Therapist-case managers: more than brokers of services.

For satisfactory adjustment into the community, the long-term patient often needs assistance in dealing with a bureaucracy of agencies and departments. Some professionals have suggested establishing the role of case manager, but the case manager system is susceptible to becoming an impersonal bureaucracy itself. The author suggests that case management functions are part of the normal duties of a conscientious therapist, and that only through significant therapeutic involvement does a case manager acquire the in-depth knowledge of the patient to adequately assess his needs and facilitate the processes for meeting them. Thus the case manager should be not simply an intermediate broker of services but the patient's primary therapist. With the "therapist-case manager," the functions of therapy and case management would be combined. If therapists fail to do case management or to treat long-term patients altogether, this problem should be dealt with directly rather than simply by adding another member to the team.