Outcome of case management and comprehensive support services following policy changes in mental health care delivery.
An assessment of policy toward the care of seriously mentally ill (SMI) persons residing in a suburban Chicago community was undertaken. Results indicated the SMI population was classically "underserved." Few alternatives to a state inpatient hospital were being utilized. A policy change in SMI care was instituted by the local community mental health board which included implementation of the Unified Services Program (USP). The features of the USP were: centralized case management and outreach; and an expansion of service philosophy into a comprehensive, multidisciplinary service model of mental health delivery.


METHODS
This study examined SMI service utilization, quality of life, and satisfaction with care outcomes following 12 months of USP exposure. Fifty percent of USP caseloads were randomly sampled for study participation. USP study results were compared to a large SMI population with similar exposures in another state.


RESULTS
100% of USP SMI reported to be satisfied or very satisfied with their place of residence compared to the state hospital; and 100% were satisfied or very satisfied with the USP overall. Eighty two to 100% of the study participants rated their status as better than before enrolling in USP. SMI utilized USP services, and service combinations which they find useful (88 to 100%); and felt they could not access their services without USP case managers or outreach. Compared to New York State SMI, study SMI reported similar scores, but superior ratings on "services/facilities."


CONCLUSIONS
The study supports use of the USP for SMI living in the community, and also identified areas for programmatic improvement.
Rydman
R J
RJ
Division of Health Policy and Administration, School of Public Health, University of Illinois at Chicago 60637, USA.
Trybus
D
D
Butki
N
N
Kampe
L M
LM
Marley
J A
JA
D000328:Adult; D019090:Case Management / Q000191:economics; D002641:Chicago; D003156:Community Mental Health Services / Q000191:economics; D003191:Comprehensive Health Care; D003365:Costs and Cost Analysis; D003627:Data Interpretation, Statistical; D005260:Female; D006291:Health Policy; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000628:therapy*; D009518:New York; D017063:Outcome Assessment, Health Care; D017060:Patient Satisfaction; D011594:Psychometrics; D011788:Quality of Life; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires