Cost-effectiveness of critical time intervention to reduce homelessness among persons with mental illness

• Objectives: Cost-effective programs are needed to assist homeless persons with severe mental illness in their transition from shelters to community living. The authors investigated the cost-effectiveness of the critical time intervention program, a time-limited adaptation of intensive case management, which has been shown to significantly reduce recurrent homelessness among men with severe mental illness. Methods: Ninety-six study participants recruited from a psychiatric program in a men's public shelter from 1991 to 1993 were randomly assigned to the critical time intervention program or to usual services. Costs and housing outcomes for the two groups were examined over 18 months. Results: Over the study period, the critical time intervention group and the usual services group incurred mean costs of $52,374 and $51,649, respectively, for acute care services, outpatient services, housing and shelter services, criminal justice services, and transfer income. During the same period, the critical time intervention group experienced significantly fewer homeless nights than the usual care group (32 nights versus 90 nights). For each willingness-to-pay value - the additional price society is willing to spend for an additional nonhomeless night - greater than $152, the critical time intervention group exhibited a significantly greater net housing stability benefit, indieating cost-effectiveness, compared with usual care. Conclusions: Although difficult to conduct, studies of the cost-effectiveness of community mental health programs can yield rich information for policy makers and program planners. The critical time intervention program is not only an effective method to reduce recurrent homelessness among persons with severe mental illness but also represents a cost-effective alternative to the status quo.

Subject headings

MEDICIN OCH HÄLSOVETENSKAP  -- Hälsovetenskap (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Health Sciences (hsv//eng)

Keyword

adult

article

clinical trial

community care

controlled clinical trial

controlled study

cost effectiveness analysis

criminal justice

disease severity

evaluation

health care cost

health care planning

health care policy

health care utilization

health program

homelessness

housing

human

income

major clinical study

male

mental disease

mental health care

mental health service

outcomes research

outpatient

randomized controlled trial

technique

Community Psychiatry

Cost-Benefit Analysis

Crisis Intervention

Homeless Persons

Humans

Mental Disorders

New York City

Program Evaluation

Progressive Patient Care

Social Class

Publication and Content Type

ref (subject category)

art (subject category)