Cost-effectiveness of assertive community treatment for homeless persons with severe mental illness

Anthony F. Lehman, Lisa Dixon, Jeffrey S Hoch, Bruce Deforge, Eimer Kernan, Richard Frank

Research output: Contribution to journalArticlepeer-review

100 Scopus citations


Background. Homelessness is a major public health problem among persons with severe mental illness (SMI). Cost-effective programmes that address this problem are needed. Aims. To evaluate the cost-effectiveness of an assertive community treatment (ACT) programme for these persons in Baltimore, Maryland. Methods. A total of 152 homeless persons with SMI were randomly allocated to either ACT or usual services. Direct treatment costs and effectiveness, represented by days of stable housing, were assessed. Results. Compared with usual care, ACT costs were significantly lower for mental health in-patient days and mental health emergency room care, and significantly higher for mental health outpatient visits and treatment for substance misuse. ACT patients spent 31% more days in stable housing than those receiving usual care. ACT and usual services incurred $242 and $415 respectively in direct treatment costs per day of stable housing, an efficiency ratio of 0.58 in favour of ACT. Patterns of care and costs varied according to race. Conclusion. ACT provides a cost-effective approach to reducing homelessness among persons with severe and persistent mental illnesses.

Original languageEnglish (US)
Pages (from-to)346-352
Number of pages7
JournalBritish Journal of Psychiatry
Issue numberAPR.
StatePublished - 1999
Externally publishedYes

ASJC Scopus subject areas

  • Neuroscience(all)
  • Psychiatry and Mental health


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