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Robert A. Rosenheck, MD; Deborah Dennis, MA

Arch Gen Psychiatry. 2001;58:1073-1080.

Background  The assertive community treatment (ACT) model for people with severe mental illness was originally designed to be provided continuously without termination. This study evaluated postdischarge changes in health status and service use associated with the time-limited provision of ACT to homeless people with severe mental illness.

Methods  Clients in the fourth annual cohort of the Access to Community Care and Effective Services and Supports (ACCESS) program (N = 1617) were assessed at entry into ACT and 3, 12, and 18 months later. Random effects models were used to compare outcomes and service use among clients who terminated ACT and clients who remained in ACT, controlling for potentially confounding factors.

Results  Altogether, of clients who participated in follow-up, 8.7% participated for less than 3 months; 40.6%, for 3 to 10 months; 15.3%, for 11-13 months; and 35.3%, for 14 months or more. Controlling for potentially confounding factors, mental health, substance abuse, and housing outcomes did not significantly differ between clients who had been discharged at the time of follow-up as compared with those who had not. Those who had been discharged had worked significantly more days than those who had not (t₁₇₉₄ = 3.24, P<.001), and they reported significantly less outpatient health service use though there was no decline in hospital days or receipt of public support payments.

Conclusion  Homeless clients who have severe mental illness can be selectively discharged or transferred from ACT to other services without subsequent loss of gains in mental health status, substance abuse, housing, or employment.

From the Department of Veterans Affairs Medical Center and Yale Medical School, West Haven, Conn (Dr Rosenheck); and Policy Research Associates, Delmar, NY (Ms Dennis).

Corresponding author and reprints: Robert A. Rosenheck, MD, 182 Department of Veterans Affairs Medical Center, West Haven, CT 06516 (e-mail: robert.rosenheck{at}yale.edu).

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