Managed mental health care: problems and possibilities

Abstract

Case management has become an established organizational approach to mental health care. However, a recent development of case management, known as 'managed care' has received only limited attention in the UK and this has been confined to acute medical or surgical hospital care. The potential of managed care as applied to mental health care is uncertain. This paper clarifies the nature of managed care and discusses its relevance to mental health care, in particular to the care of people suffering from schizophrenia. The high incidence and heavy resource demands of this user group makes these people an ideal focus for managed care. However, there are conceptual and practical problems hindering its development and implementation, including: the variability and unpredictability of the disease process of schizophrenia; challenges of outcome measurement; and problems relating to the current organization of mental health care.

Implementation of hospital care pathways for patients with schizophrenia

“…The changes to the study ward were unpredictable and proved devastating to the overall goal of implementing the care pathway. However, the complex nature of schizophrenia may also complicate the procedure of implementation given the diversity of views regarding its care and treatment ( Jones & Norman 1998). However, the implementation of a care pathway may work towards a more integrated service which values collaborative working and a more responsive and inclusive relationship with the user.…”

“…The positive effect of recording and analysing variances is to be able to instigate remedial action to ensure the patient meets oncoming outcomes and secondly, to improve on future care pathways ( Schriefer 1995). This latter function is usually performed in quality audit meetings ( Jones & Norman 1998). There have been many reported advantages of the care pathway system, such as reduced length of stay (LOS) and costs of care, although most studies focus on medical/surgical conditions ( Zehr et al .…”

“…As reported in a previous paper, Jones & Kamath (1998) attempted to develop a care pathway for inpatients with schizophrenia. Respondents were able to identify reasons for changing the current provision of care such as the knowledge deficits of interprofessional roles and the poorly co‐ordinated LOS.…”

Language, therapeutic relationships and individualized care: addressing these issues in mental health care pathways

“…These are the types of problems that are faced by users of mental health services. It has been suggested that as so little is known about the course and outcomes of serious mental illness, and as treatment tends to be so individual, it would be difficult to develop pathways in the area (Jones & Norman 1998). Empirical research and evaluation concerning care pathways in mental health is limited (Jones 2003).…”

The case management practices of community mental health nurses: ‘Doing the best we can’

“…The variety of differing meanings ascribed to the term 'case management' has resulted in confusion regarding its practice and definition (Jones, 1998). Community case management has its origins within the post-Second World War healthcare reforms of the USA (Jones, 1998). It is recognized as being a systematic approach to service delivery, ensuring adequate support for those discharged from institutional care (Stein & Test, 1980).…”