BMJ 2001;323:1093 ( 10 November )

Papers

Reducing violence in severe mental illness: randomised controlled trial of intensive case management compared with standard care

Elizabeth Walsh, clinical lecturer, ^a Catherine Gilvarry, research psychologist, ^b Chiara Samele, research fellow, ^c Kate Harvey, research psychologist, ^c Catherine Manley, research associate, ^d Peter Tyrer, professor of community psychiatry, ^d Francis Creed, professor of psychological medicine, ^e Robin Murray, professor of psychiatry, ^b Thomas Fahy, professor of forensic mental health, ^a for the UK700 Group.

^a Section of Forensic Mental Health, Guy's, King's and St Thomas's School of Medicine, Institute of Psychiatry, London SE5 8AF, ^b Division of Psychological Medicine, Institute of Psychiatry, ^c Department of Community Psychiatry, St George's Hospital Medical School, London SE17 0RE, ^d Academic Unit of Psychiatry, St Mary's Hospital Medical School, St Charles Hospital, London W10 6DZ, ^e University Department of Psychiatry, Manchester Royal Infirmary, Manchester M13 9WL

Correspondence to: E Walsh sppmemw{at}iop.kcl.ac.uk

Objectives: To establish whether intensive case management reduces violence in patients with psychosis in comparison with standard case management.
Design: Randomised controlled trial with two year follow up.
Setting: Four inner city community mental health services.
Participants: 708 patients with established psychotic illness allocated at random to intervention (353) or control (355) group.
Intervention: Intensive case management (caseload 10-15 per case manager) for two years compared with standard case management (30-35 per case manager).
Main outcome measure: Physical assault over two years measured by interviews with patients and case managers and examination of case notes.
Results: No significant reduction in violence was found in the intensive case management group compared with the control group (22.7% v 21.9%, P=0.86).
Conclusions: Intensive case management does not reduce the prevalence of violence in psychotic patients in comparison with standard care.

What is already known on this topic Psychosis and violence are known to be associated Community psychiatric interventions aimed at reducing the risk of violence have not been evaluated What this study adds Increasing the intensity of contact between patients and case managers does not reduce the prevalence of violent behaviour in patients with psychosis Younger age, learning difficulties, and a history of violence, drug misuse, and victimisation predict violent behaviour in psychotic patients

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