Case Management and Assertive Community Treatment

Abstract

For nearly 50 years, case management has been the keystone of community mental health care for people with serious mental illnesses, essential for optimal treatment and support. Specific models of case management have emerged and evolved in response to inadequacies in systems of care at any particular time. Many of these models have been further refined as part of the evidence-based practices movement in an attempt to bind together an array of effective services called evidence-based practices. But much has changed in the past few years that will challenge the future development and effectiveness of case management. Basic social supports have eroded. People with mental illnesses have been shunted into the criminal justice system. Psychiatrists in community mental health centers have been marginalized. Medical comorbidities and early mortality have become salient and have probably increased. Insurance payments to the pharmaceutical industry and to managed care companies have increased while payments for psychosocial supports have decreased. And at the same time that services have deteriorated, expectations have increased!