Journal Article

Intensive Case Management for Addiction to promote engagement with care of people with severe mental and substance use disorders: an observational study

Golay, Philippe, Bonsack, Charles, Morandi, Stéphane, Silva, Benedetta

2017

Overview

Background Co-occurring severe mental and substance use disorders are associated with physical, psychological and social complications such as homelessness and unemployment. People with severe mental and substance use disorders are difficult to engage with care. The lack of treatment worsens their health and social conditions and increases treatment costs, as emergency department visits arise. Case management has proved to be effective in promoting engagement with care of people with severe mental and substance use disorders. However, this impact seemed mainly related to the case management model. The Intensive Case Management for Addiction (ICMA) aimed to improve engagement with care of people with severe mental and substance use disorders, insufficiently engaged with standard treatment. This innovative multidisciplinary mobile team programme combined Assertive Community Treatment and Critical Time Intervention methodologies. The aim of the study was to observe the impact of ICMA upon service use, treatment adherence and quality of support networks. Participants’ psychosocial and mental functioning, and substance use were also assessed throughout the intervention. Methods The study was observational. Eligible participants were all the people entering the programme during the first year of implementation (April 2014–April 2015). Data were collected through structured questionnaires and medical charts. Assessments were conducted at baseline and at 12 months follow-up or at the end of the programme if completed earlier. McNemar-Bowker’s Test, General Linear Model repeated-measures analysis of variance and non-parametric Wilcoxon Signed Rank tests were used for the analysis. Results A total of 30 participants took part in the study. Results showed a significant reduction in the number of participants visiting the general emergency department compared to baseline. A significantly decreased number of psychiatric emergency department visits was also registered. Moreover, at follow-up participants improved significantly their treatment adherence, clinical status, social functioning, and substance intake and frequency of use. Conclusions These promising results highlight the efficacy of the ICMA. The intervention improved engagement with care and the psychosocial situation of people with severe mental and substance use disorders, with consequent direct impact on their substance misuse.

• Publisher: BioMed Central,Springer Nature B.V,BMC
• Subject: Addiction / Addictions / Adult / Alcohol / Ambulatory care / Assertive community treatment / Case Management / Collaboration / Comorbidity / Critical time intervention / Diagnosis, Dual (Psychiatry) / Disorders / Drug addiction / Efficacy / Emergency services / Female / First year / Frequency of occurrence / Health care expenditures / Health Psychology / Health services / Health Services Accessibility - statistics & numerical data / Homeless people / Humans / Implementation / Intensive Case Management / Interdisciplinary aspects / Intervention / Linear analysis / Male / Management / Medical treatment / Medicine / Medicine & Public Health / Mental disorders / Mental Disorders - complications / Mental Disorders - therapy / Mental health care / Mental health services / Multidisciplinary teams / Observational studies / Pharmacology/Toxicology / Psychopharmacology / Psychosocial factors / Psychosocial functioning / Public Health / Schizophrenia / Severe mental disorder / Severity / Social Behavior / Social conditions & trends / Social functioning / Social networks / Social Policy / Social Work / Substance abuse / Substance abuse treatment / Substance use disorder / Substance-Related Disorders - complications / Substance-Related Disorders - therapy / Support networks / Treatment Adherence and Compliance - statistics & numerical data / Treatment compliance / Unemployment / Urban areas / Variance analysis / Victimization / Young Adult