This fall, the UNC School of Social Work will launch a pilot intervention program that faculty members say could help to prevent homelessness and other adverse outcomes for adults with mental illness who have been discharged from hospitals, shelters, prisons, or other institutions.
The Kate B. Reynolds Charitable Trust in Winston-Salem, a 65-year-old organization that works “to improve the quality of life and quality of health for the financially needy in North Carolina,” awarded Barbara B. Smith, a clinical assistant professor of social work and psychiatry, a $567,257 grant to direct the project in Orange and Chatham counties. Smith received the award during her tenure as co-director of the Center for Excellence in Community Mental Health at UNC’s Department of Psychiatry; the project will be a collaborative endeavor with the Center.
The three-year grant will support the implementation of Critical Time Intervention (CTI), an intensive case-management program that helps individuals with severe mental illness transition from homelessness or institutional settings into communities.
For some, such a transition can be especially difficult without adequate support, Smith said. CTI was developed to help vulnerable adults successfully navigate those challenges. Specifically, CTI team members develop trusting relationships with these adults, then help to identify each person’s specific needs and assist the individuals in accessing necessary supports, such as mental health and substance abuse treatment and housing and vocational services. The goal is to ensure that clients receive the assistance they need upfront and when necessary, on-going support, to maintain stability in their lives, Smith said.
“The model really is flexible and allows the CTI worker to get a good sense for what the client will need formally and informally for the long-term,” she said. “I also think the model is needed because we’ve not done a very good job in addressing the needs of people with severe mental illness.”
The National Alliance to End Homelessness reports that about “25 percent of the homeless population has a serious mental illness, including chronic depression, bipolar disorder, and schizophrenia.” More than 45 percent struggle with substance abuse. According to studies, the CTI model has shown some success nationwide in helping to reduce homelessness and hospitalization stays, Smith said. Additional research, she said, also has shown some promising results in reducing the negative symptoms associated with schizophrenia.
Without adequate shelter, medical or mental health care, homeless persons with mental illness often wind up in emergency rooms or in jails, neither of which is equipped to provide long-term solutions. With the intervention model, Smith said the CTI workers have the opportunity to divert these vulnerable adults away from hospitals, emergency departments and the criminal justice system by linking them to needed assistance sooner.
“If we can get involved with people intensively when they have a high level of need, then we can perhaps avert a crisis and help people move into a more stable situation,” she said.
Smith hopes to roll out the project by September and is talking with agencies in Orange and Chatham counties now to identify intervention participants. School of Social Work Assistant Professor Gary Cuddeback, who is currently leading a federal research study in the same two counties, is co-principal investigator on the project. Cuddeback, whose interests include helping to keep people with mental illnesses from cycling in and out of the criminal justice system, will help evaluate the overall effectiveness of the CTI model.
Altogether, the project should serve about 210 people over three years. But Smith sees the potential to help many more if the pilot program is successful. As part of the project, Smith and Cuddeback will help to educate others on the CTI model and promote its adoption statewide.
“Long-term, we can save costs because emergency room, and hospitalizations and other institutional care are expensive,” she said. “But more important, we can also reduce suffering by addressing people’s real needs and finding ways to connect them to the supports they need or developing those supports because sometimes they’re just not out there.”