Case management (mental health)

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Case management is the coordination of community-based services by a professional or team to provide people the quality mental health care that is customized accordingly to an individual's setbacks or persistent challenges and aid them 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 without making disadvantageous economic costs. As a result, care coordination includes traditional mental health services but may also encompass primary healthcare, housing, transportation, employment, social relationships, and community participation. It is the link between the client and care delivery system.

Video Case management (mental health)

Development

The case management model developed in the USA was a response to the closure of large psychiatric hospitals (known as deinstitutionalisation) and initially for provision of services which enhances the quality of life 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, often in this only the personal and interpersonal resources are utilized. The process involved can be cyclical because of its client-centered nature.According to the American Association on Mental Retardation (1994) "Case Management (service coordination) is an ongoing process that consists of the assessment of wants and needs, planning, locating and securing supports and services, monitoring and follow-along. The individual or family is the defining force of this service coordination process."

A more active form of case management is present in assertive community treatment (or Intensive Case Management), this provides a holistic and integrated approach in psychiatric case management with coordinated services that promote increased wellness for the management's (homes or agencies) population. This form of management is a part of managed care systems, others include health maintenance organizations, point-of-service plans, and preferred provider arrangements.

Maps Case management (mental health)

Functions

Case management is about engaging the clients in a process, not processing clients. Hence, Rose and Moore in 1995 defined the following as case management functions:

1. Outreach or identification of clients
2. Assessment of individual needs
3. Service or Care planning
4. Plan implementation
5. Progress monitoring
6. Regular review and Termination

In cases when re-assessment might identify more than one needs and they are required to be delivered, a new case management cycle is initiated. The case manager becomes an effective facilitator or enabler by use of self, understanding the social systems, the etiology of needs, and functioning of the clients. Moore in 1990s said that a case manager should possess the clinical skills of a psychotherapist and the advocacy skills of a community organizer. A client record is maintained by the case manager for effective delivery of services per agency policy. Newer forms of record keeping involve using checklist and scan sheets for decentralized and statistical outcome management. Others who have explained the functions and tasks of a case manager are Grube & Chernesky, 2001; Mather & Hull, 2002; and Vourlekis & Green, 1962.

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Models

Several models of case management emerged to coordinate care for individuals with different assessment and re-assessments involved. These models differ in their approach to care, frequency of contact, the number of professionals and referrals involved. In addition, outcome evaluation is typically used to assess the effectiveness of treatment interventions. Researchers have developed fidelity measures to assess the implementation of a particular case management model.

A 2010 review shows the following similarities and differences in different models of case management with regards to the way they operate:

Effectiveness of managed care models

A systematic review investigated the effects of intensive case management for patients with severe mental illness:

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See also

• Assertive community treatment
• Care in the community
• Care programme approach
• Clinical formulation
• Clinical pathway
• Incentive based managed care services
• Medical case management

References

Further reading

• 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 1949434 . 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 4233116 . 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. 

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