Case management for people with severe mental disorders.

Area of Science:

• Psychiatry
• Mental Health Services Research
• Health Services Management

Background:

• Deinstitutionalization since the 1960s led to community-based care for severe mental illness.
• Rising readmission rates indicated potential limitations in standard community care models.
• Case management emerged in the 1970s to coordinate community-based care for severely mentally ill individuals.

Purpose of the Study:

• To evaluate the effectiveness of case management for severely mentally ill individuals in community settings.
• To compare case management against standard care across key outcomes: service contact, hospital admissions, clinical/social functioning, and costs.

Main Methods:

• Systematic review of randomized controlled trials (RCTs) identified through extensive electronic database searches (CINAHL, Cochrane, EMBASE, MEDLINE, PsycLIT, SCISEARCH).
• Inclusion criteria focused on RCTs comparing case management to standard community care for adults (18-65) with severe mental disorders.
• Data extraction and analysis involved categorical and continuous data, with reliability testing and heterogeneity assessments.

Main Results:

• Case management increased patient contact with psychiatric services (OR 0.70).
• Hospital admission rates were approximately doubled with case management (OR 1.84).
• No significant advantages were found for case management over standard care in psychiatric or social outcomes, except for compliance in one study. Cost data were inconclusive.

Conclusions:

• Case management improves service contact but increases hospital admissions and potentially costs.
• Current evidence does not support case management as a clinically significant improvement over standard care for severe mental illness.
• The overall value of case management is questionable, challenging its role as a cornerstone of community mental health services.