Homeless people with mental illness have complex needs but often receive the fewest services. In Ontario, there is interest in evaluating the services currently being provided for the homeless mentally ill, such as the longstanding intensive case management (ICM) program operated by the Canadian Mental Health Association (CMHA), Ottawa Branch. To address this interest, CMHA Ottawa and the Centre for Research on Community Services at the University of Ottawa are collaborating on an Evaluation of Intensive Case Management for Persons with Severe Mental Illness Who Are Homeless. The study is a clinical trial that compares clients receiving ICM with those receiving standard care, over a two-year period. Final data analysis is expected to be complete by the end of 2003.

What do we know about the homeless people with mental illness participating in this study?

Upon entry to the study, all participants had a severe and persistent mental illness, and many complex needs, such as concurrent substance abuse problems. All were homeless or at risk of becoming homeless, and most were socially isolated, with few resources. Members of this population are often labeled "hard to serve." In the nine months prior to joining the study, 25% lived primarily on the streets or in shelters, while roughly 40% reported being a victim of a violent crime during that time.

At baseline, 55% of the 147 study participants were over 40, 18% were youth (16 to 24 years), and there were roughly equal numbers of men and women. Virtually all (96%) were single and receiving social assistance. Almost half of the participants experienced their first hospitalization for mental illness by age 25, with one-quarter first hospitalized by age 18. While more than 48% have been diagnosed with schizophrenia and 52% with mood disorder, approximately half of the participants have received more than one diagnosis.

What is intensive case management and how does it compare to standard care or assertive community treatment?

The Ottawa ICM program provides client-directed case management support services, including outreach, assessment, service planning and coordination, counselling, advocacy, crisis intervention, and long-term followup. ICM helps clients to achieve their personal goals, build informal supports, and access community resources, and links clients with treatment and rehabilitation services such as social recreation, employment programs, and supportive housing.

For the purpose of this study, standard care (received by the comparison group) is any community service for which the client is eligible. This may include outreach, referrals, and/or short-term support to help clients meet their basic needs (housing, financial assistance, clothing, food, medical care), as well as other mental health services.

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