Mental Health Nursing

Case management: perspectives of the UK and US systems 95
and this cannot be done if they are expected to always meet with the
case manager on his/her home soil; i.e., a clinic or health facility.
6. The case manager will leave his/her contact details with the patient
and is effectively on call for them 24 hours a day, 7 days a week.
7. As time progresses the amount of contact between case manager and
patient will decrease, by mutual agreement. However, case managers
seldom discharge patients from their caseload, even if they have to be
re-admitted to in-patient care. The main reasons for absolute case management
discharge are that the two have irreconcilable differences and
a new case manager has to be appointed, that the patient becomes selfsupporting
and can be transferred to lower levels of supervision from
other community workers, or the patient dies. Of course, financial
pressures and resource disposition can mean that not enough case
managers are available, and under these extreme circumstances patients
may have to be transferred to other agencies even though in theory
they ought to remain with the case manager.
8. If a patient has to be re-admitted to an in-patient facility, often the
case manager will accompany them, visit them whilst admitted and
work with the patient to plan for their discharge.
9. The case manager reports back to the multidisciplinary team about
patient progress and to receive case supervision. Case management is
very time- and resource-consuming. For the case manager, often working
so autonomously, it can also cause great stress and ‘burn-out’.
Supervision, the need to feel part of a working team and sensitive
line-management are essential ingredients for the successful ongoing
support of active case managers (Ward et al., 1999).
Inevitably the nurse’s professional background will influence the way they
establish the relationship with the patient. And, whilst their interactions
with them will hopefully be of therapeutic value, the nurse, as a case manager,
is not there to provide therapy as such. For example, a patient may
require a complex package of care that includes medication, counselling,
some form of occupational therapy and social training. The case manager
will monitor the effects of medication, encourage the patient to maintain
contact with those nurses who give that medication and, if necessary,
report back to those nurses adverse effects and non-concordance with the
treatment regime. He/she will not give the medication themselves.
Similarly, they will ensure that the patient gets to the counselling
session, to the occupational therapy session or to see any other specialist
therapist identified within the care package and, again, monitor the effects
of this work. Discussing these things with the patient, reinforcing the work
of the therapists and gauging the patient’s response to them represent the
case manager’s role within the therapy process.