Abstract
Alan Rosen and Maree Teesson, Royal North Shore Hospital and Community Mental Health Services, University of Sydney and University of New South Wales, Sydney, Australia:
We join Gournay and Thornicroft in the hope that our paper [1] will provide food for thought in the UK, as well as hoping that it will dispel myths in Australia casting aspersions upon rigorous case management (originating in the UK literature) and lead to more appropriate applications of both the language and methods of evidence-based medicine.
Gournay and Thornicroft allude to the fact that many of the equivocal results in the UK literature on case management (e.g. the UK 700 trial) could be explained by staff receiving ‘a very small amount of training in assertive community treatment methods’. Our article also outlines other possible reasons, including the failure to meet the internationally accepted fidelity criteria for this set of interventions. At the same time, their letter could serve to bring more clearly into focus that these criteria do not prescribe any particular content of relevant intervention skills, except indirectly those concerning work rehabilitation, crisis management and dual disorders with substance abuse.
We agree on the importance of meeting the skills and training needs of the workforce. In fact, we stated these requirements, albeit briefly, in our section ‘Case management in practice’ (p.737), emphasizing and referencing the need for ‘supervision, mentorship’ and ‘continual training’, as well as the need for an interdisciplinary mix of fully professional staffing, rather than only ‘generic’ case-managers, to bring ‘many more up-to-date skills’ to bear upon service-users' problems and goals. We thank Gournay and Thornicroft for setting out a more detailed agenda for relevant training methods and content.
We agree that there is too little evidence regarding the efficacy and effectiveness of staff training in clinical settings. We look forward to the outcomes of their studies on such training being published.