This fact sheet outlines what services and practices are effective in ending homelessness for people with serious mental illnesses. Encouraging the adoption of evidence-based practices, establishing partnerships with governments and public agencies, and conducting research are suggested.
Question #4
How can we end homelessness among people with serious mental illnesses?
Research has provided a substantial amount of information on what services and practices are effective in ending homelessness for people with serious mental illnesses. 1 The key is to:
- Encourage the adoption of evidence-based practices for services, treatment, and prevention of homelessness;
- Establish partnerships with Federal agencies, state and local governments, and public and private agencies to reduce barriers to services and increase resources and funding; and
- Conduct research that addresses important gaps in knowledge. 2
We know what works
- Outreach, whether in shelters or on the street, is effective. 3 Given the opportunity, most people who are homeless and have serious mental illnesses are willing to accept treatment and services voluntarily. Consistent outreach and the introduction of services at the client’s pace are key to engaging people in treatment and case management services. A consistent, caring, personal relationship is required to engage people who are homeless in treatment.
- Integrated mental health and substance abuse treatment provided by multidisciplinary treatment teams can improve mental health, residential stability, and overall functioning in the community. Regular assertive outreach, lower caseloads, and the multidisciplinary nature of the services available on these teams are critical ingredients leading to positive treatment and housing outcomes. 5
- Providing supportive services to people in housing has proven effective in achieving residential stability, improving mental health, and reducing the costs of homelessness to the community. Supported housing is preferred by many homeless people with serious mental illnesses. Many people who are homeless and have serious mental illnesses can move directly from homelessness to independent housing with supports. However, the transition from homelessness to housing is a critical time that needs intensive support and attention. 5
- Prevention. Homelessness among people with serious mental illnesses can be prevented. Discharge planning to help people leaving institutions to access housing, mental health, and other necessary community services can prevent homelessness during such transitions. Ideally, such planning begins upon entry into an institution, is ready to be implemented upon discharge, and involves consumer input. Providing short-term intensive support services immediately after discharge from hospitals, shelters, or jails has proven effective in further preventing recurrent homelessness during the transition to other community providers. 6
1Fosburg, L. Dennis, D. (eds), Practical Lessons. Washington, D.C.: HHS & HUD. Koegel, P., Burnam, M.A., Baumohl, J. (1996) The causes of homelessness. In Baumohl, J.(ed), Homelessness in America. Phoenix, AZ: Oryx Press, 24-33.
2SAMHSA (2001) Strategic Plan on SAMHSA’s Role in Reducing and Preventing Homelessness 2001-2005 (draft). Rockville, MD: SAMHSA.
3Center for Mental Health Services (2001) Evaluation of the PATH Grant Program. Rockville, MD: CMHS. Lam, J.A., Rosenheck, R. (1999) Street outreach for homeless persons with serious mental illness. Medical Care 37 (9): 894-907. Tsemberis, S., Elfenbein, C. (1999) A perspective on voluntary and involuntary outreach services for the homeless mentally ill. New Directions for Mental Health Services 82: 9-19. Morse, G.A., Calsyn, R.J., Miller, J., et al. (1996) Outreach to homeless mentally ill people. Community Mental Health Journal 32 (3): 261-274. Bybee, D. Mowbray, C.T., Cohen, E.H. (1995) Evaluation of a homeless mentally ill outreach program. Evaluation and Program Planning 18(1): 13-24.
4Ziguras, S.J., Stuart, G.W. (2000) A meta-analysis of the effectiveness of mental health case management over 20 years. Psychiatric Services 51(11): 1410-1421. Morse, G. (1999) A review of case management for people who are homeless. In Fosburg, L. Dennis, D. (eds), Practical Lessons. Washington, DC: HHS & HUD; Lehman, A.F., Dixon, L.B., Kernan, E., DeForge, B.R. (1997) A randomized trial of assertive community treatment for homeless persons with severe mental illness. Archives of General Psychiatry 54: 1038-1043. Morse, G., Calsyn, R., Klinkenberg, et al. (1997) An experimental comparison of three types of case management for homeless mentally ill persons. Psychiatric Services 48(4): 497-503. Burns, B.J., Santos, A.B. (1995) Assertive community treatment. Psychiatric Services 46 (7): 669-675. Dixon, L.B., Krauss, N., Kernan, et al. (1995) Modifying the PACT model to serve homeless persons with severe mental illness. Psychiatric Services 46(7): 684-688.
5Culhane, D.P., Metraux, S., Hadley, T. (2001) The Impact of Supportive Housing for Homeless People with Severe Mental Illness on the Utilization of the Public Health, Corrections and Emergency Shelter Systems. Washington, DC: Fannie Mae Foundation. Lipton, F.R., Siegel, C., Hannigan, A.,et al. (2000) Tenure in supportive housing for homeless persons with severe mental illness. Psychiatric Services 51(4): 479-486. Tsemberis, S., Eisenberg, R.F. (2000) Pathways to housing: Supported housing for street-dwelling homeless individuals with psychiatric disabilities. Psychiatric Services 51(4): 487-493. Rosenheck, R., Morrissey, J., Lam, J., et al. (1998) Service system integration, access to services, and housing outcomes in a program for homeless persons with severe mental illness. American Journal of Public Health 88(11): 1610-1615. Shern, D., Felton, C., Hough, R., et al. (1997) Housing outcomes for homeless adults with mental illness. Psychiatric Services 48 (2): 239-241. Goldfinger, S.M., Schutt, R.K. (1996) Comparisons of clinicians’ housing recommendations and preferences of homeless mentally ill persons. Psychiatric Services 47(4): 413-415. Hurlburt, M.S., Wood, P.A., Hough, R.L. (1996) Providing independent housing for the homeless mentally ill. Journal of Community Psychology 24 (3): 291-310.
6 Rosenheck, R., Dennis, D. (2001) Time-limited assertive community treatment of homeless persons with severe mental illness. Archives of General Psychiatry. 58(11): 1073-1080. Shinn, M., Baumohl, J. (1999) Rethinking the prevention of homelessness. In Fosburg, L.B., Dennis, D.L. (eds.), Practical Lessons. Washington, DC: HHS & HUD. Interagency Council on the Homeless (1999) Exemplary Practices in Discharge Planning. Washington, DC: Interagency Council on the Homeless. Lezak, A., Edgar, E. (1998) Preventing Homelessness Among People with Serious Mental Illnesses. Rockville, MD: CMHS. Averyt, J.M., Kuno, E., Rothbard, A., Culhane, D. (1997) Impact of Continuity of Care on Recurrence of Homelessness Following an Acute Psychiatric Episode. Philadelphia, PA: Center for Mental Health Policy and Services Research, University of Pennsylvania. Susser, E., Valencia, E., Conover, S., et al. (1997) Preventing recurrent homelessness among mentally ill men. American Journal of Public Health 87(2): 256-262.