Intensive case management for the severely mentally ill. Controlled trial

Area of Science:

• Psychiatry
• Mental Health Services Research
• Clinical Psychology

Background:

• Severe mental illness (SMI) presents challenges in treatment adherence and engagement.
• Identifying effective management strategies for 'hard to treat' SMI populations is crucial.

Purpose of the Study:

• To compare the efficacy of intensive clinical case management (ICM) against standard community care for SMI patients.
• To evaluate the impact of ICM on clinical outcomes, service utilization, and patient satisfaction.

Main Methods:

• A randomized controlled trial involving 70 'hard to treat' SMI patients in a deprived urban area.
• Patients were assigned to either ICM (8 patients/worker) or standard community psychiatric nursing care (30 patients/worker).
• Outcomes assessed at 9 and 18 months included hospital admissions, symptomatology, social functioning, and patient satisfaction.

Main Results:

• No significant differences were observed in patient symptomatology, social behavior, or social functioning between groups.
• Patients receiving ICM reported significantly improved quality of life at 9 months and greater satisfaction with care.
• ICM maintained continuous contact with all patients, whereas 6 control patients refused services by 18 months.

Conclusions:

• Intensive clinical case management (ICM) did not yield improvements in the clinical outcomes of 'hard to treat' SMI patients.
• ICM proved effective in maintaining patient contact with services and enhancing perceived quality of life and satisfaction.