Case management and assertive community treatment in Europe

Objective: Case management: studies from Europe and the United States conti nue to yield conflicting results. At a symposium at the World Psychiatric C onference in Hamburg in 1999, researchers from four European countries expl ored the possible reasons for differences in outcome. They also examined re asons for the differing foci of case management studies across the differen t cultures. The authors summarize the symposium's findings. Methods: Indivi dual case presentations were given of studies and services from the United Kingdom (three studies), Sweden (two studies), Germany, and Italy (one each ). Outcomes, methodologies, and national service context were examined. Res ults and conclusions: A significant influence of national culture is eviden t both in the acceptability of case management and in approaches to researc hing it. Case management is perceived as an "Anglophone import" in Italy bu t is now national policy for persons with severe mental illness in the othe r three countries. Studies from the United Kingdom emphasized methodologica l rigor,,vith little attention to treatment content, whereas those from Swe den accepted a less disruptive research approach but with a more prescripti ve stipulation of treatment content. Studies from Italy and Germany emphasi zed the importance of differing descriptive methodologies. Marked differenc es in the range of social care provision were noted across Europe. Overall, European researchers are less concerned than U.S. researchers with studyin g the impact of case management on hospital use.