Predictors of decompensation among consumers of an intensive case management program

Recent work suggests that some people who have severe and persistent mental illnesses can be transferred to less intensive services without suffering ill effects. However, the factors that affect the success of such transitio ns remain unknown. This longitudinal study examines consumer characteristic s and types of intensive case management services that predict decompensati on. We examined the trajectories of 86 individuals in an intensive case man agement program after they attained the highest level of functioning, ident ifying three patterns: stability, immediate decline followed by improvement , and gradual decline. Number of hospitalizations prior to program entry, b eing judged suicidal at program entry, and greater use of psychiatric servi ces during program participation consistently predicted decompensation. Sub stance abuse and psychiatric symptomatology at program entry also predicted decompensation, but did so less consistently. Predictors of differences in specific patterns of decompensation are explored.