F, Clinical Case Mental Illness 3«L A Biopsychosocial Vulnerability-Stress Model Daniel Fu Keung Wong Daniel Fu Kenn g Wong, PhD Clinical Case Management for People with Mental Illness A Biopsychosocial Vulnerability-Stress Model % Pre-publication REVIEWS, COMMENTARIES, EVALUATIONS . . . //HPhis text defines case management //T^Vr. Wong provides readers with A comprehensively and clearly iden­ mJ practical and useful information tifies the functions of the case manager, regarding the treatment and manage­ including assessment, service planning, ment of people with serious mental ill­ linkage, advocacy, therapy, monitoring nesses. He incorporates compassion of services, and evaluation. A biopsy­ and offers concrete examples for how chosocial vulnerability-stress perspec­ to effectively help these patients. He tive of clinical case management and carefully explains the biospychosocial the case examples throughout the text model, making it useful to the reader as help the reader gain knowledge on in­ tegrating the case management theory a means of conceptualizing treatment in clinical practice. The book also in­ interventions for these often difficult- cludes important chapters on the assess­ to-treat patients. This book is a valuable ment of and interventions with families, resource for clinicians." and on crisis intervention with suicidal clients." Jean S. Gearon, PhD Clinical Associate Professor of Psychiatry, Teresa W. Steele, PhD Division of Community Psychiatry, Dean, School of Health, Husson College University of Maryland School of Medicine &JL L i- More pre-publication REVIEWS, COMMENTARIES, EVALUATIONS . . . y/Tt is refreshing to read Dr. Wong's 1 book on clinical case manage­ ment. His is not a single-minded ap­ proach. Instead, he surveys the best of the past thirty years of practice and sci­ entific research in community support services and reduces this massive liter­ ature to a biopsychosocial vulnerabil- ity-strcss model. His concepts and the­ ories are concisely delivered. Thus, in any instructional environment his ideas can be used as points of depar­ ture for further in-depth discussion. Wong is particularly good at de­ scribing and illustrating a cognitive-be- havioral, clinical perspective. More­ over, he slides a strengths approach, a biological/medication perspective, and a social and family model neatly along­ side cognitive-behavioral theory. His style of writing will prove helpful to beginning case managers and social workers who need introductory clinical theory and skills to complement routine coordination and linking tasks." Jerry Floersch, PhD, LISW Associate Professor, Mattdel School of Applied Social Sciences, Case Western Reserve University This page intentionally left blank Clinical Case Management for People with Mental Illness A Biopsychosocial Vulnerability-Stress Model HAWORTH Social Work in Health Care Gary Rosenberg and Andrew Wiessman Editors A Guide to Creative Group Programming in the Psychiatric Day Hospital by Lois E. Passi Social Work in Geriatric Home Health Care: The Blending of Traditional Practice with Cooperative Strategies by Lucillc Roscngartcn Health Care and Empowerment Practice in the Black Community: Knowledge, Skills, and Collectivism by Sadye L. Logan and Edilh M. Freeman Clinical Case Management for People with Mental Illness: A Vulnerahility-Stress Model by Daniel Fu Keung Wong The Social Work—Medicine Relationship: 100 Years at Mount Sinai by Helen Rehr and Gary Rosenberg Clinical Case Management for People with Mental Illness A Biopsychosocial Vulnerability-Stress Model Daniel Fu Keung Wong, PhD lì Routledge Taylor & Francis Group LONDON AND NEW YORK First published 2006 by The Haworth Press, Inc Published 2013 by Routledge 2 Park Square, Milton Park, Abingdon, Oxon 0X14 4RN 711 Third Avenue, New York, NY 10017, USA Routledge is an imprint of the Taylor & Francis Group, an informa business © 2006 by The Haworth Press. Inc. All rights reserved. No part of this work may be reproduced or utilized in any form or by any means, electronic or mcchanical, including photocopying, microfilm, and recording, or by any information storage and retrieval system, without permission in writing from the publisher. Identities and circumstances of individuals discussed in this book have been changed to protect confidentiality. Cover design by Kerry E. Mack. Library of Congress Cataloging-in-Publication Data Wong, Daniel Fu Keung. Clinical case management for people with mental illness : a biopsychosocial vulnerability- stress model / Daniel Fu Keung Wong, p. cm. Includes bibliographical references and index. ISBN-13: 978-0-7890-2854-9 (he. : alk. paper) ISBN-10: 0-7890-2854-9 (he. : alk. paper) ISBN-13: 978-0-7890-2855-6 (pbk. : alk. paper) ISBN-10: 0-7890-2855-7 (pbk. : alk. paper) 1. Psychiatric social work. 2. Mental health services. 3. Mentally ill—Services for. I. Title. [DNLM: 1. Social Work, Psychiatric—methods—Case Reports. 2. Case Management—Case Reports. 3. Community Mental Health Services— Case Reports. 4. Mental Disorders— diagnosis—Case Reports. 5. Mental Disorders—therapy—Case Reports. WM 30.5 W872c 2006] H V689.W65 2006 362.2'0425—dc22 2005012481 CONTENTS Foreword ix Preface xi Chapter 1. Clinical Case Management: An Overview 1 Introduction 1 Mental Health Services in Hong Kong: A Critical Review 1 Roles and Functions of Mental Health Workers: A Clinical Case Management Perspective 11 Chapter 2. Theoretical Framework of Clinical Case Management: A Biopsychosocial Vulnerability-Stress Perspective 25 Introduction 25 Biopsychosocial Perspective 27 Biopsychosocial Theories and Approaches for Treating Mental Illness 30 Conclusion 44 Chapter 3. Psychiatric Assessment 47 Introduction 47 Models of Assessment 47 Biopsychosocial Vulnerability-Stress Model of Psychiatric Assessment 56 Microskills in Assessment 67 Case Illustration 69 Chapter 4. Depression 73 Introduction 73 Assessing a Person with Depression 74 Case Illustration 91 Chapter 5. Anxiety Disorders 95 Introduction 95 Nature of Anxiety 95 Assessing a Person with Anxiety Problems 96 Case Illustration 116 Chapter 6. Schizophrenia 121 Introduction 121 Assessment 122 Areas of Assessment and Intervention 124 Guidelines for Working with Persons with Schizophrenia 145 Relapse Prevention 147 Case Illustration 148 Chapter 7. Personality Disorders 153 Introduction 153 Assessment 155 Interventions 164 Guidelines for Working with Persons with Personality Disorders 168 Case Illustration 169 Chapter 8. Working with Families 173 Introduction 173 Understanding the Roles and Reactions of Family Members 174 Major Perspectives on Working with Families of Persons Suffering from Serious Mental Illness 180 Guidelines for Working with Families of Mentally 111 Persons 191 Case Illustration 193 Chapter 9. Handling Psychiatric Emergencies 197 Introduction 197 Issues and Services Regarding Psychiatric Emergencies 198 Therapeutic Functions of Psychiatric Crisis 201 Critical Decisions in Psychiatric Emergencies 202