An Evaluation of the Implementation and the Effectiveness of Case Management in the Rehabilitation of Psychiatric Outpatients in South Africa

Abstract

Patients with a major mental illness usually need long-term treatment and rehabilitation. Since the adoption of the principle of de-institutionalization of psychiatric patients in South Africa in the 1970s, most treatment has been done in the community, through a system of psychiatric outpatient clinics. There is now a growing realization that more is needed than treatment with medication, but in a developing country resources, both human and financial, are limited. It is therefore important to establish which rehabilitation strategies can be implemented in the South African services, and how effective they are. In this study case management was implemented in the psychiatric service to black patients in rural areas. A sample of 41 patients formed the experimental group, who were seen by six nurses trained as case workers. The control group consisted of 15 patients in another clinic, who received additional attention to routine care. There were specific problems with the implementation of case management, especially inadequate training of nurses in these techniques, the restrictions on the functioning of the nurse by legal provisions and organizational rules, and the paucity of community resources. The case management was found to positively influence functional status, but did not achieve symptom reduction.