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 language | English |
|---|---|
| Pages (from-to) | 276-282 |
| Number of pages | 7 |
| Journal | Psychiatric Services |
| Volume | 59 |
| Issue number | 3 |
| DOIs | |
| Publication status | Published - Mar 2008 |
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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 journal › Article
TY - JOUR
T1 - Integrated care for co-occurring disorders
T2 - Psychiatric symptoms, social functioning, and service costs at 18 months
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
Y1 - 2008/3
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.
KW - Adolescent
KW - Adult
KW - Aged
KW - Brief Psychiatric Rating Scale
KW - Case Management
KW - Catchment Area (Health)
KW - Cognition Disorders
KW - Community Mental Health Services
KW - Comorbidity
KW - Costs and Cost Analysis
KW - Female
KW - Humans
KW - Life Change Events
KW - Male
KW - Middle Aged
KW - Patient Satisfaction
KW - Quality of Life
KW - Schizophrenia
KW - Social Behavior
KW - Substance-Related Disorders
KW - Surveys and Questionnaires
KW - United Kingdom
KW - Journal Article
KW - Randomized Controlled Trial
KW - Research Support, Non-U.S. Gov't
U2 - 10.1176/ps.2008.59.3.276
DO - 10.1176/ps.2008.59.3.276
M3 - Article
VL - 59
SP - 276
EP - 282
JO - Psychiatric Services
JF - Psychiatric Services
SN - 1075-2730
IS - 3
ER -