IMH Mental Health Case Management
Stakeholder Relationship Map | Patient-Centered Care, Coordinated Transitions and Operational Support
DIRECT CARE RELATIONSHIPS
MULTIDISCIPLINARY & SYSTEM SUPPORT
Family & caregivers
Communication • education • support
Psychiatrists & clinical team
Treatment plans • clinical referrals
IMH inpatient & outpatient
Discharge • handoffs • follow-up
Emergency / crisis services
Risk escalation • emergency review
Medical Social Workers
Social needs • Care Referrals
Community / transitional nurses
Home visits • Step-down Care
Community Support Partners
Housing • Services • Re-integration
IMH leadership / IT & Data
Caseloads • Epic • SOPs • dashboards
CLIENT / PATIENT
Assessment • goals • recovery
CASE MANAGER
Clinical Coordination • Follow-up
May serve as designated care coordinator
CARE PATHWAY
Assess & triage → Plan → Coordinate → Monitor Follow-Up → Document & Escalate
All lines show care coordination or operational support. The assigned Care Coordinator depends on assessed patient needs.