Severe and enduring mental illness and comorbid substance abuse or dependence Mental and Behavioural Disorders mental illness
Conditions
Interventions
Each cluster consisted of the clients on a particular case managers' caseload. The unit of randomisation was the case manager. The experimental group consisted of case managers (and the service users
Sponsors
Kings College London (UK)
Eligibility
Inclusion criteria
Inclusion criteria: All case managers were invited to participate unless they were temporary staff or had firm plans to leave during the next 18 months. Service user inclusion: a clinical diagnosis (made by psychiatrists and recorded in casenotes) of schizophrenia or schizoaffective disorder (ICD 10 codes F20, F25), delusional disorder and other non-affective psychotic illnesses (F22, F29) or bipolar affective disorder (F31) on the caseloads of participating case managers and in addition a rating of substance "abuse" or "dependence" on the Clinician Alcohol Use Scale (CAUS) and the Clinician Drug Use Scale (CDUS) based on DSMIII-R criteria.
Exclusion criteria
Exclusion criteria: Case managers excluded if they had immediate plans to leave or be absent for the study period service users were excluded if they had diagnoses other than stated above.
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Service users: Hospital bed use over the preceding 18 months, including admission to hospitals outside the catchment area on an extra-contractual referral basis. Other service use recorded using the Client Service Receipt Inventory Case managers: Alcohol and Alcohol Problems Perceptions Questionnaire | — |
Secondary
| Measure | Time frame |
|---|---|
| Service users: 1. Current adherence to medication, rated using the Medication Compliance Scale, which yields a single rating for the extent to which the patient is believed to adhere to prescribed medication 2. Stage of treatment rated using the Substance Abuse Treatment Scale (SATS), which yields a single rating of the extent to which a patient with dual diagnosis is motivated for and engaged in substance misuse treatment 3. Met and unmet needs, rated using the Camberwell Assessment of Need Short Assessment Schedule (CANSAS), which elicits ratings of patients? needs in 22 social and clinical domains 4. Social functioning, rated using the Life Skills Profile (LSP) 5. Drug and alcohol consumption and associated problems, measured using the section of the Maudsley Addictions Profile (MAP) which records consumption over a month, the Alcohol Use Disorders Identification Test (AUDIT), which screens for alcohol-related problems and may be used to categorise drinking as hazardous or harmful, and the DALI, a screening instrument for problematic drug and alcohol use developed specifically for severely mentally ill populations 6. Service satisfaction, measured by the brief global Client Satisfaction Questionnaire (CSQ-8) and the Treatment Perception Questionnaire, a short instrument developed specifically to assess satisfaction with substance misuse treatment 7. Physical symptoms, rated using the section of the MAP which enquires how often 10 common physical symptoms have been experienced in the past 30 days 8. Psychiatric symptoms, rated using the Brief Psychiatric Rating Scale (extended version) | — |
Countries
United Kingdom
Outcome results
None listed