information for practice

More than a decade after the Federal Task Force on Homelessness and Severe Mental Illness called it “unacceptable” for people with serious mental illnesses to live in unsafe and threatening conditions, more than 630,000 individuals are homeless in this country on any given night (Burt et al., 2001). About half of all adults who are homeless have substance use disorders, and many have cooccurring mental illnesses, as well. Yet, the outlook is far from bleak. Federal demonstration programs and the experience of hundreds of community-based providers offer a rich reservoir of evidence-based and promising practices. For example, recent studies reveal that the cost of providing permanent, supportive housing for people with serious mental illnesses is more than offset by savings incurred by the public hospital, prison, and shelter systems (Culhane et al., 2001). When nothing is done, people with serious mental illnesses and/or cooccurring substance use disorders who are homeless often cycle between the streets, jails, and high-cost care, including emergency rooms and psychiatric hospitals. This is inhumane, ineffective, and costly. Further, research reveals that people with serious mental illnesses and/or cooccurring substance use disorders who are homeless, once believed to be unreachable and difficult-to-serve, can be engaged into services, can accept and benefit from mental health services and substance abuse treatment, and can remain in stable housing with appropriate supports (Lam and Rosenheck, 1999; Morse, 1999; Lipton et al., 2000; Rosenheck et al., 1998). Clearly, the time has come to end homelessness among people with serious mental illnesses and/or cooccurring substance use disorders.