This Article  • References  • Full text PDF  • Reply to article  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (104)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Social Bookmarking   What's this?

Anthony F. Lehman, MD, MSPH; Lisa B. Dixon, MD; Eimer Kernan, MSW; Bruce R. DeForge, PhD; Leticia T. Postrado, PhD

Arch Gen Psychiatry. 1997;54(11):1038-1043.

Abstract
Background
This experiment evaluated the effectiveness of an innovative program of assertive community treatment (ACT) for homeless persons with severe and persistent mental illnesses.

Methods
One hundred fifty-two homeless persons with severe and persistent mental illness were randomized to either the experimental ACT program or to usual community services. Baseline assessments included the Structured Clinical Interview for DSM-III-R, Quality-of-Life Interview, Colorado Symptom Index, and the Medical Outcomes Study 36-Item Short Form Health Survey. All assessments (except the Structured Clinical Interview) were repeated at the 2-, 6-, and 12-month follow-up evaluations.

Results
Subjects in the ACT program used significantly fewer psychiatric inpatient days, fewer emergency department visits, and more psychiatric outpatient visits than the comparison subjects. The ACT subjects also spent significantly more days in stable community housing, and they experienced significantly greater improvements in symptoms, life satisfaction, and perceived health status.

Conclusions
Relative to usual community care, the ACT program for homeless persons with severe and persistent mental illness shifts the locus of care from crisisoriented services to ongoing outpatient care and produces better housing, clinical, and life satisfaction outcomes.

Author Affiliations
From the Center for Mental Health Services Research (Drs Lehman, Dixon, and Postrado and Ms Kernan) and the Department of Family Medicine (Dr DeForge), University of Maryland, Baltimore.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Identification of cognitive impairment and mental illness in elderly homeless men: Before and after access to primary health care
Joyce and Limbos
cfp 2009;55:1110-1111.e6.
ABSTRACT | FULL TEXT  

Investigation of Racial and Ethnic Disparities in Service Utilization Among Homeless Adults With Severe Mental Illnesses
Horvitz-Lennon et al.
Psychiatr. Serv. 2009;60:1032-1038.
ABSTRACT | FULL TEXT  

Influence of Family Involvement and Substance Use on Sustained Utilization of Services for Schizophrenia
Fischer et al.
Psychiatr. Serv. 2008;59:902-908.
ABSTRACT | FULL TEXT  

Rates and Risk Factors for Homelessness After Successful Housing in a Sample of Formerly Homeless Veterans
O'Connell et al.
Psychiatr. Serv. 2008;59:268-275.
ABSTRACT | FULL TEXT  

Intensive Case Management as a Jail Diversion Program for People With a Serious Mental Illness: A Review of the Literature
Loveland and Boyle
Int J Offender Ther Comp Criminol 2007;51:130-150.
ABSTRACT  

The Effectiveness of Assertive Community Treatment for Homeless Populations With Severe Mental Illness: A Meta-Analysis
Coldwell and Bender
Am. J. Psychiatry 2007;164:393-399.
ABSTRACT | FULL TEXT  

Scientific and Consumer Models of Recovery in Schizophrenia: Concordance, Contrasts, and Implications
Bellack
Schizophr Bull 2006;32:432-442.
ABSTRACT | FULL TEXT  

A randomized clinical trial of a new behavioral treatment for drug abuse in people with severe and persistent mental illness.
Bellack et al.
Arch Gen Psychiatry 2006;63:426-432.
ABSTRACT | FULL TEXT  

A Review of Economic Evaluations of Community Mental Health Care
Roberts et al.
Med Care Res Rev 2005;62:503-543.
ABSTRACT  

Capturing Intervention Effects Over Time: Reanalysis of a Critical Time Intervention for Homeless Mentally Ill Men
Lennon et al.
AJPH 2005;95:1760-1766.
ABSTRACT | FULL TEXT  

Criminal History as a Prognostic Indicator in the Treatment of Homeless People With Severe Mental Illness
McGuire and Rosenheck
Psychiatr. Serv. 2004;55:42-48.
ABSTRACT | FULL TEXT  

Non-attendance rates among patients attending different grades of psychiatrist and a clinical psychologist within a community mental health clinic
McIvor et al.
Psychiatr. Bull. 2004;28:5-7.
ABSTRACT | FULL TEXT  

Integration of Care: Integrated Treatment of Schizophrenia
Lenroot et al.
Psychiatr. Serv. 2003;54:1499-1507.
ABSTRACT | FULL TEXT  

Cost-effectiveness of Supported Housing for Homeless Persons With Mental Illness
Rosenheck et al.
Arch Gen Psychiatry 2003;60:940-951.
ABSTRACT | FULL TEXT  

Ethical Exploration of the Least Restrictive Alternative
Lin
Psychiatr. Serv. 2003;54:866-870.
ABSTRACT | FULL TEXT  

Cost-Effectiveness of Critical Time Intervention to Reduce Homelessness Among Persons With Mental Illness
Jones et al.
Psychiatr. Serv. 2003;54:884-890.
ABSTRACT | FULL TEXT  

International differences in home treatment for mental health problems: Results of a systematic review
BURNS et al.
Br. J. Psychiatry 2002;181:375-382.
ABSTRACT | FULL TEXT  

Psychotic Ideation and Receipt of Government Entitlements Among Homeless Persons in New York City
Nuttbrock et al.
Psychiatr. Serv. 2002;53:719-723.
ABSTRACT | FULL TEXT  

Improving Employment Outcomes for Persons With Severe Mental Illnesses
Lehman et al.
Arch Gen Psychiatry 2002;59:165-172.
ABSTRACT | FULL TEXT  

Reducing violence in severe mental illness: randomised controlled trial of intensive case management compared with standard care
Walsh et al.
BMJ 2001;323:1093-1093.
ABSTRACT | FULL TEXT  

Housing Attributes and Serious Mental Illness: Implications for Research and Practice
Newman
Psychiatr. Serv. 2001;52:1309-1317.
ABSTRACT | FULL TEXT  

Moving Assertive Community Treatment Into Standard Practice
Phillips et al.
Psychiatr. Serv. 2001;52:771-779.
ABSTRACT | FULL TEXT  

Correlates of Long-Term Unemployment Among Inner-City Adults With Serious and Persistent Mental Illness
Goldberg et al.
Psychiatr. Serv. 2001;52:101-103.
ABSTRACT | FULL TEXT  

Homelessness and health
Hwang
CMAJ 2001;164:229-233.
ABSTRACT | FULL TEXT  

A Meta-Analysis of the Effectiveness of Mental Health Case Management Over 20 Years
Ziguras and Stuart
Psychiatr. Serv. 2000;51:1410-1421.
ABSTRACT | FULL TEXT  

Assertive Community Treatment: Twenty-Five Years of Gold
Dixon
Psychiatr. Serv. 2000;51:759-765.
ABSTRACT | FULL TEXT  

Mentally ill adults had fewer homeless days in staffed group homes than in independent flats
Fenton
Evid. Based Ment. Health 2000;3:16-16.
FULL TEXT  

Correlates of Improvement in Quality of Life Among Homeless Persons With Serious Mental Illness
Lam and Rosenheck
Psychiatr. Serv. 2000;51:116-118.
ABSTRACT | FULL TEXT  

Case Managers' and Clients' Perspectives on a Representative Payee Program
Dixon et al.
Psychiatr. Serv. 1999;50:781-786.
ABSTRACT | FULL TEXT  

Two-Year Outcomes of Psychosocial Rehabilitation of Black Patients With Chronic Mental Illness
Baker et al.
Psychiatr. Serv. 1999;50:535-539.
ABSTRACT | FULL TEXT  

Issues in the Psychiatric Treatment of African Americans
Baker and Bell
Psychiatr. Serv. 1999;50:362-368.
ABSTRACT | FULL TEXT  

Other Articles Noted
Evid. Based Nurs. 1998;1:100-104.
FULL TEXT  

An assertive community treatment programme led to improved housing stability in homeless people with severe mental illness
Marshall
Evid. Based Ment. Health 1998;1:54-54.
FULL TEXT