Effect of full-service partnerships on homelessness, use and costs of mental health services, and quality of life among adults with serious mental illness

Todd P Gilmer, Ana Stefancic, Susan L Ettner, Willard G Manning, Sam Tsemberis
Archives of General Psychiatry 2010, 67 (6): 645-52

CONTEXT: Chronically homeless adults with severe mental illness are heavy users of costly inpatient and emergency psychiatric services. Full-service partnerships (FSPs) provide housing and engage clients in treatment.

OBJECTIVE: To examine changes in recovery outcomes, mental health service use and costs, and quality of life associated with participation in FSPs.

DESIGN: A quasi-experimental, difference-in-difference design with a propensity score-matched control group was used to compare mental health service use and costs of FSP with public mental health services. Recovery outcomes were compared before and after services use, and quality of life was compared cross-sectionally.

SETTING: San Diego County, California, from October 2005 through June 2008.

PARTICIPANTS: Two hundred nine FSP clients and 154 clients receiving public mental health services.

MAIN OUTCOME MEASURES: Recovery outcomes (housing, financial support, and employment), mental health service use (use of outpatient, inpatient, emergency, and justice system services), and mental health services and housing costs from the perspective of the public mental health system.

RESULTS: Among FSP participants, the mean number of days spent homeless per year declined 129 days from 191 to 62 days; the probability of receiving inpatient, emergency, and justice system services declined by 14, 32, and 17 percentage points, respectively; and outpatient mental health visits increased by 78 visits (P < .001 each). Outpatient costs increased by $9180; inpatient costs declined by $6882; emergency service costs declined by $1721; jail mental health services costs declined by $1641; and housing costs increased by $3180 (P < .003 each). Quality of life was greater among FSP clients than among homeless clients receiving services in outpatient programs.

CONCLUSIONS: Participation in an FSP was associated with substantial increases in outpatient services and days spent in housing. Reductions in costs of inpatient/emergency and justice system services offset 82% of the cost of the FSP.

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