Psychiatric Case Management Research Articles

The Substance Abuse Program for African-Canadian and Caribbean Youth (SAPACCY): An Innovative Program Serving the Mental Health Needs of African, Caribbean, and Black Youth

Black youth experience disproportionately poor health outcomes throughout Ontario's healthcare system, including the mental health and addictions system. The Substance Abuse Program for African Canadian and Caribbean Youth (SAPACCY) at the Centre for Addiction and Mental Health (CAMH) seeks to address this disparity by providing clinical services to youth who identify as Black and/or as having African and/or Caribbean heritage, and their families, who are struggling with problematic substance use and/or mental health concerns. The clinical team works from an Afrocentric, culturally responsive lens to promote recovery and support Black youth in working through their mental health and addiction concerns. The program offers mental health and addictions counselling and psychotherapy, psychiatric consultation, psychoeducation, resource navigation, advocacy, and case management services to assist youth and their families/caregivers in reducing harm, moving toward recovery, and making healthy choices for themselves and their family. This paper will discuss SAPACCY’s approach to helping clients build resilience and resistance to anti-Black racism.

Current Status and Prospects of Community Psychiatric Home Care

Psychiatric home care is an effective model for providing care to community-based patients with psychosocial needs who are unable to receive continuous treatment / rehabilitation in mental health hospitals. Moreover, this model has been shown to effectively reduce rehospitalization and promote recovery in these patients. Three psychiatric home care models are described in this article: medical-based home care; prevent recurrence public health home care; and preventing disability long-term care home care. Furthermore, the resources required to provide psychiatric home care are estimated and current psychiatric home care-related problems, dilemmas, and prospects are summarized. Building an accessible psychiatric home care network may be accomplished by promoting evidence-based home care case management practices and ensuring psychiatric case management nurses are properly certified. This network will help improve significantly the quality of care received by community-dwelling patients with mental illness.

Multi-disciplinary Psychiatric Case Management Model in Hong Kong: Service Coverage and Risk Stratification.

Community mental health services in Hong Kong follow a multi-disciplinary case management model. We investigated whether at-risk patients received higher intensity care and whether risk stratification concorded between personalised care programmes and integrated community centres of mental wellness. Records of all patients in North Lantau and Mongkok districts who received case management services (from personalised care programmes and/or integrated community centres of mental wellness) between 1 April 2014 and 30 June 2015 were reviewed. Patients' levels of risk, demographic data, and clinical characteristics were analysed. Identified at-risk patients received high-intensity care from personalised care programmes and integrated community centres of mental wellness. Case management was coordinated between the Hospital Authority and non-government organisations. However, risk stratification did not correlate with assessment rating scores of psychopathology or psychosocial functioning. Assessment rating scales appear unsuitable to provide any optimal cut-off scores for risk stratification. Risk stratification should be a structured clinical judgement based on comprehensive and accurate information of protective and risk factors, rather than relying on cut-off scores of assessment rating scales.

Patterns of psychiatric admissions and predictors of patient\u2019s outcome in Jimma University Teaching and Referral Hospital: a retrospective study

BackgroundPsychiatric morbidity burden accounts 12.45% of the disease admission burden in Ethiopia; only two referral hospitals are found to manage all cases. The aim of this study is to assess the predictors of patient outcomes.MethodA 3 years retrospective patients’ cards, charts and medical notes review in psychiatry case admission department of Jimma university teaching and training specialised hospital was conducted. All the admitted cases included in this study. Bivariate and multivariable logistic regression analyses were conducted to identify independent predictors of outcomes.ResultAmong 402 study participants, the majority of them 301 (74.9%), were improved from their mental illnesses. First to eight grades completed study participants were found to be 1.34 times more likely improved mental illness than not able to read or write [AOR = 1.34, 95% CI (1.18–2.78), P < 0.009)]. The probability of improving from mental illness on married study participants was found 2.81 times more likely than single study participants [AOR = 2.81, CI (1.90–4.50), P < 0.043]. First time admitted cases improved 2.82 times more likely than those having a previous admission history [AOR = 2.82, CI (2.05–3.17), P < 0.05]. Duration of stay from 31 to 44 days showed more likely than from 1 to 20 days on patient improvement, [AOR = 1.88, CI (1.42–2.65), P < 0.034]. However, the hospital stay above 44 days does not show any statistical association with patient’s medical improvement.ConclusionMarried, better educated, and the hospital stay of one to one-and-half month predicts better health outcome. Thus, this study suggests, psychiatric case management needs the collaborative care of the family in concurrence with counselling and guidance with enough time to better-off patients’ outcomes. Our findings are useful in designing and improving—patient services for psychiatric patient programs and focused health communication and counselling strategies in relation to psychoactive substances in Ethiopia.

Awareness of Pre-diabetes or Diabetes and Associated Factors in People With Psychosis.

To estimate awareness of pre-diabetes or type 2 diabetes and associated factors in people with psychosis, a known high-risk group. Cross sectional analysis of a national sample with psychosis who were aged 18-64 years, gave a fasting blood sample (n = 1155), had pre-diabetes or diabetes based on testing (n = 359) and reported if they knew they had high blood sugar or diabetes at survey (n = 356). Logistic regression was used to identify factors associated with awareness of pre-diabetes or diabetes prior to testing. The prevalence of pre-diabetes (19.0% 219/1153) or type 2 diabetes (12.1%, 140/1153) was 31.1% (359/1153); 45% (160/356) were known prior to testing. Factors associated with detection were higher fasting blood glucose, older age, a perception of poor health, severe obesity, dyslipidaemia or treatment with a lipid regulating drug, a family history of diabetes, Aboriginal or Torres Strait Islander descent, decreased cognitive functioning, regional economic disadvantage, treatment with an antihypertensive drug, and an elevated 5-year risk for cardiovascular disease. The prevalence of undiagnosed pre-diabetes/diabetes was highest in those aged 25-34 years at 34.2%. Clinical detection of pre-diabetes or diabetes in people with psychosis was strongly dependent on established risk factors for type 2 diabetes in the population but not on current antipsychotic drug treatment or psychiatric case management which should ensure regular screening. Screening must become a clinical priority and should not wait until age 40.

Psychiatric Case Management in the Emergency Department

Professional Case Management 20(5):p 228-229, September/October 2015. | DOI: 10.1097/NCM.0000000000000119

Psychiatric Case Management in the Emergency Department.

The care of the mentally ill has reached a real crisis in the United States. There were more than 6.4 million visits to emergency departments (EDs) in 2010, or about 5% of total visits, involved patients whose primary diagnosis was a mental health condition or substance abuse (). That is up 28% from just 4 years earlier, according to the latest figures available from the Agency for Healthcare Research and Quality in Rockville, MD. Using a method called scoping, the purpose of this article is to examine the range, extent, and evidence available regarding case management as an intervention in the ED to manage mental health patients, to determine whether there is sufficient quantity and quality of evidence on this topic to conduct a meta-analysis, and to identify relevant studies that balance comprehensiveness with reasonable limitations. One solution for ensuring that the costs are contained, efficiency is maintained, and quality outcomes are achieved is the placement of a case manager in the ED. According to , because the majority of hospital admissions come through the ED, it makes sense to have case managers located there to act as gatekeepers and ensure that patients who are admitted meet criteria and are placed in the proper bed with the proper status. From the scoping techniques implemented in this study, the authors came to the conclusion that case management has been and can be used to effectively treat mental health patients in the emergency room. A good number of patients with psych mental health issues are frequent visitors and repeat visitors. Case management has not been used very often as a strategy for managing patients through the ED or for follow-up after the visit. Hospitals that have developed a protocol for managing these patients outside the main patient flow have had successful results. Staff training and development on psych mental health issues have been helpful in the ED. While there are not a large number of studies available on this topic, there is sufficient evidence to warrant further examination of this research topic. The findings in this scoping study have broader implications for research, policy, and practice. The framework of this study involved an outcomes-based approach. Clinical outcomes that positively enhance patient care and save the hospital money are necessary in the current health care environment.

Mentalization-based intervention to recurrent acute presentations and self-harm in a community mental health service setting.

A proof-of-concept study over an 18-month period to determine whether a mentalization-based intervention (MBI) in a metropolitan community mental health service, when added to a recovery-based model of care, would be of clinical benefit to borderline personality disorder (BPD) consumers with a history of recurrent, deliberate self-harm. The feasibility of implementing the intervention, and factors that could improve its implementation, will be evaluated. Three-monthly focus groups with participating community mental health service case managers (N = 8) assessed the implementation and the impact of an MBI added to a recovery model of care and the way the clinicians worked with consumers with BPD and recurrent, deliberate self-harm in this context. Qualitative analysis revealed compatibility of the MBI with a recovery-based case management approach for the above group of consumers, albeit with operational barriers. MBI with consumers with BPD appears to be compatible with recovery-focused psychiatric case management and was accepted by consumers. The case managers perceived that no harm was rendered in terms of deliberate self-harm and acute service utilization. The MBI led to a sense of improved therapeutic alliance in case managers working with consumers.

S3 guideline on psychosocial therapies in severe mental illness: evidence and recommendations.

The burden of severe and persistent mental illness is high. Beside somatic treatment and psychotherapeutic interventions, treatment options for patients with severe mental illness also include psychosocial interventions. This paper summarizes the results of a number of systematic literature searches on psychosocial interventions for people with severe mental illness. Based on this evidence appraisal, recommendations for the treatment of people with severe mental illness were formulated and published in the evidence-based guideline series of the German Society for Psychiatry, Psychotherapy and Neurology (DGPPN) as an evidence-based consensus guideline ("S3 guideline"). Recommendations were strongly based on study results, but used consensus processes to consider external validity and transferability of the recommended practices to the German mental healthcare system. A distinction is made between system-level interventions (multidisciplinary team-based psychiatric community care, case management, vocational rehabilitation and participation in work life and residential care interventions) and single psychosocial interventions (psychoeducation, social skills training, arts therapies, occupational therapy and exercise therapy). There is good evidence for the efficacy of the majority of psychosocial interventions in the target group. The best available evidence exists for multidisciplinary team-based psychiatric community care, family psychoeducation, social skills training and supported employment. The present guideline offers an important opportunity to further improve health services for people with severe mental illness in Germany. Moreover, the guideline highlights areas for further research.

Psychiatric case management. Chronic Disease Management application experience in a public Mental Health Service

Aim of this study is to investigate the possible effectiveness of a specific program management needs of patients at high impact health care, case management (CM). The welfare impact is evaluated in terms of the severity of the presented disorder or to other characteristic factors of the individual patient, such as: adherence to the proposed treatments, possible resistance to drug treatment, cognitive structure, the presence of comorbid medical pathologies, abuse/addiction and, more generally, all bio-psycho-social functioning variables that can complicate the treatment of the patient. Twenty five outpatients with chronic schizophrenia (age mean 49,5 yrs) were evaluated through the Camberwell Assessment of Need (CAN20) and Life Skill Profile (LSP) before and after 1 year of CM treatment. General psychopathology was assessed by the Clinical Global Impression (CGI) and the Brief Psychiatric Rating Scale (BPRS). Demographic data were collected, as well as data related to the severity of the disorder: number of hospitalizations and number of switch in drug treatment in the year before the study. Between T0 and T1 there is a significant improvement on CGI-G, BPRS (total and HOST factor), LSP and CAN TOT in patients treated with CM. Moreover, in CM treated patients a 58% reduction of hospitalizations is noted in the year of study. There is a possible effectiveness of CM in improving patient's clinical and social needs in chronic psychiatric diseases. The CM reduces the number of hospitalizations.

Medicaid Funding Boost May Rescue At-Risk MH Services

Back to table of contents Previous article Next article Government NewsFull AccessMedicaid Funding Boost May Rescue At-Risk MH ServicesRich DalyRich DalySearch for more papers by this authorPublished Online:3 Sep 2010https://doi.org/10.1176/pn.45.17.psychnews_45_17_019AbstractMany states whose revenues have plunged due to the recession will be able to avoid implementing massive reductions in their Medicaid programs following congressional passage of a bill that extends federal financial assistance to those programs.About $16 billion in Medicaid assistance was included in a $26 billion measure (HR 1586) passed in August and signed by President Obama that will also provide states with funds to rehire public-school teachers and other state and local government workers who lost their jobs due to funding cuts resulting from budget shortfalls.The Medicaid appropriation will extend by an additional six months—to June 30, 2011—an increase in federal Medicaid payments to the states, known as the Federal Medical Assistance Percentage, that was enacted as part of the federal stimulus measure (PL 111-5).About 60 percent of states had already passed budgets that assumed the federal government would provide the additional Medicaid assistance in the wake of falling tax revenues during the recession. If the added federal funding had fallen through, those state legislatures would have had to scramble to find sufficient cuts or tax increases to make up the difference.The National Governors Association, in a letter to congressional leaders, said that the states' total estimated budget shortfall for the 2010-2012 period is expected to be $116 billion. The letter described the extended Medicaid payments as “the best way to help states bridge the gap between their worst fiscal year and the beginning of recovery.” Medicaid is dually funded by states and the federal government. The measure provides a 6.2 percent across-the-board increase to each state's Medicaid program and extra funding for states with the highest unemployment rates.The federal Medicaid boost was urged by mental health advocates, who were alarmed that many states had already sought budget savings through cuts in their mental health programs and that more such cuts could result from a lack of additional federal assistance.For instance, Michigan Gov. Jennifer Granholm (D) said in July that her state would cut mental health and prescription drug coverage under its Medicaid program if the state didn't receive the full $560 million it needed in federal Medicaid assistance, according to local media reports.“Medicaid is the primary funder of community-based mental health services and supports, including psychiatric rehabilitation and intensive case management,” said Laurel Stine, director of federal relations at the Bazelon Center for Mental Health Law. “The passage of this extension will help ensure that states can continue providing vital health care and recovery-oriented services and help fulfill community integration efforts for many individuals with disabilities.”Those who urged Congress to increase Medicaid funding highlighted the program's expansive coverage—compared with many private insurance plans—of treatment for psychiatric illnesses. Medicaid is already the largest single payer for mental health care in the United States, funding about 25 percent of such care. Advocates link the current number of Americans who have recently turned to Medicaid for their mental health care to their difficulties finding jobs that offer health insurance while struggling with the challenges of psychiatric illness.But funding mental health treatment could actually save states money by avoiding other costly medical and criminal-justice spending on people whose untreated mental illness results in deterioration of their condition. For instance, the New England Healthcare Institute estimated that the cost of poor medication adherence—linked to increased hospitalizations and worsening of illnesses—already reaches $290 billion annually, or 13 percent of all health care expenditures.Republicans in Congress objected to the Medicaid measure because of the way it is to be paid for, which is in part through raising $10 billion in taxes from U.S.-based multinational companies, while antipoverty activists complained that other offsets would phase out an increase in food-stamp payments implemented through the stimulus measure.More information on the state aid package is posted at <http://dpc.senate.gov/dpcdoc.cfm?doc_name=lb-111-2-133>. ISSUES NewArchived

The assemblage of compliance in psychiatric case management

In the post-asylum era, case managers perform much of the face-to-face work of pharmaceutical compliance for people with severe and persistent mental illness. Their work demands careful orchestration of the assemblage of compliance, including the actual medications, the ideology of biopsychiatry, the division of professional labor, and certain mundane tools. Ethnographic vignettes from an Assertive Community Treatment (ACT) team show how case managers use this assemblage in their everyday routines, but also how it undercuts key elements of the original ACT mission. Reflecting its roots in the deinstitutionalization movement, the ACT model gives case managers limitless responsibilities for clients’ lives, but then narrowly defines their role as the prosthetic extension of psychiatric authority. To produce compliance, case managers depend on the medication cassette, analyzed here as a human/non-human hybrid woven into their ordinary work. The medication cassette has pre-scripted uses that enlist clinicians in biopsychiatric thinking and also silently impose compliant behavior on clients. The elements in the assemblage of compliance depend on each other, but they do not form a seamless whole, as evidenced by the dilemmas and micropolitics of the clinical front-line. Theoretical notions of assemblages and technologies of compliance, drawn from science and technology studies, illuminate a core conundrum of practice in psychiatric case management.

APA Honors Innovative Mental Health Programs

APA Honors Innovative Mental Health Programs

Investigation of racial and ethnic disparities in service utilization among homeless adults with severe mental illnesses.

This study examined whether there are service disparities among homeless adults with severe mental illnesses, a vulnerable population with a high level of unmet need. Data were collected at baseline for 6,829 black, Latino, and non-Latino white participants in the Access to Community Care and Effective Services and Support study. Outcome variables were measures of utilization of psychiatric outpatient, housing, and case management services in the previous 60 days. The sample was divided into white-black and white-Latino cohorts. Within each cohort, participants were stratified into comparable groups by propensity scores that estimated log-odds of being black or Latino as a function of several confounding variables. White-black and white-Latino differences in mean number of visits (a measure of intensity) and in the mean probability of at least one visit (a measure of access) were subsequently estimated for each of the three services. The composition of the sample was 50% black, 6% Latino, and 44% white. Service utilization was low for the three services regardless of race-ethnicity. On multivariate analyses of service utilization in the previous 60 days, blacks made fewer psychiatric outpatient visits than whites (mean difference=.46, 95% confidence interval [CI]=.10 to .81]), yet Latinos had more case management visits than whites (mean difference=-.51, CI=-1.03 to -.05]). Analyses of access did not reveal racial-ethnic disparities. Whereas blacks used psychiatric outpatient services less frequently than whites, hence experiencing a service disparity, Latinos used case management services more than whites did. Possible contributors and clinical and methodological implications of these results are discussed.

Investigation of Racial and Ethnic Disparities in Service Utilization Among Homeless Adults With Severe Mental Illnesses

This study examined whether there are service disparities among homeless adults with severe mental illnesses, a vulnerable population with a high level of unmet need. Data were collected at baseline for 6,829 black, Latino, and non-Latino white participants in the Access to Community Care and Effective Services and Support study. Outcome variables were measures of utilization of psychiatric outpatient, housing, and case management services in the previous 60 days. The sample was divided into white-black and white-Latino cohorts. Within each cohort, participants were stratified into comparable groups by propensity scores that estimated log-odds of being black or Latino as a function of several confounding variables. White-black and white-Latino differences in mean number of visits (a measure of intensity) and in the mean probability of at least one visit (a measure of access) were subsequently estimated for each of the three services. The composition of the sample was 50% black, 6% Latino, and 44% white. Service utilization was low for the three services regardless of race-ethnicity. On multivariate analyses of service utilization in the previous 60 days, blacks made fewer psychiatric outpatient visits than whites (mean difference=.46, 95% confidence interval [CI]=.10 to .81]), yet Latinos had more case management visits than whites (mean difference=-.51, CI=-1.03 to -.05]). Analyses of access did not reveal racial-ethnic disparities. Whereas blacks used psychiatric outpatient services less frequently than whites, hence experiencing a service disparity, Latinos used case management services more than whites did. Possible contributors and clinical and methodological implications of these results are discussed.

Incidence and Documentation of Cognitive Impairment Among Older Adults With Severe Mental Illness in a Community Mental Health Setting

Cognitive impairments among older adults are commonly linked to poor medical and psychiatric treatment adherence, increased disability, and poor health outcomes. Recent investigations suggest that cognitive impairments are frequently not recognized by healthcare providers and are often poorly documented in medical records. Older adults utilizing services at community mental health centers have numerous risk factors for developing cognitive impairment. Few studies have explored the incidence and documentation of cognitive impairments in this patient population. Data were collected from 52 ethnically diverse older adults with severe mental illness who were participating in treatment at a large community mental health center. Cognitive impairment was diagnosed by neuropsychologists utilizing the Mattis Dementia Rating Scale-2 (DRS). Measures of depression severity and substance abuse history were also obtained. An age and education corrected DRS total score falling at or below the tenth percentile was used as the criteria for diagnosing cognitive impairment. A medical chart review was subsequently conducted to determine the documentation of cognitive impairments among this patient population. Cognitive impairment was exhibited by 60% of participants and documented in medical charts for 17% of the sample. Preliminary data suggests that cognitive impairment is common in individuals with severe mental illness treated at community mental health centers, but these cognitive impairments are not well recognized or documented. The impact of cognitive impairment on psychiatric treatment and case management among community mental health patients is therefore poorly understood.

Study Examines Cost-Effectiveness of Treatments Used in TADS

Study Examines Cost-Effectiveness of Treatments Used in TADS

Clinical case management of revolving door patients – a semi‐randomized study

To assess the effectiveness of psychiatric clinical case management. Subjects with at least three admissions in the previous 2 years were randomized into a clinical case management group (CMG; n = 122) and a standard care group (SCG; n = 95). Individuals who refused or were not located were included in a third, non-randomized no-treatment group (NTG; n = 153). Parameters assessed included utilization of in-patient services and psychosocial functioning. We found no difference between the CMG and the SCG in psychosocial functioning as evaluated by interviewers, and no difference between the three groups in hospitalization. In subjects' self-ratings, the CMG showed slight improvement in psychosocial functioning. Clinical case management did not prove itself superior to standard care in a revolving door population.

The impact of team processes on psychiatric case management

This paper is a report of a study to identify the structures and interactions within community mental health teams that facilitate or impede effective teamwork and psychiatric case management. Effective case management requires close collaboration between case managers or care co-ordinators and other members of the multidisciplinary mental health team, yet there has been little research into this relationship. A multiple case study of seven United Kingdom community mental health teams was conducted between 1999 and 2001, using qualitative methods of participant observation, semi-structured interviews and document review. Factors were identified that impacted on the ability of care co-ordinators to act effectively: 'structure and procedures'; 'disrespect and withdrawal'; 'humour and undermining'; 'safety and disclosure'. Care co-ordination was enhanced when team structures and policies were in place and where team interactions were respectful. Where members felt disrespected or undermined, communication, information sharing and collaboration were impaired, with a negative impact on the care provided to service users. Teams require clear operating procedures alongside interprofessional trust and respect to ensure that there is open, safe and reflective participation. Further research is required to identify how best to bring about collaborative, effective teamwork in mental healthcare.

Systematic Review of Case Management

The purpose of the present paper was to review the current state of evidence for types of case management, focusing on the last 10 years since publication of the Cochrane Systematic Reviews of case management and assertive community treatment. A literature review of electronic databases from 1995 to the present to identify recent research on psychiatric case management, both original studies and reviews, was carried out. Original articles were organized on basis of year of study, experimental group and outcome variables to determine patterns. Sixty relevant papers were located. Thirty-nine are reports of experimental trials of types of case management and 21 are reviews or discussion papers. The focus of research is on assertive community treatment or intensive case management, with only five papers on other forms of less intense case management. Numerous outcomes have been examined, of those examined often enough to draw meaningful conclusions only one, engagement with services, has been consistently positive. All other outcomes have produced mixed results. The strength of findings in favour of case management has weakened over time. A heterogeneous group of experimental designs limits comparisons. Numerous issues with methodology and definitions of types of case management have beset research in this field. Assertive types of case management (including assertive community treatment and intensive case management) are more effective than standard case management in reducing total number of days spent in hospital, improving engagement, compliance, independent living and patient satisfaction. More important than the type of service configuration is to understand the clinical criteria of the services provided and their effectiveness.