Evaluating a Case Management Model for People with Severe Mental Illness in Hong Kong: A Preliminary Study
Wong, D. F. K., Yeung, M. P. M., Ching, C. K., Hong Kong Journal of Psychiatry
Objective: To examine the efficacy of a case management model for people with severe mental illness in halfway houses in Hong Kong.
Participants and Methods: This study adopted a time-series quasi-experimental design. At time 1, newly formally admitted residents, in their first 3 months at 2 of the halfway houses in which the new case management model had been implemented, were assigned to the experimental group, while newly formally admitted residents of 3 other halfway houses were assigned to the comparison group. Time 2, Time 3 and Time 4 measurements were taken at 6-month intervals after the first interview. We hypothesised that participants who received case management services would have better outcomes in symptomatology, life skills, quality of life, re-hospitalisation rates, and length of re-hospitalisation than those who received standard halfway house services.
Results: There were significant time and group effects on symptomatology (F = 7.08, p = 0.02) and life skills (F = 13.22, p < 0.001). No such effects were observed on the quality of life of participants (F = 0.52, p = 0.67).
Conclusions: The findings reveal that those who received case management services had fewer rehospitalisations and shorter durations of inpatient treatment. Explanations of the findings and the potential implications are discussed.
Key words: Case management; Community mental health services; Half-way houses; Mentally ill persons; Social work, psychiatric
Deinstitutionalisation and the establishment of communitybased psychiatric services have been the major directions of service development for people with mental illness in Hong Kong over the past few decades. A variety of services, including residential, vocational, community networking, and supportive services, are now available. Nevertheless, these services are rather fragmented and lack coordination.1 Different professionals from different agencies provide services for the same individual. It is not uncommon to find an overlapping of services and a lack of a key worker who plans and oversees the treatment of an individual.2 Consequently, people with mental illness may not receive adequate or timely services.
Although case management has been accepted and used as a major component of mental health services in many countries, it has not been practised in Hong Kong to address the issues of system rigidity, fragmentation, inaccessibility, and lack of accountability of mental health services found in Hong Kong.2 In 2003, a local non-governmental organisation that provides services for people with mental illness began to experiment with a case management model to address the above-mentioned pitfalls but case management has not been recognised or financially supported by the government of Hong Kong. This article reports on a comparison between the outcome variables of hospitalisation rate, symptomatology, life skills, and quality of life between people who received case management services in 2 halfway houses and those who received standard halfway house services.
Case management is defined as a series of activities that aim to link the service system to a consumer and coordinate system components to achieve a successful outcome.3 It essentially serves a problem-solving function and is designed to ensure continuity of services and overcome system rigidity, fragmentation, inaccessibility, and the lack of accountability of mental health services. It is commonly described as a flexible, planned, and individualised approach to service delivery that provides consumer choice and maximises the efficient use of formal and informal resources in service provision.4-7
Numerous overseas studies have examined different models of case management for people with severe and persistent mental illness.8,9 In a meta-analysis of 75 studies on the efficacy of case management, Mueser et al10 found a consistent reduction in length of hospital stay for those in the case management groups. …