TY - JOUR
T1 - A randomized-controlled trial of intensive case management emphasizing the recovery model among patients with severe and enduring mental illness
AU - O'Brien, S.
AU - McFarland, J.
AU - Kealy, B.
AU - Pullela, A.
AU - Saunders, J.
AU - Cullen, W.
AU - Meagher, D.
PY - 2012/9
Y1 - 2012/9
N2 - Background: There is increasing interest in the application of recovery principles in mental health services. Aims: We studied the implementation of a programme of intensive case management (ICM) emphasizing recovery principles in a community mental health service in Ireland. Methods: Eighty service attenders with severe and enduring illness characterized by significant ongoing disability were randomized into (1) a group receiving a programme of ICM and (2) a group receiving treatment as usual (TAU). Groups were compared before and after the programme for general psychopathology using the Brief Psychiatric Rating Scale (BPRS) (clinician rated) and How are You? scale (self-rated). The Functional Analysis of Care Environments (FACE) scale provided assessment of multiple functional domains. Results: The overall group (mean age 44.5 ± 13.2 years; 60% male) had mean total Health of the Nation Outcome Scale (HoNOS) scale scores of 10.5 ± 4.6, with problems in social functioning especially prominent (mean social subscale score 5.0 ± 2.7). The ICM group were younger (p <0.01) with higher baseline scores on the HoNOS social subscale and BPRS (p<0.05). An analysis of covariance, controlling for these baseline differences, indicated greater improvement in BPRS scores (p = 0.001), How are You? scores (p = 0.02) and FACE domains for cognition, symptoms and interpersonal relationships (all p < 0.001) in the ICM group. The ICM group underwent greater changes in structured daily activities that were linked to improved BPRS scores (p = 0.01). Conclusions: A programme of ICM emphasizing recovery principles resulted in significant improvement across psychopathological and functional domains. Improvements were linked to enhanced engagement with structured daily activities. Recovery-oriented practices can be integrated into existing mental health services and provided alongside traditional models of care.
AB - Background: There is increasing interest in the application of recovery principles in mental health services. Aims: We studied the implementation of a programme of intensive case management (ICM) emphasizing recovery principles in a community mental health service in Ireland. Methods: Eighty service attenders with severe and enduring illness characterized by significant ongoing disability were randomized into (1) a group receiving a programme of ICM and (2) a group receiving treatment as usual (TAU). Groups were compared before and after the programme for general psychopathology using the Brief Psychiatric Rating Scale (BPRS) (clinician rated) and How are You? scale (self-rated). The Functional Analysis of Care Environments (FACE) scale provided assessment of multiple functional domains. Results: The overall group (mean age 44.5 ± 13.2 years; 60% male) had mean total Health of the Nation Outcome Scale (HoNOS) scale scores of 10.5 ± 4.6, with problems in social functioning especially prominent (mean social subscale score 5.0 ± 2.7). The ICM group were younger (p <0.01) with higher baseline scores on the HoNOS social subscale and BPRS (p<0.05). An analysis of covariance, controlling for these baseline differences, indicated greater improvement in BPRS scores (p = 0.001), How are You? scores (p = 0.02) and FACE domains for cognition, symptoms and interpersonal relationships (all p < 0.001) in the ICM group. The ICM group underwent greater changes in structured daily activities that were linked to improved BPRS scores (p = 0.01). Conclusions: A programme of ICM emphasizing recovery principles resulted in significant improvement across psychopathological and functional domains. Improvements were linked to enhanced engagement with structured daily activities. Recovery-oriented practices can be integrated into existing mental health services and provided alongside traditional models of care.
KW - Case management
KW - Community psychiatry
KW - Recovery
KW - Treatment
UR - http://www.scopus.com/inward/record.url?scp=84866737917&partnerID=8YFLogxK
U2 - 10.1007/s11845-011-0795-0
DO - 10.1007/s11845-011-0795-0
M3 - Article
C2 - 22218933
AN - SCOPUS:84866737917
SN - 0021-1265
VL - 181
SP - 301
EP - 308
JO - Irish Journal of Medical Science
JF - Irish Journal of Medical Science
IS - 3
ER -