The UK700 trial of Intensive Case Management: an overview and discussion.
Year: 2002
Type: article
Abstract: The severely mentally ill are at significant risk of neglect in large cities, where the prevalence of psychosis is high and services can be fragmented. Case management has been proposed as the service model of choice for this group of patients for some time. Case management arose, and has been chiefly researched, in the USA in response to deinstitutionalisation (1) and its procedures have been well described. An initially co-ordinating (brokerage) approach has been replaced with a practice combining direct patient care plus co-ordination (clinical case management) which requires clinically trained staff (2).
Assertive Community Treatment (ACT) is a particular form of case management which emphasises small case loads, comprehensive care and active outreach to the patient's home and neighbourhood. The relationship of Intensive Case Management (ICM), the term favoured in European studies, to ACT is close but somewhat ambiguous. Stein and Test's landmark study (3), convincingly replicated in Australia (4), demonstrated major advantages, both in clinical and social outcome for patients and in terms of reducing hospitalisation and costs. As a consequence the approach has spread rapidly and generated an extensive research literature into the varied forms of case management (5-7).
These research findings are, however, mixed. Overall, case management improves engagement with patients, but evidence for the reduction of hospitalisation rates appears restricted to ACT. Even here the evidence of superiority fades with time and is strikingly absent in European studies (2). Criticisms of this research highlight the lack of scientific rigour in many studies, in particular 'black-box' studies where the effective components are unclear and studies where bias from local enthusiasm and atypical service conditions are not minimised (8).
Four main themes emerge from the literature (9): a) the commonest outcome measure is reduced hospitalisation; b) patients with severe psychotic illness are the target group; c) a restricted case load of <15 patients per case manager is recommended; d) follow-up of over a year is needed to observe impact.
Source: Europe PMC (PubMed Central)
Author: Tom Burns
Institution: St George's, University of London
Language: English
Subfield: Clinical Psychology
Field: Psychology
Domain: Social Sciences
Open Access status: green
OpenAlex ID: W210695850