Case management (mental health)
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Case management is the coordination of community-based services by a professional or team to provide individually-customized mental health care for people experiencing frequent setbacks or persistent challenges to their recovery. Case management seeks to reduce hospitalizations and support individuals' recovery through a holistic approach that considers each person's overall biopsychosocial needs. As a result, care coordination includes traditional mental health services but may also encompass primary healthcare, housing, transportation, employment, social relationships, and community participation.
The case management model developed in the USA in response to the closure of large psychiatric hospitals (known as deinstitutionalisation) and initially following a brokerage model, where professionals arranged for the provisions of services, without the need for direct patient care or contact. Clinical or therapeutic case management then developed as the need for the mental health professional to establish a therapeutic relationship and be actively involved in clinical care was recognised. A more intensive form of case management (assertive community treatment or Intensive Case Management) was also developed for patients with more severe illness who needed a more assertive approach. With the rise in popularity of value-based purchasing in healthcare, case management has begun to undergo a transition.
In April 2014, The Maine Department of Health and Human Services introduced the Behavioral Health Home case management program which follows a value-based purchasing approach. The Behavioral Health Home provides a holistic and integrated approach to psychiatric case management with a goal to promote increased wellness amongst an agency's entire population.
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The underlying tasks of case management form a five-step cycle:
- Assessment of individual needs and strengths
- Care planning
- Plan implementation
- Progress monitoring
- Regular review and re-assessment (initiating a new case management cycle)
Several models of case management emerged to coordinate care for individuals with different needs. These models differ in their approach to care, frequency of contact, and the number of professionals and individuals involved. In addition to the outcome measures typically used to assess the effectiveness of treatment interventions, researchers have developed fidelity measures to assess the implementation of a particular case management model.
|Model||Developed||Focus||Case manager(s)||Client(s)||Fidelity measure(s)|
|Brokerage Model||?||Connect client to services||Individual||Individual||?|
|Clinical Case Management||?||Involve case manager in treatment||Individual||Individual||?|
|Assertive Community Treatment||?||Reduce hospitalizations||Multidisciplinary team,
|Intensive Case Management||?||Reduce hospital and emergency service use||Individual||Individual||?|
|Personal Empowerment Model /
|1980s||Client abilities and interests||Individual||Individual||Strengths Model Fidelity Scale|
|Rehabilitation Model||?||Client goals, disability rehabilitation plan||Individual||Individual||?|
|Individual Case Management||?||Varies||Individual||Individual||?|
|Team Case Management||?||Varies||Team||Individual||?|
|Cluster Case Management||?||Mutual support||Individual with optional assistant||Group||?|
Severe mental illness
A systematic review investigated the effects of intensive case management for patients with severe mental illness:
|Based on evidence of variable quality, ICM is effective in helping many outcomes relevant to people with severe mental illness. Compared to standard care, ICM may reduce hospitalization and increase retention in care. It also globally improved people's functioning socially, but ICM's effect on mental state and quality of life remains unclear.|
- Assertive community treatment
- Care in the community
- Care programme approach
- Clinical formulation
- Clinical pathway
- Medical case management
- Onyett, Steve (1998) . Case management in mental health (reprint ed.). Cheltenham, UK: Stanley Thornes. p. 3. ISBN 978-0-7487-3845-8.
- Ivezić, Slađana Štrkalj; Mužinić, Lana; Filipac, Vanda (March 2010). "Case management: a pillar of community psychiatry" (PDF). Psychiatria Danubina. 22 (1): 28–33. PMID 20305587.
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- Holloway, F (March 1991). "Case management for the mentally ill: looking at the evidence". International Journal of Social Psychiatry. 37 (1): 2–13. doi:10.1177/002076409103700102. PMID 2045238. (subscription required)
- Kanter, Joel (April 1989). "Clinical case management: definition, principles, components". Hospital and Community Psychiatry. 40 (4): 361–8. doi:10.1176/ps.40.4.361. PMID 2714749. (subscription required)
- Stein, Leonard I.; Test, Mary Ann (April 1980). "Alternative to mental hospital treatment: I. Conceptual model, treatment program, and clinical evaluation". Archives of General Psychiatry. 37 (4): 392–7. doi:10.1001/archpsyc.1980.01780170034003. PMID 7362425. (subscription required)
- Teague, Gregory B.; Mueser, Kim T.; Rapp, Charles A. (August 2012). "Advances in fidelity measurement for mental health services research". Psychiatric Services. 63 (8): 765–71. doi:10.1176/appi.ps.201100430. PMC . PMID 22854723.
- Dieterich, M; Irving, C; Bergman, H (2017). "Intensive case management for severe mental illness". Cochrane Database of Systematic Reviews. 1: CD007906.pub3. doi:10.1002/14651858.CD007906.pub3.
- Burns, Tom; Catty, Jocelyn; Dash, Michael; Roberts, Chris; Lockwood, Austin; Marshall, Max (18 August 2007). "Use of intensive case management to reduce time in hospital in people with severe mental illness: systematic review and meta-regression". BMJ. 335 (7615): 336. doi:10.1136/bmj.39251.599259.55. PMC . PMID 17631513.
- Burns, Tom; Fioritti, Angelo; Holloway, Frank; Malm, Ulf; Rössler, Wulf (May 2001). "Case management and assertive community treatment in Europe". Psychiatric Services. 52 (5): 631–6. doi:10.1176/appi.ps.52.5.631. PMID 11331797.
- Dieterich, Marina; Irving, Claire B.; Park, Bert; Marshall, Max (6 October 2010). "Intensive case management for severe mental illness". Cochrane Database of Systematic Reviews (10): CD007906. doi:10.1002/14651858.CD007906.pub2. PMC . PMID 20927766.
- Hangan, Catherine (September 2006). "Introduction of an intensive case management style of delivery for a new mental health service". International Journal of Mental Health Nursing. 15 (3): 157–62. doi:10.1111/j.1447-0349.2006.00397.x. PMID 16916408. (subscription required)
- Mueser, Kim T.; Bond, Gary R.; Drake, Robert E.; Resnick, Sandra G. (January 1998). "Models of community care for severe mental illness: a review of research on case management". Schizophrenia Bulletin. 24 (1): 37–74. doi:10.1093/oxfordjournals.schbul.a033314. PMID 9502546.
- Smith, Lucinda; Newton, Richard (January 2007). "Systematic review of case management". Australian and New Zealand Journal of Psychiatry. 41 (1): 2–9. doi:10.1080/00048670601039831. PMID 17464675. (subscription required)
- Ziguras, Stephen J.; Stuart, Geoffrey W. (November 2000). "A meta-analysis of the effectiveness of mental health case management over 20 years". Psychiatric Services. 51 (11): 1410–21. doi:10.1176/appi.ps.51.11.1410. PMID 11058189.