We cannot accept the current condition of homelessness in our communities. This is especially true for a sizeable and particularly tragic segment of our homeless population. A disproportionate 16 percent of adults who are homeless are diagnosed with a severe mental illness (e.g., schizophrenia, bipolar disorder) and 30-70 percent of those also have a substance-use disorder (National Coalition for the Homeless, 2008).
These individuals present complex challenges to an already under-supported and insufficient mental health “non-system.†To serve this population successfully, it’s essential that communities advance and expand mental health treatment models with demonstrated effectiveness.
One approach with well-documented superiority compared with other models is aptly named assertive community treatment (ACT). ACT is among the most evidence-supported and effective practices for improving outcomes for homeless individuals with severe mental illness (Coldwell & Bender, “The Effectiveness of ACT for Homeless Populations with Severe Mental Illness: A Meta-Analysis,†American Journal of Psychiatry, March 2007). At the center of the ACT model is a multi-disciplinary team of mental health professionals that includes at least one psychiatrist, social worker, substance abuse specialist, nurse, vocational specialist and/or housing specialist. This team delivers almost all services in the community outside of the traditional office setting. It assists clients in all areas of life and provides services directly rather than brokering them out to other agencies. Perhaps the most crucial aspect of the team is its emphasis on outreach and the building of ongoing, hope-instilling relationships.
ACT works. The American Journal of Psychiatry recently published a review of 10 separate studies on the effectiveness of ACT for homeless persons with severe mental illness. ACT showed an astonishing 104 percent greater reduction in homelessness and a 62 percent further improvement in symptoms of mental illness compared with other case-management treatments.
It is a sad reflection on our community that more people who could otherwise be helped out of homelessness and into recovery from psychiatric disabilities are not receiving needed treatment services, housing support and public embrace. ACT is part of the solution; but a problematic theme in our fragmented service system persists – ACT is scarce.
Spencer Cook
Housing coordinator
XDS INc.
I think that a lot of the problem here is ignorance.
If the general populous were educated to these facts, then it seems plausible that these sort of statistics would be unacceptable to most.
What are things that everyday people (not involved in the Mental Health or Substance Abuse fields) can do to better help this problem?
What advocacy groups are out there that can educate?