Community-Based Treatment for Severe Mental Illness: What are the Benefits and Costs?

Jack E. Scott, ScD, Lisa B. Dixon, MD, MPH


Medscape Psychiatry & Mental Health eJournal. 1997;2(5) 

In This Article

Abstract & Introduction

Case-management (CM) models for community-based care of the mentally ill provide different levels of care, ranging from the conventional generalist approach to the assertive clinical approach. The clinical effectiveness of several different approaches to CM is discussed, and the difficult area of cost analysis in community-based treatment is defined. Assertive models are clinically more effective but require standardized cost-management analysis. As managed care becomes more involved in developing mental health services, the cost effectiveness of programs will be a critical factor.

People with severe mental illness need access to treatment, rehabilitation, and support services within the community. These services can be provided through a variety of social, health, and mental health agencies, each with its own eligibility criteria and application and monitoring processes. Gaining access to the right agency is often a frustrating and time-consuming task, especially for people with mental illness. Because of the severe cognitive and motivational impairments common to mental illnesses (eg, schizophrenia), this task is especially intimidating, and many (if not most) patients simply stop trying. This invariably accelerates the revolving cycle of hospital discharge, return to the community, abandonment, relapse, and return to the psychiatric hospital.


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