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Social services case-management for long-term mental disorders: a randomised controlled trial
M Marshall1, A Lockwood, D Gath
1Oxford University Department of Psychiatry, Warneford Hospital, UK.
Lancet (London, England)
|February 18, 1995
Summary
Case management for severe mental disorders showed limited effectiveness in a UK trial. While it reduced deviant behavior, it did not significantly improve overall needs, quality of life, or psychiatric symptoms.
Area of Science:
- Mental Health Services Research
- Social Work Practice
- Community Psychiatry
Background:
- Case management originated in the USA to improve community care for individuals with severe mental disorders.
- This approach involves a case manager overseeing client needs assessment, service planning, delivery, and monitoring.
- Case management is now a cornerstone of UK community care, mandated by recent legislation.
Purpose of the Study:
- To evaluate the effectiveness of a social services case management team for individuals with long-term mental disorders.
- To assess the impact of case management on various client outcomes through a randomized controlled trial.
Main Methods:
- A randomized controlled trial was conducted with individuals referred from various homeless support services.
- Eighty participants consented to be randomized into either a case management treatment group or a control group.
- Outcomes were assessed at a 14-month follow-up using standardized interviews and behavior rating scales.
Main Results:
- No significant differences were found between groups in the number of needs, quality of life, employment, accommodation, social behavior, or psychiatric symptom severity.
- The case management group showed a statistically significant reduction in deviant behavior on the REHAB scale (mean = 0.79).
Conclusions:
- Social services case management demonstrated limited effectiveness for people with long-term mental disorders.
- The study highlights the importance of evaluating such interventions through randomized controlled trials before widespread implementation, as was done in the UK.