A RANDOMIZED TRIAL OF ASSERTIVE COMMUNITY TREATMENT FOR HOMELESS PERSONS WITH SEVERE MENTAL-ILLNESS

Background: This experiment evaluated the effectiveness of an innovati ve program of assertive community treatment (ACT) for homeless persons with severe and persistent mental illnesses. Methods: One hundred fif ty-two homeless persons with severe and persistent mental illness were randomized to either the experimental ACT program or to usual communi ty services. Baseline assessments included the Structured Clinical Int erview for DSM-III-R, Quality-of-Life Interview, Colorado Symptom Inde x, and the Medical Outcomes Study 36-Item Short Form Health Survey. Al l 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 v isits than the comparison subjects. The ACT subjects also spent signif icantly more days in stable community housing, and they experienced si gnificantly greater improvements in symptoms, life satisfaction, and p erceived health status. Conclusions: Relative to usual community care, the ACT program for homeless persons with severe and persistent menta l illness shifts the locus of care from crisis-oriented services to on going outpatient care and produces better housing, clinical, and life satisfaction outcomes.