Authors' reply

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 (Burns 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 (1995), 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.