Internal vs. external care management in severe mental illness: Randomized controlled trial and qualitative study

Abstract

Background: Case management is the encompassing model for managing people with severe mental illness, but models of case management vary. Aims: To compare the effectiveness of an integrated (internal) model of care management (in which the social worker is a member of the multidisciplinary healthcare team) against a brokerage model in which the care manager operates "externally" to the healthcare team. Method: Patients with severe mental illness meeting a high threshold of need referred to a community team were randomized to a care manager newly appointed to the team, or to a care manager outside the team. Days spent in hospital were the primary outcome measure, and costs for patients in each arm were compared. Semi-structured qualitative interviews were employed to explore a sample of cases in each category; compare joint working practice in both models; and compare practice in London to that within a well-established integrated CMHT in Nottingham. Results: The randomized trial of "internal" vs. "external" care management showed no significant differences in outcome or costs among 26 patients. However, the qualitative study revealed worker dissatisfaction with the brokerage model, and identified inefficiencies and duplication of effort. Conclusions: The brokerage model of case management should not be maintained. Declaration of Interest: This study was supported by a grant from the Trent NHS Research & Development Regional Office.

• Case Management
• Community Mental Health Team
• Social Care