, Volume 42, Issue 4, pp 377-404
Date: 04 Aug 2006

Treating Homeless Clients with Severe Mental Illness and Substance Use Disorders: Costs and Outcomes

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This study compared the costs and outcomes associated with three treatment programs that served 149 individuals with dual disorders (i.e., individuals with co-occurring severe mental illness and substance use disorders) who were homeless at baseline. The three treatment programs were: Integrated Assertive Community Treatment (IACT), Assertive Community Treatment only (ACTO), and standard care (Control). Participants were randomly assigned to treatment and followed for a period of 24 months. Clients in the IACT and ACTO programs were more satisfied with their treatment program and reported more days in stable housing than clients in the Control condition. There were no significant differences between treatment groups on psychiatric symptoms and substance use. The average total costs associated with the IACT and Control conditions were significantly less than the average total costs for the ACTO condition.

The authors thank the study participants for their co-operation in this study; we hope that their lives have improved as a result of their participation. We also appreciate the co-operation of the many agencies that provided treatment to the study participants, particularly Community Alternatives, Places for People, and Peter and Paul Community Services. The following individuals were critical to the execution of the project: Ruth Smith, Mary Maguire, Bill Tourville, Joris Miller, Gretchen Gerteis, Gail Saulnier, Kecia Smith, Dorothy Gano, Jean Mayo and Melinda Bowen. We are also grateful to the many people and agencies who provided service utilization and cost information, particularly Mr. Ed Meyers of the Missouri Department of Mental Health, Mr. Richard Koon and Melanie Neal of the Missouri Department of Social Services, Ron Konkol of the Social Security Administration, Francie Broderick and Kelly Wilson of Places for People, Steve Campbell of Peter and Paul Community Services, Bob Harvey and Marsha Wood of Independence Center, Debra Wilderman of St. Louis University Hospital, Karen Jessop of St. Alexius Hospital, Julia Rogliano of South Pointe Hospital, Nelda James of Barnes Hospital, and Joyce Ellison of the St. Louis Veterans Administration Hospital. Financial support was provided by the National Institute of Mental Health, (MH 57154) and the University of Missouri-St. Louis. However, the views expressed in this paper are the sole responsibility of the authors.
Dr. Gary A. Morse is with Community Alternatives, St. Louis, MO, USA.
Drs. Robert J. Calsyn, Thomas W. Helminiak and Mr. Matthew R. Lemming are with the University of Missouri-St. Louis, St. Louis, MO, USA.
Dr. Robert D. Yonker is now with the University of Toledo, Toledo, OH, USA.
Dr. W. Dean Klinkenberg, Mr. Gyanesh Lama and Ms. Suzanne McCudden are with the Missouri Institute of Mental Health, St. Louis, MO, USA.
Dr. Nancy Wolff is with Rutgers University, New Brunswick, NJ, USA.
Dr. Robert E. Drake is at the Dartmouth Medical School, Hanover, NH, USA.