Integrated Treatment for Persons with Concurrent Disorders: Effects on Housing Status in a Canadian Inner-City

Abstract

Objective: Residential outcomes of adults with severe and persistent mental illness (SPMI) and substance use disorders were studied over 18-months, during which participants received integrated concurrent disorders services from two models of community-based intensive case management programs. Of primary interest in this analysis were the risks associated with co-occurring addictions on housing quality and stability, and the relative effectiveness of assertive community treatment (ACT) and intensive case management (ICM) on housing outcomes. Methods: Data for this secondary analysis was drawn from one of six projects organized under the Community Mental Health Evaluation Initiative. Clients who were diagnosed as having SPMI with and without co-morbid substance dependence (N=80) were randomly assigned to two case management programs in Toronto, Canada. All clients with concurrent disorders received integrated mental health and substance abuse treatment, but half were provided more fully integrated services from ACT. Housing was classified in one of three categories to describe the quality and consistency of residential tenure: stable housing, unstable accommodation defined by number of address changes, or homeless. Results: Participants with concurrent disorders were much more likely to be homeless or living in unstable, substandard housing than subjects without substance dependence. ICM clients with co-morbid disorders showed greater improvement on housing outcomes, but both case management groups showed strong gains on subjective measures of community adjustment, including empowerment, social support, and symptom distress. Housing stability was mediated by intensity of service contacts. Conclusion: Integrated treatment is a recent innovation in service delivery for persons with concurrent disorders. The favourable outcomes found for ICM in this study raise questions about the relative effectiveness of different implementation strategies to achieve integrated treatment within individual case management programs. The results provide strong support for the hypothesis that service intensity is a critical component promoting community tenure for this at-risk population.