"Aggressive" and "problem-focused" models of case management for the severely mentally ill.

In this paper, the relative merits and limitations of two models of case management (CM) are compared: "aggressive" and "problem-focused". Although aggressive CM has a well-established history of improving the community tenure of deinstitutionalized patients, individuals participating in this treatment are likely to become dependent on health care providers and hence require indeterminate assistance. Problem-focused CM teaches patients how to identify and resolve community-based predicaments thereby making them relatively more independent of the mental health system. Patients receiving problem-focused CM, however, need reasonably competent cognitive functions thereby ruling out participation of the most severely disabled individuals. An interaction of the two approaches is proposed in which aggressive and problem-focused CM is selected depending on the patient's current needs, cognitive deficit, and level of social support.