9 Case management and ACT To function in their communities, many schizophrenic patients need a variety of treatment, rehabilitation, and support services. The staff of ACT programs meet patients and start their support systems. 13 Case management, which is generally more narrowly focused, uses a relationship between a patient and a case manager to enhance continuity and coordination of care. Through this relationship, the patient receives expanded access to services, whether these are provided directly or contracted through outside agencies. Different models emphasize certain functions.
Some models work with large caseloads, contracting services from other providers and agencies.
In other models some services are provided while others are contracted out, and the caseloads may be smaller. Both ACT and case management programs reduce hospitalization and increase use of community mental health services that usually cost less than hospitalization. 13 ACT and case management approaches can be seen as being at opposite ends of a spectrum, though some programs may overlap. ACT directly and intensively provides nearly all treatment, rehabilitation, and support services, while case management offers a limited array of direct services delivered with less intensity than ACT programs. Nursing implications One of the first concerns for the nurse working with community-based chronically ill schizophrenic patients is to encourage compliance with medical regimens.