Eligible recipients of mental health targeted case management are persons with serious and persistent mental illness, as determined by a diagnostic assessment and eligibility screening. Eligible recipients have recently (in the last two years) experienced:

• civil mental health commitment;
• extended residential mental health treatment;
• more than two hospitalizations for mental health; or
• current risk of placement, hospitalization, or commitment for mental health without intensive community supports.

Case managers assess clients’ functioning and needs for services. They refer clients to services that reduce risk of hospitalization or placement, but do not provide direct care services such as housekeeping, personal care, transportation, mental health therapy or skills training. When a client needs these services, the case manager will identify resources and make referrals to services that meet the client’s needs. The role of the case manager is to:

• Review the diagnostic assessment
• Assess current strengths, resources, needs, functioning, health, safety, vulnerability, and risk
• Screen for substance use/abuse
• Identify recipient goals
• Plan services
• Connect the recipient with resources and supports to achieve goals
• Refer and link the recipient to service providers for treatment and rehabilitation