Case Management as a Strategy for Systems Change

Abstract

Prologue: Over the years, states have emerged as a dynamic venue for health policy experimentation. States often possess more political flexibility to move ahead on health care, while federal policymakers seem to lack the political will to break the health policy deadlock. New York State recently undertook a major intervention aimed at improving the mental health outcomes for its very disabled, disenfranchised citizens. This state experiment is using “intensive case management” to change its mental health system at a structural level to serve the most seriously mentally ill who previously experienced barriers to care. In this essay, the authors present their first-year program results. According to New York State Mental Health Commissioner Richard Surles, preliminary eighteen-month data not reported here confirm the program's positive outcomes and show a continued improvement in results following an apparent plateau at twelve months. Surles, a leader among state mental health policymakers, received his doctorate in administration from the University of North Carolina at Chapel Hill. Andrea Blanch is director of the state's Bureau of Community Support Programs. She earned a doctorate in psychology from the University of Vermont. David Shern, who directs New York's Bureau of Evaluation and Services Research, received a doctorate in social psychology from the University of Colorado. Sheila Donahue is a research scientist in the department and received her master's degree in economics from the State University of New York at Albany.