["Case manager" in district psychiatry. A review of the concept]

During the past 20 years, the "case manager" has become a central expression in district psychiatry in USA. The case manager is a person who has the main responsibility for coordination and to a varying extent granting of the district psychiatric contributions to persons with prolonged psychoses. This function was introduced because the previous system with many administrative and physically separate offers appeared to be uncoordinated, mutually competitive and ineffective. The case manager acts as a supplementary "ego" for the patient on his own terms and has an active supportive function. Whereas, coordination was previously the central task, it became considered to an increasing extent more suitable that a multidisciplinary team of case managers supply the district psychiatric therapy themselves. Investigations reveal that the results are just as good or even better than those of the previous combination of hospitalization and outpatient treatment and that the patients are more satisfied. Many hospitalizations can be avoided but the employment of resources is probably not reduced on account of expenses for the case manager function and housing. The number of patients per case manager varies between four and 50, depending on the therapeutic needs of the patient group and, in particular, the tasks which the case manager must perform (all over the treatment or coordination of treatment administered by others). On account of the close contact by the case manager and his supportive activity, there are reasons for particular attention to ethical problems concerning personal choice and exchange of information. Utilization of the American experience with case managers is recommended simultaneously with avoidance of administrative practical splitting of district psychiatry which would make the total therapy ineffective.