Mental Health Nursing

104 Acute Mental Health Nursing
them to attain the highest quality of life and to give them the support
necessary to remain independent of in-patient mental health services.
Although this could be said to be the intended outcome of all community
mental health programmes, it should be remembered that clients
receiving case management support will usually be those most damaged
by their illness, generally requiring high levels of assertive contact with
their case manager, possibly several times a day in some cases. They
are also those most at risk of suicide, usually unemployable, and often
without personal family networks to watch out for them. For many,
case management is their only hope of sustaining any form of independent
living.
Perhaps the greatest success of case management within the UK is that
it has become a recognised part of the psychiatric vocabulary with practitioners
perceiving it as something that actually meets patient needs, and
researchers and senior members of the professions formulating viable
research agendas to understand how it functions best.
One significant piece of work is that of the large project funded by the
Kings Fund, the Sainsbury Centre for Mental Health and the Department
of Health ‘Working for London’ (Kings Fund, 1999); this was primarily
a combination of case management and ACT, which brought together
distinct groups of workers, from health, social care, voluntary agencies
and in one case probation services, into four separate projects. Using
assertive outreach and replicating development work undertaken in the
US, its purpose was to establish the effectiveness of multi-agency case
management for the seriously mentally ill, with particular importance
placed upon the support of those from ethnic minority groups. This sophisticated
project was well funded, its participants properly prepared, and
most importantly heavily involved users or ex-users of services. Although
still not complete, it has already shown that case management cannot
simply be added on to existing services. Rather it requires considerable
planning, multi-agency collaboration and a discrete budget to give it a
chance of success.
Finally, the UK system does have some strengths over its US counterparts
which should, in theory, give case management an advantage.
Services are largely in the public domain and therefore not dependent
upon economic interests or insurance companies. Coordination and continuity
of care through the Care Programme Approach (CPA) (Department
of Health, 1990) and Supervised Discharge (Department of Health, 1996),
particularly for the seriously mentally ill, is well organised. Additionally,
comprehensive sectorisation of care, where the same team is responsible
for both an individual’s in-patient and community care, allows for a high
degree of flexibility and response to changing client needs.