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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]
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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 

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Footnotes

Declaration of interest

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

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