Mental Health Nursing

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Case management: perspectives of the UK and US systems 107 to support these services, providers need to be trained, supervised and supported as case managers, and planners must be given the evidence to support the use of case management. However, one crucial element of case management remains unaddressed: that of the role of nursing within whatever model is adopted. Case managers undertake essentially practical work. Much that is described within this chapter forms nothing more than the basis of that work with individual patient needs determining what should take place, when and by whom. It is a complicated and tiring role because the contact between patient and case manager is so intense. Yet despite this, very few studies have actually considered the day-to-day work of case managers and even fewer have explored their work within the clinical model as both providers of social support and therapist. This situation is further compounded because politicians and those who fund mental health services are unaware of the complexities of the challenges faced by case managers. Despite this it appears that both the UK and US governments are committed to case management, and with so much attention being paid to community care for the mentally ill, it is likely that the potential for a more robust approach to their care will continue to evolve over time. Hopefully this will include a better understanding of the training and support needed for case managers. References American Nurses’ Association (ANA) (1991) Nursing’s Agenda for Health Care Reform. Kansas City, MO: American Nurses’ Association. American Nurses’ Association (ANA) (1993) Position Statement on Psychiatric Mental Health Nursing and Managed Care. Kansas City, MO: American Nurses’ Association. Andrews, G.A. and Teesson, M. (1994) ‘Smart versus dumb treatment: services for mental disorders’, Current Opinion in Psychiatry, 7: 181–7. Armstrong, C. and Ward, M.F. (1996) An Audit of the Training, Skills and Caseloads of Community Mental Health Support Workers Involved in Case Management. Interim report No. 12. Oxford: National Institute for Nursing. Atkinson, M. (1996) ‘Psychiatric clinical nurse specialists as intensive case managers for the seriously mentally ill’, Seminars for Nurse Managers, 4: 130–6. Bachrach, L. (1981) ‘Continuity of care for chronic mental patients: a conceptual analysis’, American Journal of Psychiatry, 138: 1449–56. Bergen, A. (1994) ‘Case management in the community: identifying a role for nursing’, Journal of Clinical Nursing, 3: 251–7. Burns, T. and Priebe, S. (1999) ‘Mental health care failure in England: editorial’, British Journal of Psychiatry, 174: 191–2. Burns, B. and Santos, A. (1995) ‘Assertive community treatment: an update of randomized trials’, Psychiatric Services, 46: 669–75.
108 Acute Mental Health Nursing Burns, T., Fiander, M., Kent, A., Obioha, C., Ukoumunne, B. S., Fahy, T. and RajKumar, K. (2000) ‘Effects of case-load size on the process of care of patients with severe psychotic illness’, British Journal of Psychiatry, 177: 427–33. Burns, T., Fioritti, A., Hollaway, F., Malm, U. and Rossler, W. (2001) ‘Case management and assertive community treatment in Europe’, Psychiatric Services, 52: 631–6. Case Management Society of America (1995) Standards of Practice from Case Management. Little Rock, AR: Case Management Society of America. Chase, P., Gage, J., Stanley, K. and Bonadonna, R. (2000) ‘The psychiatric consultation/ liaison nurse role in case management’, Nursing Case Management, 3: 73–7. Clark, R. (1997) ‘Financing assertive community treatment’, Administration and Policy in Mental Health, 25: 209–20. Deci, P.A., Santos, A.B., Hiott, D.W., Schoenwald, S. and Dias, J.K. (1995) ‘Dissemination of assertive community treatment programs’, Psychiatric Services, 46 (7): 676–82. Department of Health (1990) The Care Programme Approach for People with a Mental Illness Referred to the Specialist Psychiatric Services. Joint Health/Social Services circular HC9023/LASS9011. London: The Stationery Office. Department of Health (1996) Guidance on Supervised Discharge after Care under Supervision and Related Provisions Supplement to the Code of Practice Published August 1993 Pursuant to Section 118 of the Mental Health Act 1983. London: The Stationery Office. Dixon, L., Hackman, A. and Lehman, A. (1997) ‘Consumers as staff in assertive community treatment programs’, Administration and Policy in Mental Health, 25: 199–208. Doyle, A. (2001) ‘Developing a successful nurse case management program’, Issues in Interdisciplinary Care, 3: 115–19. Firn, S. (1997) ‘Developing nursing skills in an intensive case management service’, Journal of Psychiatric and Mental Health Nursing, 4: 59–61. Glettler, E. and Leen, M. (1996) ‘The advanced practice nurse as case manager’, Journal of Case Management, 5: 121–6. Hall, J. (1998) ‘State of the art case management’, Occupational Medicine, 13: 705–10. Hoult, J. and Reynolds, I. (1983) Psychiatric Hospital versus Community Treatment: A Controlled Study. Canberra: Department of Health. Kings Fund (1999) Working for London: A Joint Funded Project to Establish the Effectiveness of Multi-agency Case Management in London. London: Kings Fund. Kirk, S.A., Koeske, G.F. and Keoske, R.D. (1993) ‘Changes in health and job attitudes of case managers providing intensive services’, Hospital and Community Psychiatry, 44: 168–73. Leff, J. and Trieman, N. (2000) ‘Long-stay patients discharged from psychiatric hospitals’, British Journal of Psychiatry, 176: 217–23. Lehman, A. (1998) ‘Translating research into practice: the schizophrenia Patient Outcomes Research Team (PORT) treatment recommendations’, Schizophrenia Bulletin, 24: 1–12. Lehman, A.F., Dixon, L., Hoch, J.S., Deforge, B., Kernan, E. and Frank, R. (1999) ‘Costeffectiveness of assertive community treatment for homeless persons with severe mental illness’, British Journal of Psychiatry, 174: 346–52. Marshall, M., Gray, A., Lockwood, A. and Green, R. (1997) ‘Case management or severe mental disorders’, in C.E. de Jesus Adams and P. Mari-J White (eds), Schizophrenia Module of the Cochrane Database of Systematic Reviews, Issue 2. Oxford: The Cochrane Collaboration.
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EDITED BY Marc Harrison David Howar
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Acute Mental Health Nursing From Ac
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Contents List of contributors vii F
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List of Contributors Ian Baguley qu
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List of Contributors ix background
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Foreword When I first started my ca
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An introduction to acute mental hea
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• Care management • Management
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organisations providing it. Followi
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works, and to be understanding of t
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Introduction ONE Acute psychiatric
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Assessment framework Acute psychiat
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Evidence suggests that the quality
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‘Can you tell me something about
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negative thoughts, anxiety may sugg
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attempting to observe behaviours th
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These scales are often used as ‘s
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thoughts as and when they occur. Th
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Acute psychiatric in-patient assess
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Acute psychiatric in-patient assess
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Introduction TWO Measuring health a
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Measuring health and social functio
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have timely, accurate and appropria
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easy to see why many staff have bec
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Acknowledgements Parts of this chap
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Introduction THREE Social inclusion
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Social inclusion and acute care 53
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Health Consortium (GPMH, 1989) desc
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Page 76 and 77: professionals, belief in the value
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Page 80 and 81: networks that we can hope to help t
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Page 128 and 129: services. Pre-formulation helps sec
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Page 146 and 147: Stage 13 Stage 14 Integrated care p
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Page 156 and 157: SEVEN Risk assessment and managemen
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Risk assessment and management in a
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Observation 163 of people who had c
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towards others. For nurses, having
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no evaluative work conducted to ass
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Observation 169 All local trusts an
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Table 8.1 Four levels of observatio
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most intensive level of observation
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Observation 175 (DoH, 1999a, 2001);
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strongly influenced by cultural iss
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who conducted the special observati
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Fletcher (1999) employed an ethnogr
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Observation 183 Bowers, L. and Park
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Introduction NINE Cognitive behavio
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Cognitive behaviour therapy in in-p
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provided a great deal of hope for a
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Assessment of Need (Phelan et al.,
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3. Changing cognitive processes. 4.
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hallucinations, which are so common
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nurse practitioner. Until very rece
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Psychosocial interventions 199 clie
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Psychosocial interventions 201 a fi
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levels of staff sickness. If workin
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Psychosocial interventions 205 for
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Problem list and assessment Psychos
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should be introduced until the pati
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Psychosocial interventions 211 rece
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Psychosocial interventions 213 Barr
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Psychosocial interventions 215 Barr
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Psychosocial interventions 217 Rix,
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emphasises the need for mental heal
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encountered with their use. Anti-ps
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can be almost exclusively attribute
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to establish a link between EPS and
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Interventions to enhance compliance
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The use of cognitive behavioural in
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• giving patients information abo
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Medication management 233 Bennett,
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Medication management 235 Meltzer,
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238 Index institutionalisation, 63-
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