July 20, 2015
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Substance use, mental health improves among homeless following Housing First intervention

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Housing First with intensive case management improved housing stability and community functioning and reduced alcohol-related problems among homeless individuals with mental health and substance use disorders.

“To address the pervasive problem of homelessness among individuals experiencing mental illness, in 2009, the Mental Health Commission of Canada launched the At Home/Chez Soi (AH/CS) research demonstration project, a four-year multi-site randomized controlled trial of Housing First,” study researcher Vicky Stergiopoulos, PhD, of St. Michael’s Hospital in Toronto, and colleagues wrote. “Developed in New York City by Pathways to Housing, [Housing First] provides immediate access to independent housing and mental health supports, typically Assertive Community Treatment.”

Vicky Stergiopoulos, PhD

Vicky Stergiopoulos

To assess efficacy of Housing First with intensive case management, researchers randomly assigned 378 homeless individuals living in Toronto with a serious psychiatric disorder to the intervention or treatment as usual for 24 months. Some study participants also had a substance abuse disorder.

Participants in the intervention group received a case manager who helped them develop an individualized service plan based on their recovery goals. Independent scattered-site housing was provided to the intervention group. Housing expenses were covered by a study rent allowance of $600 CAD and up to 30% of the participant’s monthly income.

Participants who received treatment as usual had access to traditional housing programs and community services available in Toronto and were given information on these services.

At follow-up, individuals who received Housing First with intensive case management spent more time in stable residences compared with individuals who received usual treatment (75.1% vs. 39.3%).

Similarly, individuals who received the intervention exhibited greater improvement in community functioning than those who received usual treatment (mean difference = 1.67; 95% CI, 0.04-3.3).

Individuals who received the intervention experienced a 53% reduction in the number of days spent experiencing alcohol problems, with a rate ratio of 0.47 (95% CI, 0.22-0.99) compared with those in the treatment-as-usual group.

ED visits did not differ between treatment groups; however, hospitalizations were less common among those who received the intervention.

Among participants who received Housing First with intensive case management, those of non-white ethnicity exhibited increased spending on alcohol and a reduced physical community integration compared with their white peers.

“[Housing First with intensive case management] resulted in significant improvements in housing stability, probability of hospitalization, community functioning, and a reduction in number of days experiencing problems due to and money spent on alcohol use in an ethnically diverse sample of homeless individuals with mental illness living in a large urban metropolis,” Stergiopoulos and colleagues wrote. “Although future research will help further clarify the longer-term effects of this approach, our findings suggest that [Housing First] with [intensive case management] can be effective in a diverse population of homeless individuals experiencing mental illness that may face additional barriers to accessing and engaging in treatment.” – by Amanda Oldt

Disclosure: Please see the full study for a list of all other authors’ relevant financial disclosures.