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부록 1. 1 차조사 (2011 년전검사 ) 설문지 16) 개별조사표 - 제공기관명조사일시년월일 이용자명 조사자명 성별 남 여조사장소 가정방문 기관내방 전화 연 령 만 세, ( ) 년생 이용경로 기초생활보장수급자 사회보장 장애수당 학 력 노령연금 의료급여 1종 의료보장 의료급여 2종 혼인상태 국민건강보험 아웃리치 의뢰 ( 소개 ) 본인 ( 의뢰기관 ) 무학 초등졸 중졸 고졸 전문대졸 대졸이상 미혼 기혼 동거 이혼또는별거 사별 기타 동거형태 3대이상대가족과동거 부모형제와동거 부모와동거 형제및친지와동거 배우자와동거 독거 주거시설 기타 가구소득 월 100만원미만 월 100-200 만원미만 월 200-300 만원미만 월 300-400 만원미만 월 400-500 만원미만 월 500만원이상 서비스이후취업경험 없음 있음총 ( ) 개월월수입 ( ) 만원 주진단 정신분열증 조울증 우울증 기타 ( ) 최초정신의료기관이용연령 만 세 서비스이후입원경험 없음 있음 ( 옆으로) 입원회수및기간 총 총 ( 회 ) 개월 최근 2년간정신과입원경험 없음 있음 ( 옆으로 ) 최근2년간입원회수, 기간 회 ( ) 일 약물복용 하지않음 복용함 ( 옆으로 ) 일일복용횟수하루회 정신과외래의료이용상태 이용않음 주 1 회 ( 옆으로 ) 월 2 회 ( 옆 ) 월 1 회 ( 옆 ) 기타 ( ) 회 서비스이용시작시기 ( ) 년 ( ) 월부터 회당의료이용수준 약처방만받음 10분이내정신과치료 10-30분정신과치료 30분초과정신과치료 - 130 -

- 131 - Brief Psychiatric Rating Scale (BPRS) -24 Instructions : Circle the appropriate rating for each item following the specified clinical interview 1=absent, 2=minimal, 3=mild, 4=moderate, 5=moderate severe, 6=severe, 7=extreme 1 Somatic Concern 2 Anxiety 3 Depression 4 Suicidality 5 Guilt feeling 6 Hostility 7 Elevated mood 8 Grandiosity 9 Suspiciousness 10 Hallucination 11 Unusual thought content 12 Bizarre behavior 13 Self-neglect 14 Disorientation 15 Conceptual disorganization 16 Blunted affect 17 Emotional withdrawal 18 Motor retardation 19 Tension 20 Uncooperativenss 21 Excitement 22 Distractability 23 Motor hyperactivity 24 Mannerism and Posturing 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 Total BPRS score

제공기관명 조사일시 이용자명 이용자일련번호로대체할수있음조사자명 지역사회적응척도 (MCAS) Instructions : Circle the appropriate rating for each item following the specified clinical interview 1, 2, 3, 4, 5 의평가기준은척도로확인하십시오. 1 신체장애 1 2 3 4 5 2 지적기능 1 2 3 4 5 3 사고과정 1 2 3 4 5 4 기분이상 1 2 3 4 5 5 스트레스 불안에대한반응 1 2 3 4 5 6 재정관리능력 1 2 3 4 5 7 일상생활에서의독립성 1 2 3 4 5 8 질병에대한수용태도 1 2 3 4 5 9 사회적수용성 1 2 3 4 5 10 사회적관심 1 2 3 4 5 11 사회적효과성 1 2 3 4 5 12 사회적지지망 1 2 3 4 5 13 의미있는활동 1 2 3 4 5 14 약물치료순응도 1 2 3 4 5 15 치료자와의협조 1 2 3 4 5 16 알코올 / 약물남용 1 2 3 4 5 17 충동조절 1 2 3 4 5 Total MCAS score - 132 -

부록 2. 2 3 차조사 (2011 년후검사및 2012 년전검사 ) 설문지 17) 개별조사표 - 제공기관명조사일시 이용자명 이용자일련번호로대체할수있음조사자명 성 별 남 여 조 사 장 소 가정방문 기관내방 전화 연 령 만 세, ( ) 년생 이 용 경 로 아웃리치 의뢰 ( 소개 ) 본인 ( 의뢰기관 ) 기초생활보장수급자 무학 초등졸 사회보장 장애수당 학 력 중졸 고졸 노령연금 전문대졸 대졸이상 의료급여 1종 미혼 기혼 의료보장 의료급여 2종 혼 인 상 태 동거 이혼또는별거 국민건강보험 사별 기타 동거형태 3대이상대가족과동거 부모형제와동거 부모와동거 형제및친지와동거 배우자와동거 독거 주거시설 기타 가구소득 월 100만원미만 월 100-200 만원미만 월 200-300 만원미만 월 300-400 만원미만 월 400-500 만원미만 월 500만원이상 최근 1 년간 없음 현 재 미취업 취업경험 있음총 ( ) 개월 취 업 상 태 취업월수입 ( ) 만원 주 진 단 최초 정신분열증 조울증정신의료기관 우울증 기타 ( ) 이용연령 만 세 정신과병원입 원 경 험 없음 있음 ( 옆으로 ) 입원회수및기간 총 회 총 ( ) 개월 최근 2년간정신과입원경험 없음 있음 ( 옆으로 ) 최근2년간입회원회수, 기간 ( ) 일 약물복용 하지않음 복용함 ( 옆으로 ) 일일복용횟수 하루 회 정신과외래의료이용상태 이전의지역사회서비스이용경험및기간 현재지역사회서비스이용여부 이용않음 주1회 ( 옆으로 ) 월2회 ( 옆) 월1회 ( 옆) 기타 ( ) 회 회 당 의 료 이 용 수 준 약처방만받음 10 분이내정신과치료 10-30 분정신과치료 30 분초과정신과치료 사회복귀시설 ( 이용시설 ) ( ) 년 ( ) 개월 사회복귀시설 ( 주거시설 ) ( ) 년 ( ) 개월 정신보건센터주간재활 ( ) 년 ( ) 개월 정신보건센터방문사례관리 ( 월1회이상 ) ( ) 년 ( ) 개월 장애인직업재활시설 ( ) 년 ( ) 개월 기타 ( ) ( ) 년 ( ) 개월 사회복귀시설 ( 이용시설 ) 사회복귀시설 ( 주거시설 ) 정신보건센터주간재활 정신보건센터방문사례관리 ( 월1회이상 ) 장애인직업재활시설 기타 ( ) 서비스이용 시작시기 ( ) 년 ( ) 월부터 - 133 -

A B S T R A C T The Effects of Case Management Service of People with Mental Illness in the Community on Rehabilitation Outcome - Focusing on Mental Health Total Care Service - Kim, Byoungsoo Department of Social Welfare Graduate School Seoul National University The case management service is inevitable for the successful community rehabilitation of people with the mental illness. However, it was difficult for case management programs performed by the community mental health service center to provide services satisfying the demands of the users because the workload of case managers was too high. Accordingly, the mental health total care service, a case management service lowering the caseload of case manager and providing customized services to users, was introduced. The purpose of this study was to evaluate the rehabilitation performance of the mental health total care service based on psychosocial rehabilitation model from the dimension of psychiatric symptoms and social adaptation and identify the characteristics of service users affecting on the achievements based on the psychological rehabilitation model exploratively. Therefore, the research problems that this study set were; first, Are there achievements of the mental health total care service? and second Is there difference in achievements according to characteristics of mental health total care service users? This study was performed on the responders who continuously used the service from the first measurement time to the third measurement time and answered the mental health total care service achievement survey in two - 134 -

mental health total care service providers under H Mental Health Welfare Foundation from March, 2011 to March, 2012. To analyze data, repeated measure ANOVA analysis on BPRS and MCAS were administered to identify cross-sectional changes of rehabilitation achievements and the difference according to demographical, medical, social security, social supports and employment characteristics. Major results can be summarized as follows. First, it was found that the mental health total care service made positive effects on the rehabilitation achievements of the users. When looking into the trend of achievements change, although there was a decrease of psychiatric symptoms and an increase of social adaptation, the variable breadth was decreasing as time went by. Second, there was a difference in psychiatric symptoms according to the characteristics of service users. Demographical characteristics (sex, age and marital status), medical characteristics (diagnosis, age of onset, experience in hospitalization in a mental hospital, hospitalization for the last two years, mental hospital outpatient status, and whether to take drugs), social security, social supports and employment characteristics were found to make effects on the changes in psychiatric symptoms. Third, it was found that there was a difference in social adaptation according to characteristics of service users. Demographical characteristics (age and marital status), medical characteristics (diagnosis, mental hospital outpatient status, the level of medical service usage per time and whether to take drugs), social security and social supports made effects on the social adaptation. As shown in the above study results, the positive effects of the mental health total care service were confirmed. Accordingly, the case management service should be expanded to people with mental disorders in a community and the achievement evaluation of the case management service for the people with mental disorders in a community should be performed in the long-term - 135 -

basis so that we can identify the change trend of users. Additionally, a case manager should consider the difference in rehabilitation achievements according to characteristics of users during the service provision and operate promotion programs to supplement the decrease of rehabilitation effects with time. Additionally, a mutual supplementary integration of the case management service and the psychiatric medical service is needed. This study is meaningful in that it proved the effects of the case management service with low case workload through the mental health total care service, the social service project went in progress, in that it measured the rehabilitation achievements of case management service users in the dimension of cross-section, and in that the diversity of the process and the result of mental disorders was reconfirmed by identifying the difference in changes of rehabilitation achievements according to users characteristics. Nevertheless, there were limitations such that we could not set an experimental group and a control group utilizing secondary data, that we could not consider various variables influencing rehabilitation achievements, that it was difficult to generalize the result because of the selective sampling, and that we could not reflect the characteristics of suppliers that could influence the achievements of the service. Keywords: Case Management, People with Mental Illness in the Community, Rehabilitation Outcome, Mental Health Total Care, Repeated Measure ANOVA Analysis Student Number: 2010-22996 - 136 -