Housing histories of assertive community treatment clients: program impacts and factors associated with residential stability.

OBJECTIVE: Although housing is widely recognized as a crucial issue for people with severe and persistent mental illness, there is much to learn about the ongoing housing experiences of this group of people. Using secondary data, this study examined the housing histories of 65 assertive community treatment (ACT) clients from 2 years prior until up to 7 years after intake, totalling 407 addresses. METHOD: We used statistical process control to assess the significance and longevity of pre- and post-ACT changes in residential tenure and independent living. We used multivariate survival analysis to explore participant and residence characteristics associated with residential stability. RESULTS: After 6 months in ACT, the client population showed a significant, sustained improvement in housing stability. Similarly, shortly after ACT entry, there was a marked increase in the proportion of participants living independently. At the participant level, substance abuse was the strongest predictor of residential instability; other predictors included age (30 years or younger) and sex (female). Residence characteristics also proved important; independent housing, neighbourhood income (a proxy for housing quality), and receipt of a rental subsidy were associated with significantly longer tenure, controlling for client characteristics. CONCLUSIONS: The timing and magnitude of the observed changes imply that ACT was effective in helping clients to achieve stable housing and to live independently. The results also underscore the importance of high-quality housing in promoting residential stability.

Patient factors associated with missed appointments in persons with schizophrenia.

OBJECTIVE: There is limited research on factors that may predict missed appointments. This study examined correlates to missed appointments in a sample of persons attending an outpatient schizophrenia program. METHOD: We measured the rate of missed appointments for 342 outpatients with severe and persistent mental illness (that is, with diagnoses of schizophrenia, schizoaffective disorder, and delusional disorder) attending a psychiatric outpatient clinic over a period of 2 years and 3 months. We collected and analyzed demographic and clinical variables to ascertain differences between patients with high and low rates of nonattendance. RESULTS: Patients who missed 20% or more of their appointments were significantly younger, were more likely to abuse drugs and alcohol, and manifested lower levels of community functioning. CONCLUSIONS: This profile may be useful in helping clinicians to schedule appointments for this clinical population, to identify those who may need community outreach services, and to improve their treatment prospects.