Hostname: page-component-7c8c6479df-ph5wq Total loading time: 0 Render date: 2024-03-19T02:19:18.369Z Has data issue: false hasContentIssue false

Intensive case management for the severely mentally ill

Controlled trial

Published online by Cambridge University Press:  03 January 2018

Frank Holloway*
Affiliation:
Maudsley Hospital
Jerome Carson
Affiliation:
Institute of Psychiatry, London
*
Dr F. Holloway, Maudsley Hospital, Denmark Hill, London SE5 8AZ

Abstract

Background

The aim was to compare the efficacy of intensive clinical case management (ICM) with standard community care in the management of ‘hard to treat’ patients with a severe mental illness.

Method

A randomised controlled trial was carried out in East Lambeth, a deprived area of inner London. Seventy people with psychosis designated as ‘hard to treat’ by referring teams were included; 35 were randomised to ICM (case load eight patients per worker), and 35 to standard care, which offered follow-up by a community psychiatric nursing service (30 patients per worker). Outcome measures were admissions and hospital bed utilisation; contact with services; symptomatology; social behaviour; social functioning; quality of life; patients' satisfaction with care at 9 and 18 months.

Results

There were no differences in patients' symptoms, social behaviour or social functioning. Quality of life was significantly improved in patients receiving ICM at 9 months. Satisfaction with care was significantly greater among case-managed patients. All ICM patients remained in contact with services throughout the study, while six control patients were refusing all contact with services at 18 months.

Conclusions

ICM failed to improve the clinical outcome of ‘hard to treat’ patients. The service was successful in maintaining contact with patients, was greatly appreciated and had a positive effect on their perceived quality of life.

Type
Papers
Copyright
Copyright © 1998 The Royal College of Psychiatrists 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Andreason, N. (1982) Negative symptoms in schizophrenia. Definition and reliability. Archives of General Psychiatry, 39, 784788.CrossRefGoogle Scholar
Armitage, P. (1971) Statistical Methods in Medical Research. Oxford: Blackwell Scientific.Google Scholar
Asberg, M., Perris, C., Schalling, D., et al (1978) The CPRS – development and applications of a psychiatric rating scale. Acta Psychiatrica Scandinavica, Suppl. 271.Google Scholar
Beck, A., Rush, A., Shaw, B., et al (1979) Cognitive Therapy of Depression. New York: Guilford Press.Google Scholar
Cullen, D., Waite, A., Oliver, N., et al (1997) Case management for the mentally ill: a comparative evaluation of client satisfaction. Health and Social Care in the Community, 5, 106115.CrossRefGoogle Scholar
Holloway, F. (1995) Home treatment as an alternative to acute psychiatric inpatient admission: a discussion. In Community Psychiatry in Action: Analysis and Prospects (ed. Tyrer, P. & Creed, F.), pp. 8595. Cambridge: Cambridge University Press.CrossRefGoogle Scholar
Holloway, F., Oliver, N., Collins, E., et al (1995) Case management: a critical review of the outcome literature. European Psychiatry, 10, 113128.CrossRefGoogle ScholarPubMed
Holloway, F., Murray, M., Squire, C., et al (1996) Intensive case management: putting it into practice. Psychiatric Bulletin, 20, 395397.CrossRefGoogle Scholar
Intagliata, J. (1982) Improving the quality of community care for the chronically mentally ill: the role of case management. Schizophrenia bulletin, 8, 655674.CrossRefGoogle Scholar
Kemp, R., Hayward, P., Applewhaite, G., et al (1996) Compliance therapy in psychotic patients: a randomised controlled trial. British Medical Journal, 312, 345349.CrossRefGoogle ScholarPubMed
Marshall, M., Gray, A., Lockwood, A., et al (1996) Case management for people with severe mental disorders. In Schizophrenia Module of The Cochrane Database of Systematic Reviews (eds Adams, C., Anderson, J. & De Jesus Mari, J.). Oxford: Update Software.Google Scholar
Mueser, K. T., Bond, G. R., Drake, R. E., et al (1997) Models of community care for severe mental illness: a review of research on case management. Schizophrenia Bulletin, in press.CrossRefGoogle Scholar
Oliver, J. (1991) The social care directive: development of a quality of life profile for use in community services for the mentally ill. Social Work and Social Sciences Review, 3, 5360.Google Scholar
Solomon, P. (1992) The efficacy of case management services for severely mentally disabled clients. Community Mental Health Journal, 28, 163180.CrossRefGoogle ScholarPubMed
Stein, L. & Test, M. (1980) Alternative to mental hospital treatment. Archives of General Psychiatry, 37, 392397.CrossRefGoogle ScholarPubMed
Waite, A., Carson, J., Cullen, D., et al (1997) Case management: A week in the life of a clinical case management team. Journal of Psychiatric and Mental Health Nursing, in press.CrossRefGoogle Scholar
Wing, J. K., Cooper, J. E. & Sartorius, N. (1974) The Description and Classification of Psychiatric Symptoms: an Instruction Manual for the PSE and CATEGO System. London: Cambridge University Press.Google Scholar
World Health Organization (1988) WHO Psychiatric Disability Assessment Schedule (WHO/DAS). Geneva: WHO.Google Scholar
Wykes, T. & Sturt, E. (1986) The measurement of social behaviour in psychiatric patients: an assessment of the reliability and validity of the SBS schedule. British Journal of Psychiatry, 148, 111.CrossRefGoogle ScholarPubMed
Submit a response

eLetters

No eLetters have been published for this article.