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Intense case management for severe mental health problems reduces time in hospital and loss to follow-up compared with standard care, but benefits over non-ICM are less clear

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How does intensive case management (ICM) compare with non-ICM or standard community care in people with severe mental illness?


Primary outcomes: (i) hospitalisation (mean number of days per month in hospital) (ii) failure to remain in contact with psychiatric services. Secondary outcomes: A large number of secondary outcomes were also assessed.



Systematic review and meta-analysis.

Data sources

The Cochrane Schizophrenia Group's Register was searched for this updated review. The original review (2009) searched CINAHL, EMBASE, Medline, PsychLIT, the Cochrane Schizophrenia Group's Register and reference lists of included trials.

Study selection and analysis

38 trials (including 7328 participants) were identified. Participants in included trials were 18–65 years old with severe mental illness and were treated in community care settings in the USA, Canada, Europe or Australia. Trials compared ICM with non-ICM or standard care. ICM was defined as a long-term outpatient care package (comprising management, rehabilitation and social support) based on Assertive Community Treatment (ACT), provided by healthcare professionals with a case load of 20 people or fewer. Non-ICM was defined as the same care package but delivered by healthcare professionals with a case …

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  • Sources of funding Department of Health, UK; University of Verona, Italy.


  • Competing interests None.

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