Preventing recurrent homelessness among mentally ill men: a "critical time" intervention after discharge from a shelter.

OBJECTIVES This study examined a strategy to prevent homelessness among individuals with severe mental illness by providing a bridge between institutional and community care. METHODS Ninety-six men with severe mental illness who were entering community housing from a shelter institution were randomized to receive 9 months of a "critical time" intervention plus usual services or usual services only. The primary analysis compared the mean number of homeless nights for the two groups during the 18-month follow-up period. To elucidate time trends, survival curves were used. RESULTS Over the 18-month follow-up period, the average number of homeless nights was 30 for the critical time intervention group and 91 for the usual services group. Survival curves showed that after the 9-month period of active intervention, the difference between the two groups did not diminish. CONCLUSIONS Strategies that focus on a critical time of transition may contribute to the prevention of recurrent homelessness among individuals with mental illness, even after the period of active intervention.

[1]  E. McGlynn,et al.  An experimental evaluation of residential and nonresidential treatment for dually diagnosed homeless adults. , 1996, Journal of addictive diseases.

[2]  E. Torrey Jails and prisons--America's new mental hospitals. , 1995, American journal of public health.

[3]  L. Dixon,et al.  Modifying the PACT model to serve homeless persons with severe mental illness. , 1995, Psychiatric services.

[4]  John B. Willett,et al.  It’s Déjà Vu All Over Again: Using Multiple-Spell Discrete-Time Survival Analysis , 1995 .

[5]  Bruce G. Link,et al.  Lifetime and five-year prevalence of homelessness in the United States. , 1994, American journal of public health.

[6]  R. Rosenheck Homelessness in America. , 1994, American journal of public health.

[7]  D. Bybee,et al.  Short versus longer term effectiveness of an outreach program for the homeless mentally Ill , 1994, American journal of community psychology.

[8]  R. Wyatt,et al.  Follow-up of chronically homeless mentally ill men. , 1993, The American journal of psychiatry.

[9]  R. Smith,et al.  Experimental comparison of the effects of three treatment programs for homeless mentally ill people. , 1992, Hospital & community psychiatry.

[10]  R. Rosenheck,et al.  Mental health status and community adjustment after treatment in a residential treatment program for homeless veterans. , 1992, The American journal of psychiatry.

[11]  M Davies,et al.  The Structured Clinical Interview for DSM-III-R (SCID). II. Multisite test-retest reliability. , 1992 .

[12]  C. Cohen,et al.  Homeless mentally ill or mentally ill homeless? , 1992, The American journal of psychiatry.

[13]  E. Susser,et al.  Risk factors for homelessness among patients admitted to a state mental hospital. , 1991, American Journal of Psychiatry.

[14]  R. Drake,et al.  Homelessness and dual diagnosis. , 1991, The American psychologist.

[15]  M. Olfson Assertive community treatment: an evaluation of the experimental evidence. , 1990, Hospital & community psychiatry.

[16]  R. Wyatt,et al.  An evaluation of a mental health program for homeless men. , 1990, The American journal of psychiatry.

[17]  R. Wyatt,et al.  Scienceless to homeless. , 1986, Science.

[18]  H. Goldman,et al.  The alchemy of mental health policy: homelessness and the fourth cycle of reform. , 1985, American journal of public health.

[19]  L. Bachrach Asylum and chronically ill psychiatric patients. , 1984, The American journal of psychiatry.

[20]  K. Hopper,et al.  The new mendicancy: homeless in New York City. , 1982, The American journal of orthopsychiatry.

[21]  B. Weisbrod,et al.  Alternative to mental hospital treatment. II. Economic benefit-cost analysis. , 1980, Archives of general psychiatry.

[22]  L. Stein,et al.  Alternative to mental hospital treatment. I. Conceptual model, treatment program, and clinical evaluation. , 1980, Archives of general psychiatry.

[23]  D. Mechanic Mental health and social policy , 1970 .

[24]  R. Rosenheck,et al.  Multisite experimental cost study of intensive psychiatric community care. , 1995, Schizophrenia bulletin.

[25]  B. Burns,et al.  Assertive community treatment: an update of randomized trials. , 1995, Psychiatric services.

[26]  R. Diamond,et al.  Estimated societal costs of assertive community mental health care. , 1995, Psychiatric services.

[27]  H H Goldman,et al.  Evaluating the Robert Wood Johnson Foundation program on chronic mental illness. , 1994, The Milbank quarterly.

[28]  Bruce G. Link,et al.  Risk factors for homelessness. , 1993, Epidemiologic reviews.

[29]  E. Susser,et al.  Diagnosis and screening for psychotic disorders in a study of the homeless. , 1990, Schizophrenia bulletin.

[30]  R. Drake,et al.  Housing instability and homelessness among aftercare patients of an urban state hospital. , 1989, Hospital & community psychiatry.

[31]  F. R. Lipton,et al.  Housing the homeless mentally ill: a longitudinal study of a treatment approach. , 1988, Hospital & community psychiatry.

[32]  J. Talbott The Chronic mentally ill : treatment, programs, systems , 1981 .