Case management for the mentally ill: a comparative evaluation of client satisfaction

This paper reports on client satisfaction with community mental health services. A Client Satisfaction Interview was used as one outcome measure in a randomized controlled study of clinical case management vs. standard community care. The Interview had high internal consistency reliability (Cronbach's alpha = 0.89) with very high inter-rater reliability for overall scores (r= 0.99) and good inter-rater reliability for individual items (kappa over 0.9 for 18 of 22 items). Case management clients had significantly higher total satisfaction scores than control group clients who received standard community care at 9 months (t= 2.02 P= 0.05) but not at baseline (t= 0.59, P= 0.55) or 18 months (t= 1.76, P= 0.09). In addition to a quantitative measure of satisfaction, clients were asked to provide more qualitative accounts of their experience with services. The findings are discussed in relation to the team's model of case management and the differences between case management and control services. The limitations of this study are considered in the context of methodological issues surrounding measurement of client satisfaction and the study's own methodological shortcomings.