Case Management in Mental Health in the United States

by

Victoria Stanhope

• LAST REVIEWED: 29 October 2013
• LAST MODIFIED: 29 October 2013
• DOI: 10.1093/obo/9780195389678-0096

Introduction

Case management is a core service for people with severe mental illnesses and an integral part of community-based mental health services. The service is part of the broader field of case management within social service settings but should be distinguished from case management in managed care, which focuses on utilization review rather than service provision. Case management evolved in response to the acute need to provide comprehensive supports for people in the community after deinstitutionalization. Designed to be the “glue” that holds together the complex and fragmented array of social services, case managers engage people in services and help them navigate the service system. Case management has been defined broadly as “the process of accessing, coordinating, and ensuring the receipt of services to assist individuals with psychiatric disabilities to meet their multiple and complex needs in an effective and efficient manner”. Case managers can also be referred to as service coordinators to avoid the implication that the people receiving services are “cases.” They work primarily in the community, engaging consumers, building relationships, and collaborating with them to meet their needs, which can include housing, benefits, mental health and health, and social support. Settings for case managers are primarily community mental health clinics, but can include substance abuse agencies, supportive housing programs, and hospitals. Case managers can be paraprofessionals or master’s level professionals from a variety of backgrounds, including social work, psychology, and psychiatric rehabilitation. Although they may have limited training, case managers are usually supervised by an experienced professional with master’s level training. One study found that over half of case managers have a bachelor’s degree, and three-quarters of supervisors have master’s degrees. There are various models of case management, including broker, clinical, Assertive Community Treatment (ACT), intensive case management, and rehabilitation. These models differ in respect to their practice and theoretical orientation, philosophy and values, and service intensity. Medicaid predominantly funds case management services under the categories of targeted case management or rehabilitative services. The seminal research on case management, much of which was conducted in the 1980s and the 1990s, has reflected a traditional mental health framework and therefore, has focused on its effectiveness in reducing hospitalization rates. Assertive community treatment, the most widely researched of the case management models, particularly had to demonstrate cost savings as its intensity and multidisciplinary approach make it a high-cost intervention. Positive findings prompted the widespread adoption of case management in the United States and globally, but still there remains debate about how case management impacts people’s quality of life. More recent research has focused on aspects of the service that are more consumer-oriented, including mental health recovery. As with many evidence-based practices, there are challenges in its translation to routine mental health settings, including fidelity to the model, level of training and skills among case managers, job stress, and high rates of turnover.

Introductory Works

Case management is often presented as one program among the array of community-based mental health services available to people with severe mental illnesses. While case managers are usually paraprofessionals, the knowledge base and skills draw on elements of psychiatric rehabilitation, psychology, psychiatry, and social work. These chapters describe the functions of case management and the differing models within the context of community-based mental health. Goscha, et al. 2012 provides an overview of case management, focusing on assertive community treatment. Corrigan, et al. 2008 and Pratt, et al. 2007 introduce case management from the psychiatric rehabilitation perspective, focusing on how services facilitate empowerment and community integration, whereas Sands 2001 considers case management from a social work perspective, which emphasizes the person-in-environment approach and psychosocial interventions.

• Corrigan, Patrick W., Kim T. Mueser, Gary R. Bond, Robert E. Drake, and Phyllis Solomon. 2008. Case management. In Principles and practice of psychiatric rehabilitation: An empirical approach. By Patrick Corrigan, Kim T. Mueser, Gary R. Bond, Robert E. Drake, and Phyllis Solomon, 137–159. New York: Guilford.

  This chapter gives an overview of case management within the framework of psychiatric rehabilitation. Case management is defined and the different models are presented. Implementation, funding, and research are also addressed.

• Goscha, Richard J., Charles Rapp, Gary R. Bond, and Robert E. Drake. 2012. Case management and assertive community treatment. In Handbook of community psychiatry. Edited by Hunter L. McQuistion, Wesley E. Sowers, Jules M. Ranz, and Jacqueline M. Feldman, 293–308. New York: Springer.

  DOI: 10.1007/978-1-4614-3149-7

  The authors give an overview of case management, focusing on the effectiveness of the various models. The core components of case management are presented and prevention and advocacy are discussed.

• Pratt, Carlos W., Kenneth J. Gill, Nora M. Barrett, and Melissa M. Roberts. 2007. Assertive community treatment and case management. In Psychiatric rehabilitation. 2d ed. By Carlos W. Pratt, Kenneth J. Gill, Nora M. Barrett, and Melissa M. Roberts, 190–219. Burlington, MA: Elsevier Academic.

  This chapter describes case management and assertive community treatment in the context of continuity of care. A case example is given to illustrate case management in practice, and class exercises are given to reinforce learning.

• Sands, Roberta. 2001. Community care of persons with severe mental illness: Case management and community resources. In Clinical social work practice in behavioral mental health: A postmodern approach to practice with adults. 2d ed. By Roberta Sands, 255–286. Boston: Allyn and Bacon.

  This book gives a postmodern perspective on social work practice within mental health. In the chapter focusing on case management, the author presents a case scenario and then delineates case management practice, its underlying assumptions, and the variety of community-based services and resources that case managers utilize in their work.