North Carolina Coalition to End Homelessness

Preventing Recurrent Homelessness Among Mentally Ill Men: A "Critical Time" Intervention After Discharge from a Shelter

This randomized clinical trial tested an approach to prevent homelessness among mentally ill individuals. Although it is widely believed that mentally disabled persons merit care and accommodation in the community, we frequently fail
in providing it.1-9 In the United States, men and women with chronic mental illnesses such as schizophrenia have a 25%T to 50% risk of becoming homeless, which is about 10 to 20 times the risk of homelessness for the general population. Few would dispute that the prevention of homelessness among mentally ill men and women is a vital issue for public health. Those who become homeless not only may suffer from demoralization and destitution but also may be exposed to related adversities, for instance, to become victims of rape or assault or to
contract serious medical illnesses such as tuberculosis.4.5.8'10"12 In light of the broader
social and historical causes of homelessness, l6 it may be unrealistic to think that all homelessness in this population can be prevented by a health care intervention, but it should be possible to reduce the risk. In recent years there have been notable advances in community psychiatric care and important efforts to find ways to care for mentally ill persons who become homeless. Nonetheless, more than a decade after Baxter and Hopper drew attention to the reemergence of homelessness in developed societies, controlled studies of health care strategies to prevent homelessness in this (and related) population(s) are scant. Most studies
that have attempted to test preventive interventions have failed to achieve conclusive results, partly because of the difficulty of follow-up in this population. The strategy tested in the present
study, critical time intervention (CTI) is designed to prevent homelessness by enhancing the continuity of care for individuals being discharged from institutional to community living. Homelessness among the mentally ill has been attributed, in part, to discontinuity in mental
health services. Discontinuity often occurs when an individual is deinstitutionalized, that is, transferred from an institution to community living. Therefore, CTI creates a bridge between institutional and community care at a critical time in the deinstitutionalization process. We have proposed that the first months of community living are crucial for adjustment. Generally during these first months, relationships are exquisitely fragile and mutual obligations are being
negotiated between the deinstitutionalized individual and those who may offer formal or informal support in community living. In CTI, the period of active intervention is limited to this critical time.
We hypothesized. however, that the effects might endure beyond the period of active intervention.
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Ezra Susser
Author: Ezra Susser
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