Community mental health services are lifeline to homeless

March 27, 2000

Washington, DC - Community services are becoming the lifeline to persons with mental illnesses who are homeless or battling substance abuse, according to three articles published in the April issue of Psychiatric Services.

Homeless persons with severe mental illnesses can achieve long term residential stability when given access to safe, affordable housing linked to outpatient services that include case management, according to researchers from New York University School of Medicine.

Researchers followed almost 3,000 individuals for up to five years, and found in the sample that 75 percent, 64 percent, and 50 percent of individuals remained in stable housing after one, two, and five years respectively. Substance abuse was a major factor in disrupting residential stability, highlighting the need to develop new strategies to improve housing alternatives for individuals diagnosed with two illnesses.

"The study demonstrates supportive housing is a powerful vehicle through which the community can address the problem of homelessness among the mentally ill," said researcher Frank R. Lipton, M.D. "It confirms that housing linked to support services is one of the crucial missing links in constructing a community based system of care for individuals with serious mental illness."(1.)

A second published study from the Veterans Affairs Palo Alto Health Care System and Stanford University found more residential substance abuse treatment programs in the community responding to clients with more severe problems than several years ago. However, these community programs now are more likely to have professional staff members and specialized counseling, educational, rehabilitation, and medical services, and to require that patients conform to program rules. (2.)

In a third study, United Behavioral Health in San Francisco surveyed managed care companies to determine if they were disallowing coverage for mental health outpatients before treatment was completed in order to cut costs. Researchers followed 190 mental health patients and their providers, and found more than three-quarters of those surveyed reported that care had ended because of patients' decisions, largely because they had partly or completely met their treatment goal.

Only 10 patients (five percent) stated that treatment ended because the managed care company denied coverage, and in most of those cases, a provider did not request more sessions or failed to negotiate with the managed care company. Researchers speculate that one reason providers may fail to pursue additional sessions for patients is the perceived burden of paperwork, which may interfere with the care process. (3.)
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Note: Copies of these articles are available in their entirety by calling APAfastFAX at 888-357-7924.

1. ["Tenure in Supportive Housing for Homeless Persons with Severe Mental Illness," by Frank R. Lipton, et. al., p. 479] APAfastFAX#6927

2. ["Changes in Services and Structure in Community Residential Treatment Facilities for Substance Abuse Patients," by Christine Timko, et. al., p. 494] APAfastFAX#6928

3. ["Patients' and Providers' Perceptions of Outpatient Treatment Termination in a Managed Behavioral Health Organization," by Brian Cuffel, et. al., p. 469] APAfastFAX#6929

The American Psychiatric Association is a national medical specialty society, founded in 1844, whose 40,000 physician members specialize in the diagnosis and treatment of mental and emotional illnesses and substance use disorders.

American Psychiatric Association

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