Case management for individuals with severe mental illness. A process-outcome study of ten pilot services in Sweden

Abstract: All clients admitted to ten pilot case management services for individuals with severe mental illness during 1995 and up to 1996-09-30 were invited to participate in the present study. A total of 176 clients were included. The clients were in all services assessed at admission and at an 18 months follow-up with regard to needs of care, psychosocial functioning. Use of health care and social services during the 18-month period before and after the client’s admission to the services was registered. At 18-month follow-up client satisfaction was obtained. In seven of the services assessments of quality of life, social network and symptoms were also performed, and in one of these a randomised controlled study was performed using a control group receiving standard care. The case manager made weekly reports concerning number of contacts with the client, type of interventions, and life areas of the clients involved. The results from the randomised study showed a significantly greater reduction in use of psychiatric inpatient care and in number of needs for care for clients in the case management condition. The main study showed that more interventions directed towards finances and co-ordination of care and support were related to less use of psychiatric inpatient care. A more pronounced decrease in needs for care was related to more interventions in the areas of brokerage, intervention planning and ADL-skills. More time spent on indirect work on behalf of the clients was related to a better outcome with regard to psychiatric symptoms and social network. In general the clients reported a high satisfaction with the case management services, and clients in the randomised study reported a significantly better satisfaction with services compared to clients in standard care.