The British Journal of Psychiatry
Cost-effectiveness of assertive community treatment for homeless persons with severe mental illness.
A F Lehman, L Dixon, J S Hoch, B Deforge, E Kernan, R Frank


BACKGROUND Homelessness is a major public health problem among persons with severe mental illness (SMI). Cost-effective programmes that address this problem are needed.

AIMS To evaluate the cost-effectiveness of an assertive community treatment (ACT) programme for these persons in Baltimore, Maryland.

METHODS A total of 152 homeless persons with SMI were randomly allocated to either ACT or usual services. Direct treatment costs and effectiveness, represented by days of stable housing, were assessed.

RESULTS Compared with usual care, ACT costs were significantly lower for mental health in-patient days and mental health emergency room care, and significantly higher for mental health out-patient visits and treatment for substance misuse. ACT patients spent 31% more days in stable housing than those receiving usual care. ACT and usual services incurred $242 and $415 respectively in direct treatment costs per day of stable housing, an efficiency ratio of 0.58 in favour of ACT. Patterns of care and costs varied according to race.

CONCLUSION ACT provides a cost-effective approach to reducing homelessness among persons with severe and persistent mental illnesses.