Mental Health Nursing

106 Acute Mental Health Nursing
wider acceptance of consumers, survivors of services or ex-users, being
employed within the US system as case managers in their own right
(Dixon et al., 1997). This is certainly not the case in the UK where
ex-users of services are both less inclined to be involved in supporting
State care services, and services themselves are reluctant to involve ex-users
in any real way as part of the therapeutic process. In fact, as Burns and
Priebe (1999) point out, there is excessive preoccupation with risk in UK
mental health care and this extends itself to any genuine involvement of
its patients or ex-patients.
Not every mental health care professional is convinced of the necessity
to switch total care contact to community settings. Nor are they convinced
that different therapeutic processes have to be introduced for different
sub-groups of clients. Moreover, high proportions of staff are not adequately
versed or familiar with intensive therapy techniques but provide standardised
support within blanket services. Given these realities, there exists a
philosophical resistance to the introduction of yet more complex and
seemingly elitist care models.
So, too, a major challenge exists in the need to conduct research, which
informs both case management models and the therapeutic processes used
within these models. Evaluation studies are needed in which many outcome
measures are employed that are culturally sensitive and locally relevant.
The social consequences of community-based care, such as
violence, disruptive behaviour and stigma, should increasingly be measured
when mental health services are compared. Another major research
agenda for case management is the need to disaggregate and evaluate individual
components of complex interventions. One can therefore anticipate
a new generation of research into case management that uses it as a vehicle
to ask questions that are more precise and more difficult to answer, but
that are likely to have more far-reaching importance for community mental
health initiatives.
Tyrer (2000) acknowledges that there are cultural differences between
countries that will interfere with the way services are designed, set up and
managed. And Burns and colleagues (2000) have shown that studies in the
UK have increasingly failed to replicate the significant advantages of case
management over standard community care achieved in the early American
(Stein and Test, 1980) and Australian (Hoult and Reynolds, 1983) work.
But, Tyrer also states that, to establish clear evidence to support the investment
in case management, researchers have to make every effort to investigate
services that are configured in the same way as the successful ones
in North America.
To further disseminate the benefits of case management programmes,
distinct client groups need to be identified, funds need to be made available