A Randomized Trial of Assertive Community Treatment for Homeless Persons With Severe Mental Illness

doi:10.1001/archpsyc.1997.01830230076011

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Vol. 54 No. 11, November 1997

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A Randomized Trial of Assertive Community Treatment for Homeless Persons With Severe Mental Illness

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 innovativeprogram of assertive community treatment (ACT) for homelesspersons with severe and persistent mental illnesses.

Methods
One hundred fifty-two homeless persons with severe and persistentmental illness were randomized to either the experimental ACTprogram or to usual community services. Baseline assessmentsincluded the Structured Clinical Interview for DSM-III-R, Quality-of-LifeInterview, Colorado Symptom Index, and the Medical OutcomesStudy 36-Item Short Form Health Survey. All assessments (exceptthe Structured Clinical Interview) were repeated at the 2-,6-, and 12-month follow-up evaluations.

Results
Subjects in the ACT program used significantly fewer psychiatricinpatient days, fewer emergency department visits, and morepsychiatric outpatient visits than the comparison subjects.The ACT subjects also spent significantly more days in stablecommunity housing, and they experienced significantly greaterimprovements in symptoms, life satisfaction, and perceived healthstatus.

Conclusions
Relative to usual community care, the ACT program for homelesspersons with severe and persistent mental illness shifts thelocus of care from crisisoriented services to ongoing outpatientcare and produces better housing, clinical, and life satisfactionoutcomes.

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.

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