Evaluating a case management model for people with severe mental illness in Hong Kong: A preliminary study

Introduction Deinstitutionalisation and the establishment of community-based based psychiatric services have been the major directions of service development for people with mental illness in Hong Kong over the past few decades. A variety of services, including residential, vocational, community networking, and supportive services, are now available. Nevertheless, these services are rather fragmented and lack coordination. (1) Different professionals from dif different agencies provide services for the same individual. It is not uncommon to find an overlapping of services and a lack of a key worker who plans and oversees the treatment of an individual. (2) Consequently, people with mental illness may not receive adequate or timely services. Although case management has been accepted and used as a major component of mental health services in many countries, it has not been practised in Hong Kong to address the issues of system rigidity, fragmentation, inaccessibility, and lack of accountability of mental health services found in Hong Kong. (2) In 2003, a local non-governmental or organisation that provides services for people with mental illness began to experiment with a case management model to address the above-mentioned pitfalls but case management has not been recognised or financially supported by the government of Hong Kong. This article reports on a comparison between the outcome variables of hospitalisation rate, symptomatology, life skills, and quality of life between people who received case management services in 2 halfway houses and those who received standard halfway house services. Case management is defined as a series of activities that aim to link the service system to a consumer and coordinate system components to achieve a successful outcome. (3) It essentially serves a problem-solving function and is designed to ensure continuity of services and overcome system rigidity, fragmentation, inaccessibility, and the lack of accountability of mental health services. It is commonly described as a flexible, planned, and individualised approach to service delivery that provides consumer choice and maximises the efficient use of formal and informal resources in service provision. (4-7) Numerous overseas studies have examined different models of case management for people with severe and persistent mental illness. (8,9) In a meta-analysis of 75 studies on the efficacy of case management, Mueser et al (10) found a consistent reduction in length of hospital stay for those in the case management groups. Holloway et al (11) reviewed a number of studies and found that people who received case management services had a statistically significant decrease in symptomatology when compared with those who did not. Two studies have found that people who received case management services showed an improvement in overall functioning and social adjustment, and an increase in global functioning as measured by the Global Assessment Schedule (GAS). (12,13) Stein and Test (14) found that case management improved the quality of life of clients. Wright right et al (15) also reported increased satisfaction in life for patients. Other studies reported that case management had positive effects on patients' social networks and relationships. (14,16,17) According to Aviram, (18) social workers in a case management team occupy a special role involving coordinating different disciplines, mobilising resources at the systems' levels, or organising consumers and the families into self-help and / or advocacy groups, and serving as authorisation and utilisation reviewers for case management companies under the managed care system. Moreover, as case managers, social workers also render supportive and psychotherapeutic counselling to people with severe mental illness in the community. (2) In short, social workers are always considered members of a case management team, and work closely and collaboratively with other professionals to provide services for people with severe mental illness. …