We propose a controlled study of Critical Time Intervention (CTI) for men and women with severe mental illness (SMI) during the transition from psychiatric hospital to community care. The primary objective of CTI is to reduce adverse outcomes during this transition and thereby improve community integration for mentally ill persons. Homelessness is the primary adverse outcome we hope to diminish. Other adverse outcomes include: suicidal ideation and behavior; violence toward others; and psychiatric re-hospitalization. CTI is a time-limited intervention designed specifically to enhance the continuity and focus of care during such transitions. It does not replace community treatment and supports, but instead is meant to complement available services. CTI has previously been demonstrated to be effective with severely mentally ill men following discharge from psychiatric care in a shelter institution to community care. It consists of in vivo training in community living skills and team-managed transfer of caregiving to services and supports in the community. A key aspect of CTI is that the post-discharge phase of the intervention is delivered by staff who have established relationships with patients during their institutional stay. Effective outreach and support are greatly enhanced by staff knowledge of the population and the strength of the individual relationships that have been previously developed. A sample of 250 individuals (175 men and 75 women) will be enrolled into the study during their hospital stay. Subjects will receive a thorough baseline assessment, including research diagnoses of major mental disorders. After this assessment, subjects will be randomized into control (n=125) and experimental (n=125) treatment groups. Following hospital discharge, the control group will receive usual aftercare and community care services; aftercare services from this hospital are considered among the best in the region. Those in the experimental group will receive these services as well as nine months of CTI. Both groups will be followed for eighteen months.
