Hostname: page-component-78c5997874-s2hrs Total loading time: 0 Render date: 2024-11-16T19:26:02.309Z Has data issue: false hasContentIssue false
  • English
  • Français

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

Published online by Cambridge University Press:  02 January 2018

Anthony F. Lehman ,
Lisa Dixon ,
Jeffrey S. Hoch ,
Bruce Deforge ,
Eimer Kernan  and
Richard Frank
Anthony F. Lehman*
Affiliation:
University of Maryland Center for Mental Health Services Research
Lisa Dixon
Affiliation:
University of Maryland Center for Mental Health Services Research
Jeffrey S. Hoch
Affiliation:
University of Maryland Center for Mental Health Services Research
Bruce Deforge
Affiliation:
University of Maryland Department of Family Medicine
Eimer Kernan
Affiliation:
University of Maryland Center for Mental Health Services Research
Richard Frank
Affiliation:
Harvard University Department of Health Care Policy
*
Dr A. Lehman, Department of Psychiatry, University of Maryland, 685 West Baltimore St., MSTF 300, Baltimore, MD 21201. Tel: 410-706-2490; Fax: 410-706-0022; e-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Homelessness is a major public health problem among persons with severe mental illness (SMI). Cost-effective programmes 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 ACT or usual services. Direct treatment costs and effectiveness, represented by days of stable housing, were assessed.

Results

Compared with usual care, ACT costs were significantly lower for mental health in-patient days and mental health emergency room care, and significantly higher for mental health out-patient visits and treatment for substance misuse. ACT patients spent 31% more days in stable housing than those receiving usual care. ACT and usual services incurred $242 and $415 respectively in direct treatment costs per day of stable housing, an efficiency ratio of 0. 58 in favour of ACT. Patterns of care and costs varied according to race.

Conclusion

ACT provides a cost-effective approach to reducing homelessness among persons with severe and persistent mental illnesses.

Type
Papers
Information
The British Journal of Psychiatry , Volume 174 , Issue 4 , April 1999 , pp. 346 - 352
Copyright
Copyright © 1999 The Royal College of Psychiatrists 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Declaration of interest

This work was supported by a grant from the Center for Mental Health Services, Rockville, Maryland.

References

Burns, B. J. & Santos, A. B. (1995) Assertive community treatment: an update of randomized trials. Hospital and Community Psychiatry, 46, 669–675.Google ScholarPubMed
Chandler, D., Meisel, J., McGowen, M., et al (1996) Client outcomes in two model capitated integrated services agencies. Psychiatric Services, 47, 175–180.Google Scholar
Chaudhary, M. A. & Stearns, S. C. (1996) Estimating confidence intervals for cost-effectiveness ratios: an example from a randomized trial. Statistics in Medicine, 15, 1447–1458.3.0.CO;2-V>CrossRefGoogle ScholarPubMed
Clark, R. E., Ricketts, S. K. & McHugo, G. J. (1996) Measuring hospital use without claims: a comparison of patient and provider reports. Health Services Research, 31, 153–169.Google ScholarPubMed
Dixon, L. B., Krauss, N., Kernen, E., et al (1995) Modifying the PACT model to serve homeless persons with severe mental illness. Psychiatric Services, 46, 684–688.Google ScholarPubMed
Flynn, L., Bevilacqua, J. J., Meisler, N., et al (1997) NAMI Anti-stigma Foundation, NAMI PACT Institute for National Dissemination of the PACT Model. Community Support Network News, 11, 10–11.Google Scholar
Gold, M. R., Siegel, J. E., Russell, L. B., et al (1996) Cost-Effectiveness in Health and Medicine: Report on the Panel on Cost-Effectiveness in Health and Medicine. New York: Oxford University Press.CrossRefGoogle Scholar
Goldman, H. H., Gatozzi, A. A. & Taube, C. A. (1981) Defining and counting the chronically mentally ill. Hospital and Community Psychiatry, 32, 21–27.Google ScholarPubMed
Goldman, H. H., Morrissey, J. & Ridgely, S. (1994) Evaluating the Robert Wood Johnson Foundation Program on Chronic Mental Illness. Millbank Quarterly, 71, 37–47.CrossRefGoogle Scholar
Gray, A. M., Marshall, M., Lock wood, A., et al (1997) Problems in conducting economic evaluations alongside clinical trials. Lessons from a study of case management for people with mental disorders. British Journal of Psychiatry, 170, 47–52.CrossRefGoogle ScholarPubMed
Lehman, A. F. (1989) Financing case management. New Directions for Mental Health Services, 40, 67–78.Google Scholar
Lehman, A. F., Postrado, L. T., Roth, D., et al (1994) Continuity of care and client outcomes in the Robert Wood Johnson Foundation Program on Chronic Mental Illness. Millbank Quarterly, 72, 105–122.CrossRefGoogle Scholar
Lehman, A. F., Dixon, L. B., Keman, E., et al (1997) A randomized trial of assertive community treatment for homeless persons with severe mental illness. Archives of General Psychiatry 54, 1038–1043.CrossRefGoogle ScholarPubMed
Marshall, M. & Lockwood, A. (1998) Assertive community treatment for people with severe mental disorders (Cochrane Review). In The Cochrane Library, Issue 2. Oxford: Update Software.Google Scholar
Morrissey, J. P. & Dennis, D. L. (eds) (1990) Homelessness and Mental Illness: Toward the Next Generation of Research Studies. Proceedings of a NIMH-sponsored conference. Rockville, MD: National Institute of Mental Health.Google Scholar
Mueser, K. T., Bond, G. R., Drake, R. E., et al (1998) Models of community care for severe mental illness: a review of research on case management. Schizophrenia Bulletin, 24, 37–74.CrossRefGoogle ScholarPubMed
Mullahy, J. & Manning, W. G. (1995) Statistical issues in cost-effectiveness analysis. In Valuing Health Care: Cost, Benefits, and Effectiveness of Pharmaceuticals and Other Medical Technologies (ed. Sloan, F. A.). Cambridge: Cambridge University Press.Google Scholar
Newman, S. J. (1992) The Severely Mentally III Homeless: Housing Needs and Housing Policy. (The Johns Hopkins University Institute for Policy Studies, occasional paper 12.) Baltimore, MD: Johns Hopkins University Press.Google Scholar
Oifson, M. (1990) Assertive community treatment: an evaluation of the experimental evidence. Hospital and Community Psychiatry 41, 634–641.Google Scholar
Reed, S. K., Hennessy, K. D., Mitchell, O. S., et al (1994) A mental health capitation program: II. Cost-benefit analysis. Hospital and Community Psychiatry 45, 1097–1103.Google ScholarPubMed
Rosenheck, R. M., Neale, P., Leaf, P., et al (1995) Multisite experimental cost study of intensive psychiatric community care. Schizophrenia Bulletin, 21, 129–140.CrossRefGoogle ScholarPubMed
Schinnar, A. P., Rothbard, A. B., Kanter, R., et al (1990) An empirical literature review of definitions of severe and persistent mental illness. American Journal of Psychiatry, 147, 1602–1608.Google ScholarPubMed
Scott, J. E. & Dixon, L. B. (1995) Assertive community treatment and case management for schizophrenia. Schizophrenia Bulletin, 21, 657–668.CrossRefGoogle ScholarPubMed
STATA Corporation (1997) STATA Reference Manual. College Station, TX: STATA Press.Google Scholar
Stein, L. I. & Test, M. A. (1980) Alternative to mental hospital treatment: I. Conceptual model, treatment program, and clinical evaluation. Archives of General Psychiatry, 37, 392–397.CrossRefGoogle ScholarPubMed
Weisbrod, B. A., Test, M. A. & Stein, L. I. (1980) Alternative for mental hospital treatment: II. Economic benefit–cost analysis. Archives of General Psychiatry 37, 400–405.CrossRefGoogle ScholarPubMed
Wolff, N., Heiminiak, T. W. & Diamond, R. J. (1995) Estimated societal costs of assertive community treatment. Psychiatric Services, 46, 898–906.Google Scholar
Submit a response

eLetters

No eLetters have been published for this article.