Characteristics and activities of case managers in the RWJ Foundation Program on chronic mental illness

Case management was seen as the major strategy for integrating mental health, housing, and social supports for clients in the Robert Wood Johnson Foundation Program on Chronic Mental Illness, a five-year multisite demonstration project designed to test the effects of reorganizing mental health systems in large urban areas. The authors assessed data on case management programs in the demonstration project to try to explain the lack of consistent improvement in clients' outcomes that was found in the national evaluation of the project.

Data on case management programs from five demonstration sites-Baltimore; Cincinnati; Columbus, Ohio; Denver; and Toledo, Ohio-were reviewed. Data sources included onsite interviews, documentary material, studies of case managers' contact with community agencies that were conducted in 1989 and 1991, and telephone interviews with coordinators of case management programs.

The characteristics and activities of case managers changed little between 1989 and 1991. Case managers tended to become the principal service providers for their clients rather than coordinating service provision among multiple service providers. Case managers reported that their clients received few services from other agencies in the local community support system.

Although lack of change in case managers' activities during the demonstration project may help explain clients' lack of improvement over time, case management by itself does not constitute comprehensive treatment. More attention must be paid to the development and refinement of community-based medical-psychiatric and psychosocial treatments with a proven track record of improving clients' level of symptoms and quality of life.