Assertive community treatment for homeless persons with schizophrenia and other chronic mental disorders
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文摘
Approximately 25 % of homeless persons in the United States suffer from a chronic mental illness. In an effort to develop an innovative treatment approach, 152 homeless persons with chronic mental illnesses (SCID diagnoses: 58 % schizophrenia, 28 % major affective disorders, 14 % other diagnoses; 71 % co-morbid substance use disorders) were randomized to either an experimental Assertive Community Treatment (ACT) team or to usual community services. The ACT Team is a mobile, interdisciplinary team of psychiatrists, nurses, social workers, case managers, and consumer advocates. One year outcomes revealed a 50 % reductions in nights spent homeless on the streets, emergency room visits, and nights in jail; 25 % reduction in hospital days; and a 30 % increase in stable housing among the ACT patients compared to controls. ACT patients experienced a significant reduction in symptoms (Colorado Symptom Index) compared to controls within two months of initiation of the intervention. ACT patients also reported enhanced satisfaction with their living situation, neighborhood, safety, and life in general. However, functional status, reflected by interpersonal relations, daily activities, and employment, did not improve for ACT patients relative to controls. The study demonstrates the potential for Assertive Community Treatment programs to engage homeless persons with chronic mental illnesses in treatment that enhances their clinical status and quality of life. The findings also highlight the persistent disabilities imposed on these patients by their psychiatric disorders.