We propose to test the efficacy of an outreach model for providing psychiatric care to the seriously and persistently mentally ill olderly. The model addresses 2 findings from the Epidemiological Catchment Area (ECA) study; first, that the elderly mentally ill are less likely than other age groups to receive needed psychiatric treatment and second, that the elderly living in public housing have 2.5 fold higher rates of mental disorder than the elderly living in public housing. The model is designed to address i) the resistance the elderly have to accepting psychiatric care by providing in-home assessment and initial treatment and ii) the lack of knowledge and resistance to utilizing psychiatric treatment resources present among social service (here building staff) providers. This study will first determine rates of psychiatric, medical and functional disorder in 4 Baltimore City elderly public housing sites. The treatment model will then be implemented for 24 months in 2 of the sites and the other 2 sites used as a comparison group. Monthly hospitalization, eviction, and death data will be collected from building staff. Six monthly medical, social agency and psychiatric service use data will be collected from the residents of the intervention and comparison sites. The primary outcomes will be 2 year rates of undesirable exits, percentage of disorder identified i the screening phase that is detected by the treatment model, depression rating scores and overall psychiatric symptomatology ratings in cases at the treatment site, and life satisfaction (quality of life) of building residents.
