Providing the safety net: Case management for people with a serious mental illness.

Case managers in four teams provided intensive community support, focusing on assertive outreach and being a single accountable point of contact. "Most in need" mentally ill people were selected using illness severity guidelines. On one site entry to case management or a control condition was randomised for an 18 month follow-up period; 3% (1/39) of clients lost contact with specialist psychiatric services in the experimental group compared to 24% (9/38) in the control condition (p<0.05). Contacts with all forms of health and social care were greater for the case managed group. Similar low levels of lost contact (1% to 8%) for a further sample of 291 clients were found across the other three sites with non-randomised entry. These findings suggest that intensive community support for people with long-term mental illness, at risk of injury to themselves or others, can maintain service contact in many different settings.