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PURPOSE. To describe outcomes of clients with serious mental illnesses who used regional public mental health services; and what the public mental health system did well or needed to change to better satisfy clients' needs.
METHODS. A modal case study analysis method was used with 15 clients. Participants were interviewed three times.
FINDINGS. Participants reported dissatisfaction with their social functioning and general health, and unmet needs for case management servises, social/recreational activities, and vocational rehabilitation.
CONCLUSION. The case study method is an effective way for nurses to evaluate public mental health systems and to determine areas for system intervention.
Search terms: Case management, case study, mental health systems, patient satisfaction, quality of life
Case studies have traditionally been used in psychiatric-mental health nursing to study outcomes of individuals, yet case studies also can be conducted with groups, institutions, and organizations (Sechrist, Stewart, Sickle, & Sidani, 1996; Yin, 1994). Although case studies have been used frequently to evaluate trends and outcomes in business and for-profit agencies, nurses have used this method less frequently to evaluate public mental health systems. Case studies show promise for mental health systems research as nurses learn how to evaluate these systems effectively to improve mental health nursing care. The purposes of this case study were to describe outcomes (functioning; quality of life; service use, need, and satisfaction) of clients with serious mental illnesses who used regional public mental health services, and to describe what the public mental health system did well or needed to change to better satisfy clients' needs.
The case study method was selected for this study because it allowed us to explore a number of variables within the context of the current public mental health system. The system selected for evaluation serves a fivecounty area in a southwestern state and provides public mental health services to approximately 16,500 clients annually. As seen in Figure 1, the case study method uses all types of data to make generalizations about the system, which can be used to inform policy to support system change. The advantage of using both quantitafive and qualitative data is that it permits findings to be validated with different, but complementary, methods. Each type of data adds to the knowledge and understanding about the problem of...