Dvoskin J A, Steadman H J
Forensic Services, New York State Office of Mental Health, Albany 12229.
Hosp Community Psychiatry. 1994 Jul;45(7):679-84. doi: 10.1176/ps.45.7.679.
Aggressive and intensive case management and a comprehensive array of community support services are the keys to reducing the risk of violence by people with serious mental illness in the community. The authors describe the elements of intensive case management for potentially violent clients, including use of individual case managers responsible for small caseloads, 24-hour availability of case managers, and strong linkages to agencies providing mental health services, substance abuse treatment, and social services as well as to the criminal justice system. They summarize the results of three recent studies of intensive case management programs suggesting that this intervention is effective in reducing clients' dangerousness in the community. They discuss cultural and human resource issues that affect planning of intensive case management services. Intensive case managers need to be "boundary spanners" with the training, experience, and personality to bridge the often-broad gap between human service and criminal justice systems.
积极且深入的个案管理以及一系列全面的社区支持服务是降低社区中患有严重精神疾病者暴力风险的关键。作者描述了针对潜在暴力客户的深入个案管理要素，包括使用负责少量个案的个案经理、个案经理24小时随时待命，以及与提供心理健康服务、药物滥用治疗、社会服务的机构以及刑事司法系统建立紧密联系。他们总结了最近三项深入个案管理项目研究的结果，表明这种干预措施在降低客户在社区中的危险性方面是有效的。他们讨论了影响深入个案管理服务规划的文化和人力资源问题。深入个案经理需要成为“边界跨越者”，具备培训、经验和个性，以弥合人类服务和刑事司法系统之间通常存在的巨大差距。
