiveness of low case-load size within the framework of current clinical expertise in the UK.

REFERENCES

Burns, T., Fahy, T., Thompson, S., et al (1999) Intensive case management for severe psychotic illness (authors' reply). Lancet, 354, 1384-1386.

Gournay, K. & Beadsmore, A. (1995) The report of the Clinical Standards Advisory Group: standards of care for people with schizophrenia in the UK and implications for mental health nursing. Journal of Psychiatric and Mental Health Nursing, 2, 359-364.

UK700 Group (1999) Intensive versus standard case management for severe psychotic illness: a randomised trial. Lancet, 353, 2185-2189.[CrossRef][Medline]

This Article Submit an eLetter Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Martin, F.M. Articles by Fahy, T. Search for Related Content PubMed Articles by Martin, F.M. Articles by Fahy, T.