cost of housing, The

Mental Health Nursing,  May 1999  by Lehman, A F

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ACT for homeless persons with severe mental illness

Lehman AF et al.

British Journal of Psychiatry 1999; 174; 346-352.

Assertive community treatment (ACT) is a cost-effective approach to treating homeless people with severe mental illness, researchers from Baltimore, USA, have concluded.

An earlier study by the same researchers reported the benefits of ACT for homeless people with severe mental illness (SMI), showing that ACT, compared with usual community services, meant shorter in-patient stays, and fewer emergency room visits and days homeless. The latest study examined comparative treatment costs to see whether savings are made, through the ACT programmes, by providing on-going, stable community housing, rather than more expensive crisis-oriented programmes.

The Baltimore ACT team is available 24 hours a day, seven days a week, and consists of Iz full-time-equivalent staff, including a medical director and six case managers (nurses, social workers and counsellors).

In the study, I52 homeless people with SMI were randomly allocated either to the ACT team or to usual services.

The researchers found that compared with usual care, costs for ACT were significantly lower for in-patient days and mental health emergency room care, and significantly higher for outpatient visits and treatment for substance misuse. ACT was also more effective in producing more days of stable housing.

The researchers conclude that ACT is at least as cost-effective as usual care, but say its impact may vary according to patient subgroups.

Copyright Community Psychiatric Nurses Association May 1999
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