Case management has its historical roots in social work practice and in the mental health reforms of the 1970s when the federal government, through the Substance Abuse and Mental Health Services Administration, put forth policy guidelines that included community support services for persons with severe mental illness. The case manager helps the person with complex needs access services from multiple agencies.
North Carolina is in the process of redefining case management services in large part due to increased federal limitations on what case management can include. For example, in order for a mental health service provider or agency to bill Medicaid for case management, it cannot include direct services. Rather, case management is seen as a service coordination activity. As a result, the case manager is only allowed to assess the need for services; develop a service plan; refer for services in the plan; and monitor the delivery of services.
Case management is also being examined because of controversies surrounding a service called community support. Community support was an attempt by the state to better serve people with mental illness, but unfortunately there were not enough built-in protections to ensure costs were contained or verified.
People with psychotic disorders and other severe mental illnesses often need help navigating the world. Some have difficulty functioning independently in the community due to the symptoms of their illness and accompanying disability, making recovery even more difficult. Despite good treatment, these folks need someone to intervene on their behalf. The case manager takes on this role of advocating and providing support for his clients.
Clearly, case managers should assure that basic needs are met—including housing and adequate nutrition. This specialized service provider can also play a significant role in making sure their client is engaged in psychiatric treatment. To accomplish this, we believe that the case manager must have clinical skills, and must be able to develop a nurturing relationship with clients.
At the Center for Excellence, we believe that case management is meaningful for people with severe mental illness only if it is carefully coordinated with psychiatric care. To ensure the highest quality outcome, only licensed professionals deliver our case management services.
Our clinical case managers are experienced working with people who have severe mental illness. They provide the patients with practically oriented psychotherapy, with a focus on engagement in treatment, illness management, and support. Based on individual need, the clinical case manager also links people to other services in the community. To comply with federal guidelines, psychotherapy and case management services are distinct and billed separately.
Many of the clients in our clinical programs are capable of managing their recovery and their own lives quite well and do not need case management. But others need flexible, long-term support so that they can live well in communities of their own choosing. Our intention is to provide the right level of service, based on the needs identified in clinical assessments and our clients' preferences.
The media, whether through movies or sensationalized reportage of individual acts, would have us believe that people with schizophrenia are likely to commit extremely violent acts. On the contrary, research shows that individuals with schizophrenia who are in treatment are no more dangerous than the general population.
Individuals who are not in treatment do have increased risk for violence. It is not unusual for the first-episode patient to have done bizarre or aggressive acts. In fact, about a third of patients commit a violent act prior to first treatment contact that proves to be embarrassing to the patient, or affects their relationships, especially if the target of the aggression was a family member, employer, teacher, or friend. (Source: OASIS Early Psychosis Toolkit)
Individuals with schizophrenia who are the most dangerous are those who are not receiving treatment and are also abusing substances. Research also shows that most individuals with a serious mental illness who commit violence, hurt people they know and see on a regular basis, usually family caretakers. Studies have shown that between 50 and 60 percent of the victims are family members.
Founded in January 2009, the Center for Excellence in Community Mental Health is part of the Department of Psychiatry in the School of Medicine at the University of North Carolina at Chapel Hill. Addressing quality of care and workforce development issues in North Carolina's mental health system, the Center and its clinical programs are supported by a three-year grant from The Duke Endowment, as well as Cross Area Services Program (CASP)
funds. The program operates in conjunction with multiple university, state, and community-based partners.
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