JAMA: A program that included scattered-site supportive housing using rent
supplements and case management services led to more stable housing for
homeless adults with mental illness in four cities in Canada, compared
with usual access to existing housing and community services, but the
intervention did not result in significant improvements in
health-related quality of life, according to a study in the March 3
issue of JAMA.
Homelessness affects large numbers of people in many countries and is
associated with enormous personal and societal costs. One-year
prevalence estimates indicate there were at least 150,000 homeless
people in Canada in 2009 and 1.5 million in the United States in 2012.
Large numbers of homeless adults have mental illness, with or without
substance use disorders. Although the intervention Assertive Community
Treatment (ACT) provides support via a resource-intensive
interdisciplinary team (including a psychiatrist and nurses) and small
caseloads, Intensive Case Management (ICM) is a less-intensive
intervention in which individual case managers broker necessary services
to other supports in the community. Intensive Case Management may be an
appropriate and less-costly treatment option for homeless individuals
not requiring ACT service intensity, according to background information
in the article.
Vicky Stergiopoulos, M.D., and Stephen W. Hwang, M.D., of St.
Michael’s Hospital, Toronto, and colleagues conducted a study in which
1,198 homeless adults with mental illnesses (recruited in Vancouver,
Winnipeg, Toronto, and Montreal) were randomly assigned to the
intervention group (n = 689) or usual care group (n = 509), and followed
up for 24 months. The intervention consisted of scattered-site housing
(using rent supplements) and off-site ICM services. The usual care group
had access to existing housing and support services in their
communities.
The researchers found that during the 24 months following
randomization, the percentage of days stably housed was higher among the
intervention group than the usual care group: Site A, 63 percent vs 30
percent; Site B, 73 percent vs 24 percent; Site C, 74 percent vs 39
percent; and Site D, 77 percent vs 32 percent.
On a measure of quality of life, assessed by a health questionnaire,
the average change of the score from baseline to 24 months was not
statistically different between intervention or usual care participants.
Additional analyses suggested significant gains in condition-specific
quality of life among the intervention group compared with the usual
care group, such as for measures of living situation and safety.
“Our findings highlight that scattered-site housing with ICM services
is effective in reducing homelessness among a broader spectrum of the
homeless population who may have a severe mental illness but do not
require ACT support, best reserved for a smaller group of homeless
adults with high needs for mental health and other support services,”
the authors write.
(doi:10.1001/jama.2015.1163; Available pre-embargo to the media at http://media.jamanetwork.com)
Editor’s Note:
This research has been made possible through a financial contribution
from Health Canada. Please see the article for additional information,
including other authors, author contributions and affiliations,
financial disclosures, etc.
Editorial: Housing as a Remedy for Chronic Homelessness
Mitchell H. Katz, M.D., of the County of Los Angeles, Department of
Health Services, Los Angeles, comments on this topic in an accompanying
editorial.
“Clinicians who provide care for homeless persons are aware that they
can order a variety of reimbursable tests and treatments for them,
except the one intervention that most likely would make all the
difference—supportive housing. There are many conditions medicine cannot
cure; chronic homelessness does not need to be one of them.”
“More than half a million persons are homeless in the United States
on a given night. The study by Stergiopoulos et al suggests that there
is a solution to what has been a difficult and emotionally distressing
problem in the United States, Canada, and around the world.”
(doi:10.1001/jama.2015.1277; Available pre-embargo to the media at http://media.jamanetwork.com)
Editor’s Note: Please see the article for additional information, including financial disclosures, funding and support, etc.