How does case management for long-term mentally ill individuals affect their use of health care services? An 18-month follow-up of 10 Swedish case management services

As part of an evaluation of 10 Swedish case management services, outcome in terms of changes in use of health care services was explored. The sample consisted of 176 long-term mentally ill individuals. Changes in use of psychiatric inpatient and outpatient services, primary health care services, and somatic inpatient and outpatient services during an 18-month follow-up were investigated. The results showed a marked and significant decrease in use of psychiatric inpatient services, which were on average reduced by 43% in terms of bed days used. There was no significant change in use of compulsory psychiatric care. The reduction in psychiatric inpatient care was largest for individuals with a diagnosis of schizophrenia. Case manager interventions directed towards the client's finances and coordination of care and support was related to less use of psychiatric inpatient services. To have more contacts with the case manager was related to fewer visits in psychiatric outpatient care. The use of primary health care and other somatic health care was unaffected. It is concluded that admission to a case management service resulted in a substantial reduction in use of psychiatric inpatient care, which to some extent was related to specific activities of the case manager.