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Cited by 115Homelessness and Social IssuesPsychiatric care and mental health servicesSchizophrenia research and treatment

Cost-effectiveness evaluation of three approaches to case management for homeless mentally ill clients

Nancy Wolff, Thomas W. Helminiak, Gary A. Morse, Robert J. Calsyn, William Dean Klinkenberg, Michael L. Trusty·1997·American Journal of Psychiatry
DOI 10.1176/ajp.154.3.341
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Abstract

OBJECTIVE: In this study the authors compared the cost-effectiveness of three approaches to case management for individuals with severe mental illness who were at risk for homelessness: assertive community treatment alone, assertive community treatment with community workers, and brokered case management (purchase of services). METHOD: Individuals were randomly assigned to the three treatment conditions and followed for 18 months. Eligibility requirements included a severe DSM-III axis I diagnosis, such as schizophrenia, and either current homelessness or risk for homelessness based on prior history of homelessness. Participants were recruited from the emergency rooms and inpatient units of local psychiatric hospitals. Data on 85 people were available for analyses: 28 in assertive community treatment alone, 35 in assertive community treatment with community workers, and 22 receiving brokered case management (purchase of services). RESULTS: Clients assigned to the two assertive community treatment conditions had more contact with their treatment programs, experienced greater reductions in psychiatric symptoms, and were more satisfied with their treatment than clients in the brokered condition. There was no statistically significant difference between treatment conditions in terms of the total costs of treating the participants. However, the assertive community treatment conditions spent less money on inpatient services than brokered case management, but more on case management services and maintenance (i.e., food stamps, housing subsidies, and Supplemental Security Income payments). CONCLUSIONS: Assertive community treatment has better client outcomes at no greater cost and is, therefore, more cost-effective than brokered case management.

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  • In that 2009 review, only one mental health study was included: an RCT of ACT, ACT plus CHWs, and brokered case management for homeless or at-risk people with serious psychiatric diagnoses.

    “Only one study within this 2009 review addressed mental health: a randomized controlled trial comparing assertive community treatment (ACT), ACT + CHWs, and brokered case management for those with a serious psychiatric diagnosis who are homeless or at risk for being homeless.21,22”

    From Task-sharing approaches to improve mental health care in rural and other low-resource settings: a systematic review (2018) · cites this paper as [21]

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Authors
Wolff, N., Helminiak, T. W., Morse, G. A., Calsyn, R. J., Klinkenberg, W. D., & Trusty, M. L.
ORCID
Nancy Wolff
Venue
American Journal of Psychiatry
Publisher
American Psychiatric Association Publishing
Published
1997-03-01
Volume
154
Issue
3
Pages
341-348
ISSN
  • 0002-953X (ISSN-L)
  • 1535-7228
DOI
10.1176/ajp.154.3.341
OpenAlex
W2399712634
Cited by
115
References
16
Citations by year
2026: 2 · 2025: 2 · 2023: 1 · 2022: 4 · 2021: 1 · 2020: 3 · 2019: 4 · 2018: 1 · 2017: 3 · 2016: 3 · 2015: 1 · 2013: 5 · 2012: 4
FWCI
18.86
Type
journal article
Language
en
Open access
closed
Locations
  • American Journal of Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • National Institutes of Health (5r18mh046160-03)
  • National Institute of Mental Health (MH 46160)
Topics
  • Health Sciences › Health Professions › General Health Professions › Homelessness and Social Issues
  • Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
  • Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
Keywords
cost-effectiveness, case management, homelessness, severe mental illness, assertive community treatment, community workers, schizophrenia, psychiatric hospitalization, housing subsidies, Supplemental Nutrition Assistance Program, Supplemental Security Income, client satisfaction, psychiatric symptoms
MeSH terms
Adult, Mental Disorders, Community Mental Health Services, Cost-Benefit Analysis, Criminal Law, Female, Ill-Housed Persons, Hospitalization, Humans, Male, Patient Dropouts, Probability, Random Allocation, Social Welfare, Treatment Outcome, Health Care Costs, Patient Satisfaction, Case Management

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