OBJECTIVES: This study examined a strategy to prevent homelessness among individuals with severe mental illness by providing a bridge between institutional and community care. METHODS: Ninety-six men with severe mental illness who were entering community housing from a shelter institution were randomized to receive 9 months of a "critical time" intervention plus usual services or usual services only. The primary analysis compared the mean number of homeless nights for the two groups during the 18-month follow-up period. To elucidate time trends, survival curves were used. RESULTS: Over the 18-month follow-up period, the average number of homeless nights was 30 for the critical time intervention group and 91 for the usual services group. Survival curves showed that after the 9-month period of active intervention, the difference between the two groups did not diminish. CONCLUSIONS: Strategies that focus on a critical time of transition may contribute to the prevention of recurrent homelessness among individuals with mental illness, even after the period of active intervention.

OBJECTIVES This study assessed the effectiveness of a previously tested model, Critical Time Intervention (CTI), in producing an enduring reduction in homelessness for persons with severe mental illness who were discharged from inpatient psychiatric treatment facilities. METHODS A total of 150 previously homeless men and women who were diagnosed with severe mental illness and were discharged from inpatient psychiatric hospitalization were randomly assigned to receive either usual care or usual care plus CTI. The nine-month CTI intervention aims to gradually pass responsibility for providing ongoing support to community sources that will remain in place after the intervention ends, thereby leading to a durable reduction in the risk of future homelessness. Participants’ housing status was assessed every six weeks for eighteen months via participant self-report collected by interviewers blind to condition. RESULTS In an intent-to-treat analysis, participants assigned to the CTI group had significantly less homelessness at the end of the follow-up period (the final three six-week intervals) than did those assigned to the control group (OR=0.22, 95% CI=.06--.88). CONCLUSIONS We have shown that a relatively brief, focused intervention for persons with severe mental illness led to a reduction in homelessness that was evident nine months after the end of the intervention. This work suggests that targeted, relatively short interventions applied at critical transition points may enhance the efficacy of long-term supports for persons with severe mental illness living in the community.

This intervention successfully reduced sexual risk behaviors of homeless men with mental illness. The effect diminished over 18 months but did not disappear. Similar approaches may be effective in other impaired high-risk groups.

We report on the prevalence of human immunodeficiency virus (HIV) infection among psychiatric patients in a New York City shelter for homeless men. We reviewed the records of all 90 men discharged from the shelter psychiatry program to community housing over a 2-year period. HIV serostatus was recorded for 62 of the 90 men. Of these 62, 12 (19.4%) were positive. There were 28 men whose serostatus was not recorded. Data on the HIV risk behaviors of these 28 men suggested that seroprevalence could have been similarly high among them. The results indicate an urgent need to develop and apply preventive interventions for HIV in this population.

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