| Case
Management
"I’m not a case and I don’t need
to be managed!" reads a lapel pin popular with some mental health activists,
and admittedly "case management" is a term with both unfortunate connotations
and an unfortunate history. But at CHOICE the purpose of case management is to
assist consumers in identifying, securing, and sustaining the range of resources
necessary to a satisfying life in the community. Our case management is not about
treatment; it’s not about imposing a structure, or making sure someone takes
medication. We don’t focus on what’s wrong with someone; our principle
focus is on what’s right.
Unlike CHOICE’s peer advocacy and
homeless outreach programs, case managers meet with their clients on a regular
schedule: two face to face meetings per month, primarily in the community. A service
plan is developed which specifies what the client’s goals are and how they
are going to attempt to meet them. These will vary from person to person. One
client may wish to secure stable housing in the community while another may want
assistance in obtaining a learner’s permit.
One client, Gloria
(not her real name) came to us owing several months rent. She already had an active
referral to a county housing provider, but the housing agency was reticent to
grant her a subsidy until the arrears, which were in excess of $5000, were paid
off. Gloria’s case manager first accessed the Department of Social Services
(DSS) for these monies but was rejected pending a letter from the housing provider
verifying that they would subsidize Gloria’s rent in the future. The housing
provider would not draft such a letter unless the arrears were paid. To address
this Catch-22 the case manager persistently called both agencies, drafted a letter
to DSS outlining this predicament and called upon DSS for leniency. His persistency
paid off. After 3 weeks of negotiation DSS faxed the letter of guarantee verifying
their payment of Gloria’s rent arrears. The housing provider in turn has
accepted Gloria into their program and her subsidy is slated to begin next month.
Although they are not clinicians, case managers can play the important
role of liaison between client and physician. A client on medication may be unhappy
with the side effects she is experiencing. Many times the client would just like
the opportunity to explore different options. Clients sometimes feel that their
psychiatrist is unapproachable-"he won’t talk to me". This is where
a case manager can be crucial. In essence the case manager can act as a spokesperson
for the client, expressing concerns and negotiating for a medication plan that
works and is agreeable to those involved.
One client, Susan (not her
real name), a veteran of the state psychiatric system, came to us distrusting
the mental health system. When her case was first opened, Susan attended a local
day treatment program. Though she went to the program a few days a week and met
with the psychiatrist bi-weekly to review her blood work, she avoided contact
with her assigned therapist.
Susan’s priority was work. Treatment
was low on her list. Susan’s case manager stepped in to assist her in working
towards this goal. Together they drafted an updated resume for Susan and called
previous and prospective employers. Over time Susan shared not only her goals
with her case manager but also her fears. Susan explained her distrust for the
system and why she was reluctant to open up to her therapist. Her case manager
disclosed that she had spent time in the same state institution as Susan and validated
Susan’s hesitance to trust. Three years later, Susan is meeting with her
therapist on a weekly basis and has maintained steady employment each summer.
Our clients know what they want out of life; the problem is, often they
have been told by clinicians, family members, or other authority figures that
they don’t. The fact of being diagnosed with mental illness has robbed them
of the right to have dreams and aspirations, even of the right to make their own
mistakes. A case manager can function as a support, a sounding board, a resource
specialist and an advocate for clients looking to create positive and lasting
change in their lives.
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