The case manager's role includes the functions of assessment, treatment and working through patient's recovery from a first episode of psychosis. Needless to say, the therapeutic relationship that develops throughout the two year follow-up is essential to each of these functions. Involvement in the direct delivery of one or more specific psychosocial group interventions is an important component of a case manager's role. An overview of each of the functions, including group interventions, follows:
A strong working relationship with the client is essential to the process of recovery and reintegration. It is likely that the client will have more contact with the case manager than with any other member of the interdisciplinary team. The case manager plans with the client and family, coordinates, and directly delivers a major portion of the care to the client and family. The case manager sees the client through states of acute symptomatology to full recovery with all the intervening ups and downs in achieving that goal.
The working alliance is nurtured from the very first contact, even though the client may be in a state of acute psychosis. All other interventions at this point are secondary to the respect, acceptance and understanding shown to the client. This is a difficult task as many clients and families will reject and sometimes deny any need for intervention. It is often through the ongoing and patient efforts of the case manager that treatment is initiated and maintained. Through ongoing dialogue and instrumental help from the case manager, the client is likely to develop trust and begin to confide personal concerns and experiences.
Confidentiality must be respected and maintained even though family involvement is necessary for a successful outcome. Goals articulated by the client and supported by the case manager and family are more likely to be successful than those articulated by the treatment team. However case managers must empower clients to make informed decisions by providing ample opportunities for learning and open discussion about psychosis with the treatment team and their own families.
The case manager acts as the liaison between the psychiatrist and client, and is, therefore, in the position of reinforcing medical treatment recommendations, particularly medication. Case managers also advocate for the client bringing his/her difficulties and concerns to the psychiatrist. As well, the case manager can often find him/herself in the middle of family concerns and issues. In this situation, the case manager must be careful to acknowledge the client as his/her first priority. The strength of the therapeutic relationship is deepened through the case manager taking a very active role in helping the client acquire the necessary skills to negotiate the demands of the adult world.
