Intensive case management for high-risk patients with first-episode psychosis: Service model and outcomes

Warrick James Brewer, Timothy J. Lambert, Katrina Gisela Witt, John Dileo, Cameron Duff, Carol Crlenjak, Patrick D McGorry, Brendan Patrick Murphy

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Background: The first episode of psychosis is a crucial period when early intervention can alter the trajectory of the young person's ongoing mental health and general functioning. After an investigation into completed suicides in the Early Psychosis Prevention and Intervention Centre (EPPIC) programme, the intensive case management subprogramme was developed in 2003 to provide assertive outreach to young people having a first episode of psychosis who are at high risk owing to risk to self or others, disengagement, or suboptimal recovery. We report intensive case management model development, characterise the target cohort, and report on outcomes compared with EPPIC treatment as usual. 
Methods: Inclusion criteria, staff support, referral pathways, clinical review processes, models of engagement and care, and risk management protocols are described. We compared 120 consecutive referrals with 50 EPPIC treatment as usual patients (age 15–24 years) in a naturalistic stratified quasi-experimental real-world design. Key performance indicators of service use plus engagement and suicide attempts were compared between EPPIC treatment as usual and intensive case management, and psychosocial and clinical measures were compared between intensive case management referral and discharge. 

Findings: Referrals were predominately unemployed males with low levels of functioning and educational attainment. They were characterised by a family history of mental illness, migration and early separation, with substantial trauma, history of violence, and forensic attention. Intensive case management improved psychopathology and psychosocial outcomes in high-risk patients and reduced risk ratings, admissions, bed days, and crisis contacts. 

Interpretation: Characterisation of intensive case management patients validated the clinical research focus and identified a first episode of psychosis high-risk subgroup. In a real-world study, implementation of an intensive case management stream within a well-established first episode of psychosis service showed significant improvement in key service outcomes. Further analysis is needed to determine cost savings and effects on psychosocial outcomes. Targeting intensive case management services to high-risk patients with unmet needs should reduce the distress associated with pathways to care for patients, their families, and the community. 

Funding: National Health & Medical Research Council and the Colonial Foundation.
Original languageEnglish
Pages (from-to)29 - 37
Number of pages9
JournalThe Lancet Psychiatry
Volume2
Issue number1
DOIs
Publication statusPublished - 2015

Cite this

Brewer, Warrick James ; Lambert, Timothy J. ; Witt, Katrina Gisela ; Dileo, John ; Duff, Cameron ; Crlenjak, Carol ; McGorry, Patrick D ; Murphy, Brendan Patrick. / Intensive case management for high-risk patients with first-episode psychosis : Service model and outcomes. In: The Lancet Psychiatry. 2015 ; Vol. 2, No. 1. pp. 29 - 37.
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Intensive case management for high-risk patients with first-episode psychosis : Service model and outcomes. / Brewer, Warrick James; Lambert, Timothy J.; Witt, Katrina Gisela; Dileo, John; Duff, Cameron; Crlenjak, Carol; McGorry, Patrick D; Murphy, Brendan Patrick.

In: The Lancet Psychiatry, Vol. 2, No. 1, 2015, p. 29 - 37.

Research output: Contribution to journalArticleResearchpeer-review

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T1 - Intensive case management for high-risk patients with first-episode psychosis

T2 - Service model and outcomes

AU - Brewer, Warrick James

AU - Lambert, Timothy J.

AU - Witt, Katrina Gisela

AU - Dileo, John

AU - Duff, Cameron

AU - Crlenjak, Carol

AU - McGorry, Patrick D

AU - Murphy, Brendan Patrick

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