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Intensive case management for severe mental illness.

Marina Dieterich1, Claire B Irving2, Hanna Bergman3

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Summary

Intensive Case Management (ICM) may reduce hospitalizations for severe mental illness compared to standard care. High fidelity to the Assertive Community Treatment (ACT) model and high baseline hospital use improve ICM

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Area of Science:

  • Psychiatry and Mental Health Research
  • Community-Based Care Models
  • Evidence-Based Practice in Mental Health

Background:

  • Intensive Case Management (ICM) is a community-based care model for individuals with severe mental illness who do not require immediate hospitalization.
  • ICM evolved from Assertive Community Treatment (ACT) and Case Management (CM), emphasizing small caseloads and high-intensity support.
  • This review assesses ICM's effectiveness against non-ICM and standard community care for severe mental illness.

Purpose of the Study:

  • To evaluate the effects of Intensive Case Management (ICM) for severely mentally ill individuals in community settings.
  • To compare ICM with non-ICM (larger caseloads) and standard community care.
  • To investigate if fidelity to the ACT model and baseline hospital use influence ICM's effect on hospitalization.

Main Methods:

  • A systematic review and meta-analysis of randomized controlled trials (RCTs) were conducted.
  • Searches included the Cochrane Schizophrenia Group's Trials Register up to April 2015.
  • Data were extracted and analyzed using random-effects models, including meta-regression for fidelity and baseline hospital use.

Main Results:

  • Compared to standard care, ICM showed low-quality evidence for reducing hospital days and early trial withdrawal, with uncertain effects on suicide and unemployment.
  • Compared to non-ICM, ICM demonstrated moderate-quality evidence for little to no difference in hospitalization or admissions, but may reduce early withdrawal.
  • Meta-regression indicated that higher fidelity to the ACT model and higher baseline hospital use were associated with reduced time in hospital.

Conclusions:

  • Intensive Case Management (ICM) shows potential benefits in reducing hospitalizations and improving retention in care for severe mental illness, particularly for those with high prior hospitalization rates.
  • High fidelity to the ACT model and high baseline hospital use enhance ICM's effectiveness in reducing hospital time.
  • Further trials comparing ICM to standard or non-ICM are not recommended; a review comparing non-ICM to standard care is suggested.