The effect of intensive case management on the relatives of patients with severe mental illness.
OBJECTIVE
Relatives play a vital role in caring for patients with severe mental illness but receive inadequate support from psychiatric services. Evidence suggests that although intensive case management is directed primarily at patients, relatives may benefit as well. This study examined whether relatives of patients who were receiving intensive case management had more contact with mental health professionals than relatives of patients who were receiving standard case management. It also examined whether relatives of patients receiving intensive case management appraised caregiving less negatively and experienced less psychological distress than relatives of patients receiving standard case management.


METHODS
The sample was drawn from the pool of patients participating in the UK700 randomized controlled trial of intensive case management. Prospective data on contact between case managers and the relatives of 146 patients were collected over a two-year period. At a two-year follow-up assessment, relatives of 116 patients were interviewed with the Experience of Caregiving Inventory and the 12-item General Health Questionnaire.


RESULTS
Considerably more relatives of patients receiving intensive case management had contact with a case manager during the study period than relatives of patients receiving standard case management (70 percent compared with 45 percent). However, relatives of patients receiving intensive case management did not appraise caregiving less negatively or experience less psychological distress than relatives of patients who were receiving standard case management.


CONCLUSIONS
Reducing case managers' caseloads alone will not guarantee adequate support for relatives. Instead, providing more support will need to be an explicit aim, and staff will require specific additional training to achieve it.
Harvey
Kate
K
Guy's, King's and St. Thomas' School of Medicine, London, UK. k.n.harvey@reading.ac.uk
Burns
Tom
T
Fiander
Matthew
M
Huxley
Peter
P
Manley
Catherine
C
Fahy
Tom
T
D000293:Adolescent; D000328:Adult; D000368:Aged; D019090:Case Management; D017281:Cost of Illness; D005190:Family / Q000523:psychology; D005192:Family Health; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000628:therapy*; D008875:Middle Aged; D012720:Severity of Illness Index