Case management: An update

Background: Case management in its various forms represents a major innovat ion in mental health care. Its efficacy remains controversial. Aims: To update after a decade a previous review article (Holloway, 1991). Methods: Descriptive literature and controlled trials of case management an d its derivative Assertive Community Treatment (ACT) was accessed through f our comprehensive and systematic reviews of the literature, repeated Medlin e and Embase searches and personal contacts. Results and Conclusions: The concept of case management has continued to ev olve over the past decade. No controlled trial has been published exploring the model of the case manager as a service broker without responsibility f or the provision of care. Basic case management principles have frequently been incorporated within routine clinical practice. Published controlled tr ials of ACT, which were almost exclusively carried out in North America, ha ve shown markedly positive results. However caution is required in extrapol ating these findings to routine clinical practice within different systems of health and social care. Case management is not in itself an effective tr eatment for severe mental illness.