The study comes at a time of national policy discussions about provision of permanent subsidized housing for the homeless. In fact, President George W. Bush set a goal of ending chronic homelessness in 10 years.
Advocates of this approach proposed that decreased expenditure of shelter resources, health care and criminal justice services would offset the additional cost of the program. The Yale study published this month in the Archives of General Psychiatry is the first to examine this hypothesis and suggests that costs may increase, although modestly.
Researchers tested three models of subsidy, according to the principal investigator of the study, Robert Rosenheck, M.D., professor of psychiatry and epidemiology and public health. The first group received housing vouchers and intensive case management; the second group case management alone; the third group received standard VA treatment.
Study participants were required to be homeless and living in the streets or shelters with a diagnosis of schizophrenia, bi-polar disorder, major affective disorder, posttraumatic stress disorder, and/or an alcohol or drug abuse disorder. Four hundred sixty homeless veterans were randomly assigned to the study groups and monitored over a three-year period. The study sites were Veterans Administration (VA) Medical Centers in San Francisco, San Diego, New Orleans and Cleveland, Ohio.
In the study, veterans who received a combination of housing vouchers and intensive case management spent 25 percent more nights housed than those who received standard VA treatment and 16 percent more nights housed than veterans who received case management without vouchers. They also had larger networks of social support than either comparison group. The group receiving only case management had only seven percent more days housed than the group that received standard VA care.
The study also addressed another timely issue. The final report of the Freedom Commission on Mental Illness recently concluded that one of the most serious impediments to the delivery of effective services is the fragmentation of the mental health service system. This study demonstrates that the "team-based" approach to solving this problem appears to be more effective than past efforts to integrate entire service systems from the top down.
Citation: Archives of General Psychiatry, Vol. 60: 940-951 (September 2003).