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Authors' reply

Published online by Cambridge University Press:  02 January 2018

S. Byford
Affiliation:
Centre for Health Economics, University of York, Heslington, York YO1 5DD
M. Fiander
Affiliation:
St George's Hospital Medical School, Cranmer Terrace, Tooting, London SW17 0RE
T. Burns
Affiliation:
St George's Hospital Medical School, Cranmer Terrace, Tooting, London SW17 0RE
T. Fahy
Affiliation:
South London & Maudsley NHS Trust, Denmark Hill, London SE5 8AZ
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Abstract

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Columns
Copyright
Copyright © 2000 The Royal College of Psychiatrists 

The training and expertise of the case managers involved in the UK700 case management trial have been described in a previous publication (UK700 Group, 1999) and discussed in subsequent correspondence (Reference Gournay and BeadsmoreBurns et al, 1999). The clinical staff providing both intensive and standard case management were equally experienced in terms of training and skills, had considerable expertise in working with severe mental illness, and were representative of the staff working in community mental health teams throughout the UK. All staff received courses in case management, and intensive case managers additionally received training in out-reach practice from a team leader in assertive community treatment.

The recommendations made by Gournay & Beadsmore (Reference Gournay and Beadsmore1995), such as implementation of the Care Programme Approach and emphasis on post-qualification training, are ones we would agree with, and were in place in the collaborating sites during the period of the trial. They are, however, general recommendations and there is currently no research or strong clinical consensus to suggest which specific skills or training components are required for effective or cost-effective care in this area.

Although we agree that the skills of case managers working with people who have severe mental illness are an important issue in need of research, Martin has misunderstood the purpose of the UK700 case management trial. We aimed to test rigorously one component of intensive case management - reduced case-load size - in a pragmatic situation representative of clinical services within the UK. We stand by the conclusions of our paper, which relate to the cost-effectiveness of low case-load size within the framework of current clinical expertise in the UK.

References

Burns, T., Fahy, T., Thompson, S., et al (1999) Intensive case management for severe psychotic illness (authors' reply). Lancet, 354, 13841386.Google Scholar
Gournay, K. & Beadsmore, A. (1995) The report of the Clinical Standards Advisory Group: standards of care for people with schizophrenia in the UK and implications for mental health nursing. Journal of Psychiatric and Mental Health Nursing, 2, 359364.Google Scholar
UK700 Group (1999) Intensive versus standard case management for severe psychotic illness: a randomised trial. Lancet, 353, 21852189.CrossRefGoogle Scholar
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