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Intensive case management for the severely mentally ill

Controlled trial

Published online by Cambridge University Press:  03 January 2018

Frank Holloway  and
Jerome Carson
Frank Holloway*
Affiliation:
Maudsley Hospital
Jerome Carson
Affiliation:
Institute of Psychiatry, London
*
Dr F. Holloway, Maudsley Hospital, Denmark Hill, London SE5 8AZ
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Abstract

Background

The aim was to compare the efficacy of intensive clinical case management (ICM) with standard community care in the management of ‘hard to treat’ patients with a severe mental illness.

Method

A randomised controlled trial was carried out in East Lambeth, a deprived area of inner London. Seventy people with psychosis designated as ‘hard to treat’ by referring teams were included; 35 were randomised to ICM (case load eight patients per worker), and 35 to standard care, which offered follow-up by a community psychiatric nursing service (30 patients per worker). Outcome measures were admissions and hospital bed utilisation; contact with services; symptomatology; social behaviour; social functioning; quality of life; patients' satisfaction with care at 9 and 18 months.

Results

There were no differences in patients' symptoms, social behaviour or social functioning. Quality of life was significantly improved in patients receiving ICM at 9 months. Satisfaction with care was significantly greater among case-managed patients. All ICM patients remained in contact with services throughout the study, while six control patients were refusing all contact with services at 18 months.

Conclusions

ICM failed to improve the clinical outcome of ‘hard to treat’ patients. The service was successful in maintaining contact with patients, was greatly appreciated and had a positive effect on their perceived quality of life.

Type
Papers
Information
The British Journal of Psychiatry , Volume 172 , Issue 1 , January 1998 , pp. 19 - 22
Copyright
Copyright © 1998 The Royal College of Psychiatrists 

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