© 1998 by Oxford University Press and the Maryland Psychiatric Research Center (MPRC)
Models of Community Care for Severe Mental Illness: A Review of Research on Case Management
Professor, Departments of Psychiatry and Community and Family Medicine, Dartmouth Medical School Hanover, NH
Professor of Psychology, Indiana University-Purdue University Indianapolis, IN
Director, New Hampshire-Dartmouth Psychiatric Research Center and Professor of Psychiatry, Community and Family Medicine, Dartmouth Medical School Hanover, NH
doctoral student, Department of Psychology, Indiana University-Purdue University Indianapolis, IN
Reprint requests should be sent to Dr. K.T. Mueser, New Hampshire-Dartmouth Psychiatric Research Ctr., Main Bldg., 105 Pleasant St., Concord, NH 03301
We describe different models of community care for persons with severe mental illness and review the research literature on case management, including the results of 75 studies. Most research has been conducted on the assertive community treatment (ACT) or intensive case management (ICM) models. Controlled research on ACT and ICM indicates that these models reduce time in the hospital and improve housing stability, especially among patients who are high service users. ACT and ICM appear to have moderate effects on improving symptomatology and quality of life. Most studies suggest little effect of ACT and ICM on social functioning, arrests and time spent in jail, or vocational functioning. Studies on reducing or withdrawing ACT or ICM services suggest some deterioration in gains. Research on other models of community care is inconclusive. We discuss the implications of the findings in terms of the need for specialization of ACT or ICM teams to address social and vocational functioning and substance abuse. We suggest directions for future research on models of community care, including evaluating implementation fidelity, exploring patient predictors of improvement, and evaluating the role of the helping alliance in mediating outcome.
Keywords: Case management / assertive community treatment / community care
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