Comparison of intensive and standard case management for patients with psychosis

BACKGROUND: Case management, particularly in intensive form, has been widely introduced for the treatment of severe mental illness. However, the optimal intensity of case management has not been determined. AIMS: We aimed to assess whether intensive case management (small case load) reduces hospitalisation and costs compared with standard case management. METHOD: Development and rationale of a large randomised controlled trial comparing intensive case management (case load per worker < or = 15 patients) with standard case management (case load 30-35 patients). RESULTS: Two-year outcome data will be obtained on patients representative of the seriously mentally ill in inner-city mental health services. CONCLUSIONS: The study planned with 700 patients should be sufficient to detect small differences in the readmission of patients to hospital (10%), the number of days spent in hospital over a two-year period (10 days) and the average weekly cost of care per patient. The sample is large enough to compare the cost-effectiveness of intensive and standard case management in mild and severe disability and in people of African Caribbean origin and White Caucasians.