Housing the Homeless Mentally Ill

The effectiveness of case management interventions for the homeless, vulnerably housed and persons with lived experience: A systematic review

“…ICM had mixed effects on participants' hospitalization outcomes. Two studies reported significant reductions in the number of emergency department visits but not in the use of other hospital services compared to usual care [76,79]; while three additional trials reported no significant reductions in the number of days in hospital compared to usual services or support groups [72][73][74].…”

“…Fourteen of sixteen trials on ICM assessed housing stability [64,65,67,68,[71][72][73][74][75][76][77][78][79][80]. Overall, ICM showed small positive effects on housing outcomes, with seven of these fourteen studies [67,68,72,75,[77][78][79] suggesting improvements in housing stability and the other seven reporting no effect (Table 4). A pooled analysis shows that ICM significantly reduced the number of days spent homeless (SMD -0.22 95% CI -0.40 to -0.03; See Fig 3) but had no significant effect on the number of days spent in stable housing compared to usual services (See Fig 4).…”

“…These findings were unchanged regardless of whether random effects or fixed effects models were used in the analysis (See S7 File). For time-limited interventions, ICM effectively housed more participants [72], reduced time spent in community housing, streets and shelters [77], and reduced the number of moves to different residences [71]. Three other trials reported that ICM was associated with no difference on the number of days in no-rent or privately rented accommodations, better or worse accommodations, stable housing or homelessness compared to standard case management or usual services [74,75,78].…”

Special programs for special groups

“…Research on Thresholds Bridge North for the Homeless. At the Thresholds Bridge North for the Homeless project, research conducted for the Illinois Department of Mental Health and Developmental Disabilities (DMHDD) (Korr and Joseph, 1994) compared homeless DMHDD inpatients randomly assigned to Bridge versus "treatment as usual." After six months of services, 75 percent of the Bridge group were stably housed compared to only 34 percent of the controls, a statistically significant difference.…”

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“…At that point probably about one third of the homeless were persons with severe mental disorders. Although a number of programs have been introduced which have been shown to reduce homelessness among persons with SMI e.g., [6], we are now seeing an increase in the number of mentally ill persons in prisons and jails.…”