Rivera James J, Sullivan Ann M, Valenti S Stavros
Department of Psychiatry, Mount Sinai School of Medicine, Elmhurst Hospital Center, Rm. H3-48, 79-01 Broadway, Elmhurst, NY 11373, USA.
Psychiatr Serv. 2007 Jun;58(6):802-9. doi: 10.1176/ps.2007.58.6.802.
Over the past decade, there has been increasing interest in the employment of mental health consumers in various roles as providers of services. Although integration of consumers into case management services has been studied, the roles of consumers have been poorly defined and the benefits have not been established. The goal of this study was to evaluate whether consumers enhance case management outcome through the provision of social support.
This study compared consumer-assisted and non-consumer-assisted case management with standard clinic-based care. The consumer role focused on the development of social support by using peer staff who matched the profile of participants. A total of 203 clients with severe and persistent mental illness were randomly assigned to one of the three conditions and followed for 12 months.
All three programs yielded the same general pattern of improvement over time for symptoms, health care satisfaction, and quality of life. Clients in the three programs also showed similar but small changes in measures of social network behavior. Consumer-assisted case management was unique in its use of peer-organized activities. Non-consumer-assisted case management made greater use of individual contacts with professional staff. Standard clinic-based care relied more on group and on individual therapy. Despite these variations in the pattern of services over a 12-month period, no one program emerged as categorically superior to the others.
Although more research is needed to determine optimal roles for consumers in mental health service delivery, a randomized trial found no evidence that the presence of consumers enhances case management outcome.
在过去十年中，人们越来越关注让精神健康消费者担任各种服务提供者的角色。尽管已经对消费者融入个案管理服务进行了研究，但消费者的角色定义不明确，其益处也尚未得到证实。本研究的目的是评估消费者是否通过提供社会支持来改善个案管理的结果。
本研究将消费者协助的个案管理和非消费者协助的个案管理与基于诊所的标准护理进行了比较。消费者的角色侧重于通过使用与参与者特征相匹配的同伴工作人员来发展社会支持。共有203名患有严重持续性精神疾病的患者被随机分配到三种情况之一，并随访12个月。
随着时间的推移，所有三个项目在症状、医疗保健满意度和生活质量方面都呈现出相同的总体改善模式。三个项目中的患者在社交网络行为指标上也显示出相似但微小的变化。消费者协助的个案管理在使用同伴组织的活动方面独具特色。非消费者协助的个案管理更多地利用与专业工作人员的个人联系。基于诊所的标准护理更多地依赖团体治疗和个体治疗。尽管在12个月的服务模式上存在这些差异，但没有一个项目明显优于其他项目。
尽管需要更多研究来确定消费者在精神健康服务提供中的最佳角色，但一项随机试验没有发现证据表明消费者的参与能改善个案管理的结果。
