Case management (mental health)

This article is about the mental health approach. For other uses, see Case management.

Case management is the coordination of community-based services by a professional or team to provide individually-customized mental health care for people experiencing frequent setbacks or persistent challenges to their recovery. Case management seeks to reduce hospitalizations and support individuals' recovery through a holistic approach that considers each person's overall biopsychosocial needs. As a result, care coordination includes traditional mental health services but may also encompass primary healthcare, housing, transportation, employment, social relationships, and community participation.

History

The case management model developed in the USA in response to the closure of large psychiatric hospitals (known as deinstitutionalisation) and initially following a brokeage model, where professionals arranged for the provisions of services, without the need for direct patient care or contact. Clinical or therapeutic case management then developed as the need for the mental health professional to establish a therapeutic relationship and be actively involved in clinical care was recognised. A more intensive form of case management (assertive community treatment or Intensive Case Management) was also developed for patients with more severe illness who needed a more assertive approach. With the rise in popularity of value-based purchasing in healthcare, case management has begun to undergo a transition. In April 2014, The Maine Department of Health and Human Services introduced the Behavioral Health Home case management program which follows a value-based purchasing approach. The Behavioral Health Home provides a holistic and integrated approach to psychiatric case management with a goal to promote increased wellness amongst an agency's entire population.

Process

The underlying tasks of case management form a five-step cycle:

1. Assessment of individual needs and strengths
2. Care planning
3. Plan implementation
4. Progress monitoring
5. Regular review and re-assessment (initiating a new case management cycle)

Models

Several models of case management emerged to coordinate care for individuals with different needs. These models differ in their approach to care, frequency of contact, and the number of professionals and individuals involved.

Model	Developed	Focus	Case manager(s)	Client(s)
Brokerage Model	?	Connect client to services	Individual	Individual
Clinical Case Management	?	Involve case manager in treatment	Individual	Individual
Assertive Community Treatment	?	Reduce hospitalizations	Multidisciplinary team, 10–12 members	Individual
Intensive Case Management	?	Reduce hospital and emergency service use	Individual	Individual
Personal Empowerment Model / Strengths Model	1980s	Client abilities and interests	Individual	Individual
Rehabilitation Model	?	Client goals, disability rehabilitation plan	Individual	Individual
Individual Case Management	?	Varies	Individual	Individual
Team Case Management	?	Varies	Team	Individual
Cluster Case Management	?	Mutual support	Individual with optional assistant	Group

In addition to the outcome measures typically used to assess the effectiveness of treatment interventions, researchers have developed fidelity measures to assess the implementation of a particular case management model. As of 2012, there are documented fidelity measures for Assertive Community Treatment (the Dartmouth ACT Scale and the Tool for Measurement of ACT) and the Strengths Model (the Strengths Model Fidelity Scale).

See also

• Medical case management
• Clinical pathway
• Care programme approach
• Assertive community treatment
• Care in the community

Further reading

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• ar:معالجة حالة (صحة عقلية)