How Much Care and How Much Control? Looking Critically at Case Management

Abstract

With an emphasis on the Australian context, the paper sets out to critically examine case management (CM). Initially, a brief history of case management is outlined prior to a detailed summary of matters relating to definition. The contention is then developed that the many variations of CM can be evaluated as tending towards either the 'agency-centred' or the 'client-centred'. On a second level of analysis, the historical factors which have driven the development of CM are introduced. These factors include the priority now given to community-based care, 'supply-side economics', the dissatisfaction of human service managers with the performance and loyalty of their professionals, and the priority increasingly being given to risk minimisation and the containment of dangerousness. Despite the stated claim that CM is primarily concerned with promoting the interests of service users, it is argued that CM can be associated with the coercive regulation of clients and practitioners, with the promotion of simplistic and unhelpful images of practice and with the disguising of structural problems. It therefore follows that if CM is not necessarily benevolent it is important to evaluate its actual operations within specific sites in order to consider to what degree instrumental and agency-centred, rather than progressive and client-centred, priorities are being performed.