Integrated care for co-occurring disorders

Psychiatric symptoms, social functioning, and service costs at 18 months

Tom K J Craig, Sonia Johnson, Paul McCrone, Sarah Afuwape, Elizabeth Hughes, Kevin Gournay, Ian White, Shamil Wanigaratne, Morven Leese, Graham Thornicroft

Research output: Contribution to journalArticle

38 Citations (Scopus)

Abstract

OBJECTIVE: Persons with severe mental illness have high rates of comorbid substance use disorders. These co-occurring disorders present a significant challenge to community mental health services, and few clinical trials are available to guide the development of effective services for this population. The study aimed to evaluate the effectiveness of a program for case managers that trained them to manage substance use disorders among persons with severe mental illness.

METHODS: A cluster-randomized controlled trial design was used in South London to allocate case managers either to training or to a waiting list control condition. Outcomes and service costs (health care and criminal justice) over 18 months of 127 patients treated by 40 case managers who received training were compared with those of 105 patients treated by 39 case managers in the control condition.

RESULTS: Brief Psychiatric Rating Scale scores for the intervention group indicated significant improvements in psychotic and general psychopathology symptoms. Participants in the intervention group also reported fewer needs for care at follow-up. No significant differences were found between the two groups in levels of substance use at 18 months. At follow-up both groups reported increased satisfaction with care. Service costs were also similar for the two groups.

CONCLUSIONS: Compared with standard care, integrated treatment for co-occurring disorders provided by nonspecialist mental health staff produced significant improvements in symptoms and level of met needs, but not in substance use or quality of life, at no additional cost.

Original languageEnglish
Pages (from-to)276-282
Number of pages7
JournalPsychiatric Services
Volume59
Issue number3
DOIs
Publication statusPublished - Mar 2008

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Social Work
Psychiatry
Costs and Cost Analysis
Substance-Related Disorders
Community Mental Health Services
Brief Psychiatric Rating Scale
Aftercare
Criminal Law
Waiting Lists
Program Evaluation
Psychopathology
Health Care Costs
Mental Health
Randomized Controlled Trials
Quality of Life
Clinical Trials
Case Managers
Population
Therapeutics

Cite this

Craig, T. K. J., Johnson, S., McCrone, P., Afuwape, S., Hughes, E., Gournay, K., ... Thornicroft, G. (2008). Integrated care for co-occurring disorders: Psychiatric symptoms, social functioning, and service costs at 18 months. Psychiatric Services, 59(3), 276-282. https://doi.org/10.1176/ps.2008.59.3.276
Craig, Tom K J ; Johnson, Sonia ; McCrone, Paul ; Afuwape, Sarah ; Hughes, Elizabeth ; Gournay, Kevin ; White, Ian ; Wanigaratne, Shamil ; Leese, Morven ; Thornicroft, Graham. / Integrated care for co-occurring disorders : Psychiatric symptoms, social functioning, and service costs at 18 months. In: Psychiatric Services. 2008 ; Vol. 59, No. 3. pp. 276-282.
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Craig, TKJ, Johnson, S, McCrone, P, Afuwape, S, Hughes, E, Gournay, K, White, I, Wanigaratne, S, Leese, M & Thornicroft, G 2008, 'Integrated care for co-occurring disorders: Psychiatric symptoms, social functioning, and service costs at 18 months', Psychiatric Services, vol. 59, no. 3, pp. 276-282. https://doi.org/10.1176/ps.2008.59.3.276

Integrated care for co-occurring disorders : Psychiatric symptoms, social functioning, and service costs at 18 months. / Craig, Tom K J; Johnson, Sonia; McCrone, Paul; Afuwape, Sarah; Hughes, Elizabeth; Gournay, Kevin; White, Ian; Wanigaratne, Shamil; Leese, Morven; Thornicroft, Graham.

In: Psychiatric Services, Vol. 59, No. 3, 03.2008, p. 276-282.

Research output: Contribution to journalArticle

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T1 - Integrated care for co-occurring disorders

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AU - Craig, Tom K J

AU - Johnson, Sonia

AU - McCrone, Paul

AU - Afuwape, Sarah

AU - Hughes, Elizabeth

AU - Gournay, Kevin

AU - White, Ian

AU - Wanigaratne, Shamil

AU - Leese, Morven

AU - Thornicroft, Graham

PY - 2008/3

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N2 - OBJECTIVE: Persons with severe mental illness have high rates of comorbid substance use disorders. These co-occurring disorders present a significant challenge to community mental health services, and few clinical trials are available to guide the development of effective services for this population. The study aimed to evaluate the effectiveness of a program for case managers that trained them to manage substance use disorders among persons with severe mental illness.METHODS: A cluster-randomized controlled trial design was used in South London to allocate case managers either to training or to a waiting list control condition. Outcomes and service costs (health care and criminal justice) over 18 months of 127 patients treated by 40 case managers who received training were compared with those of 105 patients treated by 39 case managers in the control condition.RESULTS: Brief Psychiatric Rating Scale scores for the intervention group indicated significant improvements in psychotic and general psychopathology symptoms. Participants in the intervention group also reported fewer needs for care at follow-up. No significant differences were found between the two groups in levels of substance use at 18 months. At follow-up both groups reported increased satisfaction with care. Service costs were also similar for the two groups.CONCLUSIONS: Compared with standard care, integrated treatment for co-occurring disorders provided by nonspecialist mental health staff produced significant improvements in symptoms and level of met needs, but not in substance use or quality of life, at no additional cost.

AB - OBJECTIVE: Persons with severe mental illness have high rates of comorbid substance use disorders. These co-occurring disorders present a significant challenge to community mental health services, and few clinical trials are available to guide the development of effective services for this population. The study aimed to evaluate the effectiveness of a program for case managers that trained them to manage substance use disorders among persons with severe mental illness.METHODS: A cluster-randomized controlled trial design was used in South London to allocate case managers either to training or to a waiting list control condition. Outcomes and service costs (health care and criminal justice) over 18 months of 127 patients treated by 40 case managers who received training were compared with those of 105 patients treated by 39 case managers in the control condition.RESULTS: Brief Psychiatric Rating Scale scores for the intervention group indicated significant improvements in psychotic and general psychopathology symptoms. Participants in the intervention group also reported fewer needs for care at follow-up. No significant differences were found between the two groups in levels of substance use at 18 months. At follow-up both groups reported increased satisfaction with care. Service costs were also similar for the two groups.CONCLUSIONS: Compared with standard care, integrated treatment for co-occurring disorders provided by nonspecialist mental health staff produced significant improvements in symptoms and level of met needs, but not in substance use or quality of life, at no additional cost.

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KW - Randomized Controlled Trial

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