Information Center Bulletin
Volume 1, No. 2 Winter 1997-98

Findings from Homeless Study Point the Way To Treatment for Co-Occurring Disorders

Traditional programs for homeless people with co-occurring serious mental illnesses and substance abuse disorders largely have fallen short. But new findings demonstrate that people with such problems reduce substance abuse, gain stability, and greatly improve the quality of their lives when they receive a simultaneous array of integrated treatment and support services.

What's more, these encouraging findings from the federal Center for Mental Health Services (CMHS) and its counterpart, the Center for Substance Abuse Treatment (CSAT), go beyond the homeless population. They may point the way to how all people with co-occurring mental health and substance abuse disorders should receive treatment.

"This CMHS/CSAT study contrasted integrated with traditional treatment approaches," says Lawrence Rickards, Ph.D., the director of Clinical Initiatives for CMHS's Homeless Programs Branch. "The findings may profoundly change treatment approaches and service delivery to this vulnerable homeless population."

Rickards notes that although the data from the six projects are still being analyzed, some key findings are emerging that may be useful to planners, block grant administrators, service providers, and others who work with homeless people who have co-occurring disorders.

The study's findings show that:

• Integrated services for co-occurring disorders provided within a single agency are superior to other forms of treatment (4 of 6 evaluations);
• Substance abuse declines and mental health improves (all six projects); and
• It's essential to link treatment with other supports, such as housing, child care, legal services, and income.

In the first phase of the study, 16 integrated treatment programs for homeless adults with co-occurring disorders documented the services they provided. "At the time, no one really knew the best way to provide services for these individuals," Rickards says. Six of the most promising programs then evaluated the effectiveness of their services over two years.

The projects varied in their integrated treatment programs but clustered in four approaches: outreach and early engagement, case management, day treatment services, and residential treatment. Because the cities and demographics of the homeless populations were so different at each site, the projects were not evaluated to see which approach proved most effective or whether one approach is better than another.

"For example, the kinds of disorders and the services needed were very different for homeless Vietnam veterans than those for homeless individuals in Brooklyn," says Rickards. "So what we wanted to ferret out was the effectiveness of each project for the kinds of services it provided to its unique homeless population." Each project did, however, compare its findings with a similar demographic group which received non-integrated services.

Among the study's other findings, it shows:

• Statistically significant reductions in illegal behavior;
• High rates of maintaining stable housing 3 months after graduating (almost 90 percent in one program);
• Statistically significant improvements in mental health status;
• A reduction in the number of days clients reported being homeless; and
• Statistically significant improvements in family ties and community involvement.

In addition, some participants made substantial gains in employment and income. For example, 61 percent of the participants in the Vietnam Veterans of San Diego program had been continuously employed six months after graduating. In contrast, only 33 percent of those who left the program early could claim the same. What's more, those who graduated earned, on average, $1,000 more per quarter than those who did not.

Rickards points out that the drop-out rate in programs for homeless people who have co-occurring disorders is generally extremely high. "Earlier studies have had drop-out rates as high as 66 percent. In contrast, the CMHS/CSAT projects had retention rates as high as 74 percent," he says. "It's especially gratifying to see such positive changes these individuals have made in terms of quality of life and reduced substance abuse as a result of receiving truly integrated services."

A final report is expected sometime this winter.

CMHS and CSAT are components of the Substance Abuse and Mental Health Services Administration, an agency within the Department of Health and Human Services.

For more information on the CMHS/CSAT Collaborative Demonstration Program for Homeless Individuals, contact Lawrence Rickards, Ph.D., at 301-443-3706. To receive a copy of the report call 800-789-CHMS (2647) or download it at our World Wide Web site, mentalhealth.samhsa.gov/.

Information Center Bulletin
Volume 1, No. 2