A combination of subsidized housing and intensive case management keeps more homeless people off the street, but at a higher cost, according to a Yale study.
The study comes at a time of national policy discussions about providing permanent subsidized housing for the homeless, as President George W. Bush has set a goal of ending chronic homelessness in 10 years.
Advocates of this approach proposed that decreased expenditure for shelter, health care and criminal justice services would offset the program’s added cost. The study in the September issue of the Archives of General Psychiatry is the first to test this hypothesis.
Three models of subsidy were compared, according to the principal investigator, 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.
Four hundred sixty homeless veterans at Veterans Administration (VA) Medical Centers in San Francisco, San Diego, New Orleans and Cleveland, Ohio, were randomly assigned to the study groups and monitored for three years. Each participant had a diagnosis of schizophrenia, bi-polar disorder, major affective disorder, posttraumatic stress disorder, and/or an alcohol or drug abuse disorder.
Veterans who received 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 seven percent more days housed than the group that received standard VA care. Although effective, the extended program cost an added $45 for each night the veterans spent in an apartment.
The recent report of the Freedom Commission on Mental Illness concluded 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)
