Intensive case management of psychotic patients in the community does not reduce the number of physical assaults compared to standard management
- Ford, Richard PhD
BACKGROUND
Rare acts of serious violence are committed by people with severe mental illness. It is unknown whether intensive case management reduces the incidence of these acts compared to standard care.
OBJECTIVE
To investigate the effect of intensive case management in the community on violence in people with psychosis.
SETTING
Three London and one Manchester inner city community mental health clinics; February 1994 to April 1996.
METHOD
Randomised controlled trial.
PARTICIPANTS
Seven hundred and eight of 8892 eligible people aged between 18 and 65 with a psychotic disorder.
INTERVENTION
Case managers in the intensive care arm were responsible for 10 to 15 patients. Standard care case managers had at least 30 patients over a period of 2 years. Contact with the patient (face to face or by phone), failed face to face contact, contact with a carer, and contact with another agency were monitored.
OUTCOMES
Physical assault episodes (assessed by questioning the patient or a carer, the case manager and case notes).
MAIN RESULTS
People in the intensive case management arm had 4.41 contact events every 30 days compared to 1.94 contacts in the standard management group. Physical assault was not significantly reduced (22.7% in the intensive group compared to 21.9% in the standard group, p = 0.86).
AUTHORS' CONCLUSIONS
Intensive case management of psychotic patients in the community does not reduce the number of recorded assaults compared to standard management. Identified risks for violence included past violence, drug use, relative youth and victimisation.
NOTES
Only 10% of patients had a violent act that was reported by all three information sources. Some case notes were missing in both groups.