Case Management

The provision of case management in mental health care has long been regarded as the preferred mode of service delivery. However, in recent years it has also expanded into other arenas, thereby demonstrating its clinical value and transferability. At its foundation, case management refers to the coordination of community services by a single professional who is responsible for assessing a client's needs, developing and implementing appropriate care plans based on this assessment, and then evaluating the care plan through ongoing follow-up. In some cases, case managers will also be responsible for transitioning clients to other services when they move or no longer meet program or diagnostic criteria. This approach originated in the United States and evolved following the deinstitutionalization of psychiatric patients in the 1950s and 1960s. In [Page 171]this mental health care context, case management is usually implemented for individuals with serious and persistent mental illnesses who require ongoing support with illness management, employment, socialization, and maintaining community tenure.

In the United States, the term case managementy is also applied in the priMary care realm as a component of managed care, and it has also been adapted for use in the care of the elderl, in acute health care settings, correctional services, child welfare, social housing, and employment support programs. In all cases, the goal is to develop a comprehensive psychosocial assessment in collaboration with service recipients, who will then access community resources on an ongoing basis to meet their needs. The case manager, also known as a service coordinator, will complete referrals to these programs.

Because community resources can almost universally operate at a lower cost than institutionalized care, case management is a cost-effective paradigm since a single professional, ideally knowledgeable about community resources, serves as the priMary contact for the client. This reduces the prospect of duplicating service, which would occur if each program served as its own entry point for the client. This unique structure is particularly valuable for clients with complex needs as their service coordinators can develop an intricate knowledge of their strengths, deficits, and required needs for successful community-based illness management. Additionally, this coordinated care has become more important in recent years as clients' needs have become more complex. Among other factors, this increasing complexity occurs because of an aging population, poverty and legislative restrictions, insufficient community resources, often overlapping mental health and health care needs and, ironically, the involvement of multiple agencies itself.

Case management is both a professional and organizational endeavor. While any number of regulated professionals can serve as case managers, including, for example, nurses, social workers, and occupational therapists, effective service delivery also requires a commitment by their employing organizations to provide resources that promote case management activity. This includes investing in programs and staff and monitoring quality through ongoing program evaluation. In British Columbia, Canada, an integrated case management framework has even been adopted by government ministries to promote seamless, integrated service delivery and information-sharing since clients typically receive multiple government benefits at once. According to the National Case Management Network of Canada, there are five guiding principles of case management: (1) it supports client rights, (2) it is purposeful, (3) it is collaborative, (4) it supports accountability, and (5) it strives for cultural competency.

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