Severe mental illnesses are defined by diagnosis, degree of disability and the presence of some abnormal behaviour. They include schizophrenia and psychosis, severe mood problems and personality disorder, and can cause considerable inconvenience over a long period of time both for the people are affected by them, and for their families and friends.
Until the 1970s it was common for those suffering from these disorders to stay in an institution for most of their lives, but now in most of the countries of the world, they are managed in the community with one of several different styles of intervention. Intensive Case Management (ICM) is one such intervention. It consists of management of the mental health problem and the rehabilitation and social support needs of the person concerned, over an indefinite period of time, by a team of people who have a fairly small group of clients (less than 20). It also offers 24 hour help and sees clients in a non-clinical setting.
This review compares ICM with non-Intensive Case Management (non-ICM; where people receive the same package of care but the professionals have caseloads of more than 20 people) and standard care (where people are seen as outpatients but their support needs are less clearly defined). Thirty-eight trials were found in the United States, Canada, Europe or Australia involving 7328 people in total.
When ICM was compared to standard care, those in the ICM group were significantly more likely to stay with the service, have improved general functioning, get a job, not be homeless and have shorter stays in hospital (especially when they had had very long stays in hospital previously). There was also a suggestion that it reduced the risk of death and suicide. If ICM was compared to non-ICM, the only clear difference was that those in the ICM group were more likely to be kept in care. There are no trials comparing non-ICM with standard care.
One of the drawbacks of this review is that the healthcare and social support systems of these countries are quite different, so it was quite difficult to make valid overall conclusions. In addition, much of the data on quality of life, and patient and carer satisfaction were not able to be used because the trials used many different scales of measuring these things, some of which were not validated. The development of such an overall scale and its validation would be very beneficial in producing services that people liked.
(Plain language summary prepared for this review by Janey Antoniou of RETHINK, UK www.rethink.org)