Top

Published in:

01-08-2006

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

Authors: Gary A. Morse, Ph.D., Robert J. Calsyn, Ph.D., W. Dean Klinkenberg, Ph.D., Thomas W. Helminiak, Ph.D., Nancy Wolff, Ph.D., Robert E. Drake, M.D., Robert D. Yonker, Ph.D., Gyanesh Lama, M.S.W., Matthew R. Lemming, M.A., Suzanne McCudden, B.S.

Published in: Community Mental Health Journal | Issue 4/2006

ABSTRACT

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.

American Psychiatric Association (2000). Diagnostic and statistical manual for mental disorders (DSM-IV-IR). Washington, D.C., American Psychiatric Association

Bartels S. J., Teague G. B., Drake R. E., Clark R. E., Bush P., Noordsy D. L. (1993). Service utilization and costs associated with substance abuse among rural schizophrenic patients. Journal of Nervous and Mental Disease 181: 227–232PubMedCrossRef

Bassuk E.L. (2003). Supportive housing for homeless families: Setting a research and evaluation agenda. Presentation to the Bill & Melinda Gates Foundation, Seattle, WA

Bond G. R., Drake R. E., Mueser K. T., Latimer E. (2001). Assertive community treatment for people with severe mental illness – Critical ingredients and impact on patients. Disease Management & Health Outcomes 9: 141–159CrossRef

Brunette M., Drake R. E., Lynde D. W. (eds) (2002). Integrated dual disorders treatment implementation resource kit. Rockville, MD, Center for Mental Health Services Substance Abuse and Mental Health Services Administration

Brunette M. F., Drake R. E., Woods M., Hartnett T. (2001). A comparison of long-term and short-term residential treatment programs for dual diagnosis patients. Psychiatric Services 52: 526–528PubMedCrossRef

Brunette M. F., Mueser K. T., Drake R. E. (2004). A review of research on residential problems for people with severe mental illness and co-occurring substance use disorders. Drug and Alcohol Review 23: 471–481PubMedCrossRef

Carey K. B., Coco K., Simons J. (1996). Concurrent validity of clinicians’ ratings of substance abuse among psychiatric outpatients. Psychiatric Services 47: 842–847PubMed

Clark R. E., Teague G. B., Ricketts S. K., Bush P. W., Xie H., McGuire T. G., et al. (1998). Cost-effectiveness of assertive community treatment versus standard case management for persons with co-occurring severe mental illness and substance use disorders. Health Services Research 33: 1285–1308PubMed

Culhane P. P., Metraux S., Hadley T. (2002). Public denies reductions associated with placement of homeless persons with severe mental illness in supporting housing. Housing Policy Debate 13: 107–163

Dickey B., Azeni H. (1996). Persons with dual diagnosis of substance abuse and major mental illness: Their excess costs of psychiatric care. American Journal of Public Health 86: 973–977PubMed

Drake R. E., Essock S. M., Shaner A., Carey K. B., Minkoff K., Kola L., et al. (2001a). Implementing dual diagnoses services for clients with severe mental illness. Psychiatric Services 52: 469–476CrossRef

Drake R. E., Goldmann H. H., Leff H. S., Lehman A. F., Dixon L., Mueser K. T., et al. (2001b). Implementing evidence-based practices in routine mental health service settings. Psychiatric Services 52: 179–182CrossRef

Drake R. E., McHugo G. J., Clark R. E., Teague G. B., Xie H., Miles K., Ackerson T. H. (1998a). Assertive community treatment for patients with co-occurring severe mental illness and substance use disorder: A clinical trial. American Journal of Orthopsychiatry 68: 201–215CrossRef

Drake R. E., Mercer-McFadden C., Mueser K. T., McHugo G. J., Bond G. R. (1998b). A review of integrated mental health and substance abuse treatment for patients with dual disorders. Schizophrenia Bulletin 24: 589–608

Drake R. E., Mueser K. T., Brunette M. F., McHugo G. J. (2004). A review of treatments for people with severe mental illness and co-occurring substance use disorders. Psychiatric Rehabilitation Journal 27: 360–374PubMedCrossRef

Drake R. E., Osher F. C., Wallach M. A. (1989). Alcohol use and abuse in schizophrenia: A prospective community study. Journal of Nervous and mental Disease 177: 408–414PubMedCrossRef

Drake R. E., Yovetich N. A., Bebout R. R., Harris M., McHugo G. J. (1997). Integrated treatment for dually diagnosed homeless adults. Journal of Nervous and Mental Disease 185: 298–305PubMedCrossRef

Erdfedler E., Faul F., Buchner A. (1996). G*Power. A general power analysis program. Behavior Research Methods, Instruments and Computers 29: 1–11

Essock S. M., Frisman L. K., Kontos N. J. (1998). Cost-effectiveness of assertive community treatment teams. American Journal of Orthopsychiatry 68: 179–190PubMedCrossRef

First M. B., Gibbon M., Spitzer R. L., Williams J. B. W. (1996). User’s guide for the structured clinical interview for DSM-IV Axis I disorders (research version 2.0). New York, American Psychiatric Publishing Inc

Holloway F., Carson J. (1998). Intensive case management for the severe mentally ill: Controlled trial. British Journal of Psychiatry 172: 19–22PubMed

Jerrell J. M. (1996). Cost-effective treatment for persons with dual disorders. New Directions for Mental Health Services 70: 79–91PubMedCrossRef

Lehman A. F., Dixon L., Hoch J. S., DeForge B., Kernan E., Frank R. (1999). Cost-effectiveness of assertive community treatment for homeless persons with severe mental illness. British Journal Psychiatry 174: 346–352CrossRef

Lukoff D., Nuechterlein K. H., Ventura J. (1986). Manual for the expanded brief psychiatric rating scale. Schizophrenia Bulletin 2: 594–602

McHugo, G.J., Drake, R.E., Burton, H.L., & Ackerson, T.H. (1995). A scale for assessing the stage of substance abuse treatment in persons with severe mental illness. Journal of Nervous and Mental Disease, 183, 762–767.PubMedCrossRef

McHugo G. J., Drake R. E., Teague G. B., Xie H. (1999). Fidelity to assertive community treatment and client outcomes in the New Hampshire dual disorders study. Psychiatric Services 50: 818–824PubMed

Meisler N., Blankertz L., Santos A. B., McKay C. (1997). Impact of assertive community treatment on homeless persons with co-occurring severe psychiatric and substance use disorders. Community Mental Health Journal 33: 113–122PubMedCrossRef

Morse, G. (1998). A review of case management for people who are homeless: Implications for practice policy and research. In L.B. Fosburg & D.O. Dennis (Eds.), Practical lessons: The 1998 National symposium on homeless research. U.S. Department of Housing and Urban Development/U.S. Department of Health and Human Services.

Mueser K., Bond G. R., Drake R. E., Resnick S.G. (1998). Models of community care for severe mental illness. A review of research on use management. Schizophrenic Bulletin 24: 37–74

Mueser K. T., Noordsy D. L., Drake R. E., Fox L. (2003). Integrated treatment for dual disorders: A guide to effective practice. New York, Guildford Publications

Phillips S. D., Burns B. J., Edgar E. R., Mueser K. T., Linkins K. W., Rosenheck R. A., Drake R. E., McDonel Herr E. C. (2001). Moving ACT into standard practice. Psychiatric Services 52(6): 771–779PubMedCrossRef

President’s New Freedom Commission on Mental Health (2003). Achieving the promise: Transforming mental health care in America. SAMHSA SMA 03-3832

Regier D. A., Farmer M. E., Rae D. S., Locke B. Z., Keith S. J., Judd L. J., Goodwin F. K. (1990). Comorbidity of mental disorders with alcohol and other drug abuse: Results from the Epidemiologic Catchment Area (ECA) study. Journal of American Medical Association 264: 2511–2518CrossRef

Smith J. E., Meyers R. J. (1995). Handbook of alcoholism treatment approaches: Effective alternatives (2nd ed). Needham Heights, Allyn & Bacon

Sobell M. B., Maiston S. A., Sobell L. C. (1980). Developing a prototype for evaluating alcohol treatment effectiveness. In: Sobell L. C., Sobell M. B., Ward E. (eds) Evaluating alcohol and drug abuse treatment effectiveness. New York, Pergamon

Teague G. B., Bond G. R., Drake R. E. (1998). Program fidelity in assertive community treatment: Development and use of a measure. American Journal of Orthopsychiatry 68: 216–232PubMedCrossRef

Test M. A., Wallisch L. S., Allness D. J., Ripp K. (1989). Substance use in young adults with schizophrenic disorders. Schizophrenia Bulletin 15: 465–476PubMed

UK 700 Group (1999). Intensive versus standard case management for severe psychotic illness: A randomized trial. Lancet 353:2185–2189CrossRef

Weisbrod B. A. (1983). A guide to benefit-cost analysis, as seen through a controlled experiment in treating the mentally ill. Journal of Health Politics, Policy and Law 7: 808–845PubMedCrossRef

Winter J.P., Calsyn R.J. (2000). The Dartmouth Assertive Community Treatment Scale (DACTS): A generalizability study. Evaluation Review 24: 319–388PubMedCrossRef

Wolff N., Helminiak T. W., Diamond R. J. (1995). Estimated societal costs of assertive community mental health care. Psychiatric Services 46: 898–906PubMed

Wolff N., Helminiak T. W., Morse G. A., Calsyn R. J., Klinkenberg W. D., Trusty M. L. (1997). Cost-effectiveness evaluation of three approaches to case management for homeless mentally ill clients. American Journal of Psychiatry 154: 341–348PubMed

Wolff N., Helminiak T. W., Tebes J. (1997). Getting the cost right in cost-effectiveness analyses. American Journal of Psychiatry 154: 736–743PubMed

Title: Treating Homeless Clients with Severe Mental Illness and Substance Use Disorders: Costs and Outcomes
Authors: Gary A. Morse, Ph.D.
Robert J. Calsyn, Ph.D.
W. Dean Klinkenberg, Ph.D.
Thomas W. Helminiak, Ph.D.
Nancy Wolff, Ph.D.
Robert E. Drake, M.D.
Robert D. Yonker, Ph.D.
Gyanesh Lama, M.S.W.
Matthew R. Lemming, M.A.
Suzanne McCudden, B.S.
Publication date: 01-08-2006
Publisher: Springer US
Published in: Community Mental Health Journal / Issue 4/2006
Print ISSN: 0010-3853
Electronic ISSN: 1573-2789
DOI: https://doi.org/10.1007/s10597-006-9050-y

At a glance: The STEP trials

Springer Medicine

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

ABSTRACT

At a glance: The STEP trials

Springer Medicine

ABSTRACT

Please log in to get access to this content

Other articles of this Issue 4/2006

The Challenge of Treating Forensic Dual Diagnosis Clients: Comment on “Integrated Treatment for Jail Recidivists with Co-occurring Psychiatric and Substance Use Disorders”

Variations in Mental Health Courts: Challenges, Opportunities, and a Call for Caution

Availability of Integrated Care for Co-occurring Substance Abuse and Psychiatric Conditions

Integrated Treatment for Jail Recidivists with Co-occurring Psychiatric and Substance Use Disorders

BOOK REVIEWS

Co-location of Health Care for Adults with Serious Mental Illness and HIV Infection