Community management : the implications of residential living and case management of the severely mentally ill

Research in community management of the severely mentally ill has been scarce. Two primary components of community care in particular need evaluation, residential arrangements and styles of "case management." The purpose of this study was to evaluate the interaction of two types of residential arrangements (single- and double-occupancy) and two types of case management ("assertive" and "limited") in a 2 X 2 design. Participants were individuals with a severe mental illness served by CMHS, Inc. Individuals were matched on DSM-III-R diagnoses and sex: 8 had roommates and received assertive case management, 5 had roommates and limited case management, 5 lived alone and received assertive case management, and 5 lived alone with limited case management. Data were obtained from three independent sources: (1) each client was interviewed using the Denver Community Mental Health Questionnaire (DCMHQ) and the Inventory of Socially Supportive Behaviors (ISSB) on four separate occasions over three consecutive months; (2) frequency of client contact with family members over the same time interval was tracked by case managers; and (3) concurrent attendance in day treatment sessions, diagnosis, number of previous hospitalizations, and approximate number of months of previous hospitalization were obtained from community mental health center records. DCMHQ scores for acute symptoms and interpersonal conflict were combined into an index called problems, while ISSB scores measured social support received. Monthly follow-ups for three consecutive months were used to obtain stable estimates of problems and support. Significant positive correlations were found between family involvement and problems, family involvement and residential arrangements, social support and problems, group attendance percentage and age, problems and social support, and a marginal relationship between residence and social support. Statistically significant negative correlations were found between case management and problems, social support and number of previous hospitalizations, group attendance percentage and problems, and residence and age. In multiple regression involving all predictors, the variables other than roommating and case management, (i.e., average family involvement, number of previous hospitalizations, program attendance, and age, considered together) predicted both problems reported and support received, while as second and third steps in the regression analysis case management and residence did not significantly predict problems or social support. In other words, once chronicity (i.e., number of previous hospitalizations), family contact, age, and group attendance were controlled, case management and residence both vanished as predictors. Future studies should consider these factors, and other aspects of the natural context, when evaluating community interventions for the mentally ill in a more controlled experimental design. With respect to developing new research for community adjustment, recommendations for more controlled studies were made and two new community intervention procedures were described.Department of Psychological ScienceThesis (M.A.