Mental Health Nursing

102 Acute Mental Health Nursing
The results of numerous studies have thus led researchers to believe
that, for most patients with schizophrenia, case management is a necessary
component of care (Lehman, 1998). The most frequently studied
forms of case management, assertive community treatment and intensive
case management have been associated with decreased psychiatric hospitalisation
and housing instability, as well as moderate improvement
in symptomatology and quality of life for persons with schizophrenia
(Mueser et al., 1998). Furthermore, in a meta-analysis of the effectiveness
of case management in the US over 20 years it was found that clinical case
management and assertive community treatment were associated with
reduced family burden, increased family satisfaction and decreased cost
of care. In addition, both were equally effective in reducing symptoms,
increasing clients’ contacts with services, reducing drop-out rates, improving
social functioning and increasing clients’ satisfaction (Ziguras and
Stuart, 2000).
Concerns in the US
Nonetheless, many believe that attention to how ACT has been disseminated
and replicated in the US, and systematic studies of its adaptation
within existing systems of care, are not adequate and more work needs to
be done in this area. Furthermore, a concern of programme planners is that
features of the ACT model may be either unnecessary or overly expensive
ways of achieving adequate client outcomes. It has been noted that faithful
adherence to these and other programme goals is not always easy in traditional
systems. The specialised nature of ACT programmes makes them
particularly susceptible to misunderstanding by administrators and clinicians
trained in traditional treatment models and to policies that impede
effective implementation. Even when administrators and clinicians are
well-trained and eager to follow guidelines, problems with financing and
organisational structures designed for traditional office-based treatment
can lead them to deviate from ACT principles, possibly limiting its effectiveness
(Clark, 1997). Thus, although well accepted in the US, clinical
and service-based questions about case management programmes continue
to raise debate in the field.
Case management in the United Kingdom
The US system of case management was piloted in the UK in the early
1990s but there have been the usual problems associated with transferring