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

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.