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Outcome of Case Management and Comprehensive Support Services Following Policy Changes in Mental Health Care Delivery

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Abstract

An assessment of policy toward the care of seriously mentally ill (SMI) persons residing in a suburban Chicago community was undertaken. Results indicated the SMI population was classically “underserved.” Few alternatives to a state inpatient hospital were being utilized. A policy change in SMI care was instituted by the local community mental health board which included implementation of the Unified Services Program (USP). The features of the USP were: centralized case management and outreach; and an expansion of service philosophy into a comprehensive, multidisciplinary service model of mental health delivery. Methods: This study examined SMI service utilization, quality of life, and satisfaction with care outcomes following 12 months of USP exposure. Fifty percent of USP caseloads were randomly sampled for study participation. USP study results were compared to a large SMI population with similar exposures in another state. Results: 100% of USP SMI reported to be satisfied or very satisfied with their place of residence compared to the state hospital; and 100% were satisfied or very satisfied with the USP overall. Eighty two to 100% of the study participants rated their status as better than before enrolling in USP. SMI utilized USP services, and service combinations which they find useful (88 to 100%); and felt they could not access their services without USP case managers or outreach. Compared to New York State SMI, study SMI reported similar scores, but superior ratings on “services/facilities.” Conclusion: The study supports use of the USP for SMI living in the community, and also identified areas for programmatic improvement.

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REFERENCES

  1. Rydman, R.J., More hospital or more community? A historical cohort analysis of SMI costs and outcome. Admin. Pol. Mental Health, 17(4):215–234, Summer 1990.

    Google Scholar 

  2. Gorey, K.M., Leslie, D.R., Morris, T., Carruthers, W.V., Lindsay, J., and Chacko, J. People, Effectiveness of case management with severely and persistently mentally ill. Commun. Mental Health J. 34(3):241–250, 1998.

    Google Scholar 

  3. Rydman, R.J., Using service, cost, and client-outcome information systems for decision making. In Community Mental Health: A Sourcebook for Professionals and Advisory Board Members, (W.H. Silverman, ed.), Praeger, New York: pp. 148–171, 1981.

    Google Scholar 

  4. Ware, J.E., and Snyder, M.K., Dimensions of patient attitudes regarding doctors and medical care services. Med. Care, 13:669–682, 1975.

    Google Scholar 

  5. Ware, J.E., Snyder, M.K., and Wright, W.R., Some issues in the measurement of patient satisfaction with health care services. P-6021. The Rand Corporation, Santa Monica, CA; 1977.

    Google Scholar 

  6. Intagliata, J., Improving the quality of community care for the chronically mentally disabled: The role of case management. Schizophrenia Bull. 8(4):655–674, 1982.

    Google Scholar 

  7. Social Levels of Functioning Scale. In (F.L. Newman, and J.E. Sorenson, eds.), Integrated Clinical and Fiscal Management in Mental Health, Ablex Publishing Corp., Norwood, NJ, 1985, pp. 28–32.

  8. Derogatis, L.R., Symptom Checklist Ninety. NCS Assessment, Minneapolis, MN, 1992.

  9. Endicott, J., Spitzer, R.L., Fleiss, R.L., and Cohen, J., Global Assessment Scale. Arch. Gen. Psychiatry. 33:766–771, 1976.

    Google Scholar 

  10. Baker, F., and Intagliata, J., Quality of life in the evaluation of community support systems. Eval. Progr. Plan. 5:69–79, 1982.

    Google Scholar 

  11. Caron, J., Tempier, R., Mercier, C., and Leoffre, P., Components of social support and quality of life in severely mentally ill, low income individuals and a general population group. Commun. Ment. Health J. 34(5):459–475, 1998.

    Google Scholar 

  12. Heinrichs, D.W., Hanlon, T.E., and Carptenter, W.T., The quality of life scale: An instrument for rating the schizophrenic deficit syndrome. Schizophrenia Bull. 10:388–398, 1994.

    Google Scholar 

  13. Huxley, P., and Warner, R., Case management, quality of life, and satisfaction with services of long-term psychiatric patients. Hosp. Commun. Psychiatry. 43:799–802, 1992.

    Google Scholar 

  14. Lehman, A.F., A quality of life interview for the chronically mentally ill. Eval. Progr. Plan. 11:51–62, 1988.

    Google Scholar 

  15. Lehman, A.F., and Burns, B.J., Severe mental illness in the community. In Quality of Life Assessments in Clinical Trials (B. Spilker, ed.), Raven Press, New York, 1990.

    Google Scholar 

  16. Malm, U., May, P.R.A., and Dencker, S.J., Evaluation of the quality of life of the schizophrenic outpatient: A checklist. Schizophrenia Bull. 7:477–487, 1981.

    Google Scholar 

  17. Sullivan, G., Wells, K., and Leake, B., Clinical factors associated with better quality of life in a seriously mentally ill population. Hosp. Commun. Psychiatry 43:794–798, 1992.

    Google Scholar 

  18. Bradburn, N.M., The Structure of Psychological Well-Being, Aldine, Chicago, 1969.

    Google Scholar 

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Rydman, R.J., Trybus, D., Butki, N. et al. Outcome of Case Management and Comprehensive Support Services Following Policy Changes in Mental Health Care Delivery. Journal of Medical Systems 23, 309–323 (1999). https://doi.org/10.1023/A:1020578311537

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  • DOI: https://doi.org/10.1023/A:1020578311537

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