Effect of full-service partnerships on homelessness, use and costs of mental health services, and quality of life among adults with serious mental illness
Involved in the study were chronically homeless adults (defined as an unaccompanied homeless individual with a disabling condition who has been either continuously homeless for a year or more or who has had at least four episodes of homelessness in the past three years) with severe mental illness who are heavy users of expensive inpatient and emergency psychiatric services. Full-service partnerships (FSP) provide housing and engage chronically homeless clients in treatment. The objective of this study was to examine changes in recovery outcomes, mental health service use and costs, and quality of life associated with participation in FSP. This study is a quasi-experimental, difference-in-difference design with a propensity score-matched control group that 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. The study occurred in San Diego County, California, from October 2005 through June 2008, using 209 FSP clients and 154 clients receiving public mental health services. Main outcome measures included: 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. The study found that among FSP participants, the average number of days spent homeless per year declined 129 days and outpatient mental health visits increased by 78 visits. 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. Overall quality of life was greater among FSP clients than among homeless clients receiving services in outpatient programs. 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 percent of the cost of the FSP.
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