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Case management and assertive community treatment 

Case management and assertive community treatment
Case management and assertive community treatment
Oxford Textbook of Community Mental Health

Helen Killaspy

and Alan Rosen


Recent decades have seen the relocation of psychiatric care from hospital-based settings to community-based services. The initial phases of deinstitutionalization led to a replication of the general hospital outpatient clinic model for review of community patients by psychiatrists, but gradually services began to expand the support available to people with more severe mental health problems. Over time, the addition of nurses, psychologists, occupational therapists, and social workers led to the establishment of community mental health teams. As community health and social care provision expanded, it became an increasingly complex system to navigate. Case management was developed to address this by assigning individual staff to assess service users’ needs and coordinate their treatment and care. Contemporary mental health services use a variety of models of case management of which assertive community treatment (ACT) is the most intensive and clearly defined form. This chapter explores these models of community mental health care, the evidence for them, and the possible explanations for the discrepancies in their effectiveness reported in the international literature.

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