Cost-effectiveness of assertive community treatment for homeless persons with severe mental illness

Background Homelessness is a major public health problem among persons with severe mental illness (SMI). Cost effective program mes that address this problem are needed. Aims To evaluate the cost-effectiveness of an assertive community treatment (ACT) programme for these persons in Baltimore, Maryland. Methods A total of 152 homeless persons with SMI were randomly allocated to either ACTor usual services. Direct treatment costs and effectiveness, rep resented by days of stable housing, were assessed. Results Compared with usual care, ACT costs were significantly lower for me ntal health in-patient days and mental health emergency room care, and sign ificantly higher for mental health outpatient visits and treatment for subs tance misuse. ACT patients spent 31% more days in stable housing than those receiving usual care. ACTand usual services incurred $242 and $415 respect ively in direct treatment costs per day of stable housing, an efficiency ra tio of 0.58 in favour of ACT. Patterns of care and costs varied according t o race. Conclusion ACT provides a cost-effective approach to reducing homelessness among persons with severe and persistent mental illnesses. Declaration of interest This work was supported by a grant from the Center for Mental Health Services, Rockville, Maryland.