ABSTRACT

Case managers, as one can quickly surmise from their title, are the invention of systems planners. Systems planners, in the human services field, are determined to locate problems within the existing boundaries of systems as they see them. The use of the title, ‘Case Manager’, suggests a wedding between conventional mental health clinicians comfortable with the term ‘case’ and systems planners comfortable with the use of ‘manager.’ These two influences permeate the suggested form of practice: case management emerges as a composite of a medical/psychiatric model for dealing with cases to be administered efficiently by managers accountable to a system. Taken together, this approach presumes and asserts a definition of the problems to be addressed which combines system maintenance with clinical reductionism, neither of which addresses the central problems faced by former mental patients residing in the community. On the surface, the typical tasks and functions required of case managers may seem quite benign, perhaps even helpful: who could object to working diligently to construct a comprehensive service plan, to coordinating a disparate array of service providers, to advocating for inaccessible services, etc.? But, just beneath the surface, there remains a far less rational yet systemic universe that constitutes the harsh social and economic reality of everyday life for most former patients. Sadly, this reality has little to do with the service model designed to be the panacea for hundreds of thousands of ex-patients by federal and state mental health planners.