Eric A Latimer1, Daniel Rabouin1, Zhirong Cao1, Angela Ly1, Guido Powell1, Tim Aubry1, Jino Distasio1, Stephen W Hwang1, Julian M Somers1, Vicky Stergiopoulos1, Scott Veldhuizen1, Erica E M Moodie1, Alain Lesage1, Paula N Goering1. 1. Affiliations: Department of Psychiatry (Latimer), McGill University; Douglas Mental Health University Institute (Latimer, Rabouin, Cao, Ly, Powell), West Island Integrated University Health and Social Services Centre, Montréal, Que.; Centre for Research on Educational and Community Services and School of Psychology (Aubry), University of Ottawa, Ottawa, Ont.; Department of Geography (Distasio), University of Winnipeg, Winnipeg, Man.; Division of General Internal Medicine (Hwang), Department of Medicine, University of Toronto; Centre for Urban Health Solutions (Hwang), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont.; Department of Psychiatry (Somers), Simon Fraser University, Burnaby, BC; Department of Psychiatry (Stergiopoulos), University of Toronto, Toronto, Ont.; McMaster University (Veldhuizen), Hamilton, Ont.; Department of Epidemiology and Biostatistics (Moodie), McGill University; Centre de recherche de l'Institut universitaire en santé mentale de Montréal and Department of Psychiatry (Lesage), Université de Montréal, Montréal, Que.; Centre for Addiction and Mental Health (Stergiopoulos, Goering [deceased]) and Department of Psychiatry (Goering), University of Toronto, Toronto, Ont.
Abstract
BACKGROUND: Limited evidence on the costs of homelessness in Canada is available. We estimated the average annual costs, in total and by cost category, that homeless people with mental illness engender from the perspective of society. We also identified individual characteristics associated with higher costs. METHODS: As part of the At Home/Chez Soi trial of Housing First for homeless people with mental illness, 990 participants were assigned to the usual-treatment (control) group in 5 Canadian cities (Vancouver, Winnipeg, Toronto, Montréal and Moncton) between October 2009 and June 2011. They were followed for up to 2 years. Questionnaires ascertained service use and income, and city-specific unit costs were estimated. We adjusted costs for site differences in sample characteristics. We used generalized linear models to identify individual-level characteristics associated with higher costs. RESULTS: Usable data were available for 937 participants (94.6%). Average annual costs (excluding medications) per person in Vancouver, Winnipeg, Toronto, Montréal and Moncton were $53 144 (95% confidence interval [CI] $46 297-$60 095), $45 565 (95% CI $41 039-$50 412), $58 972 (95% CI $52 237-$66 085), $56 406 (95% CI $50 654-$62 456) and $29 610 (95% CI $24 995-$34 480), respectively. Net costs ranged from $15 530 to $341 535. Distributions of costs across categories varied significantly across cities. Lower functioning and a history of psychiatric hospital stays were the most important predictors of higher costs. INTERPRETATION:Homeless people with mental illness generate very high costs for society. Programs are needed to reorient this spending toward more effectively preventing homelessness and toward meeting the health, housing and social service needs of homeless people. Copyright 2017, Joule Inc. or its licensors.
RCT Entities:
BACKGROUND: Limited evidence on the costs of homelessness in Canada is available. We estimated the average annual costs, in total and by cost category, that homeless people with mental illness engender from the perspective of society. We also identified individual characteristics associated with higher costs. METHODS: As part of the At Home/Chez Soi trial of Housing First for homeless people with mental illness, 990 participants were assigned to the usual-treatment (control) group in 5 Canadian cities (Vancouver, Winnipeg, Toronto, Montréal and Moncton) between October 2009 and June 2011. They were followed for up to 2 years. Questionnaires ascertained service use and income, and city-specific unit costs were estimated. We adjusted costs for site differences in sample characteristics. We used generalized linear models to identify individual-level characteristics associated with higher costs. RESULTS: Usable data were available for 937 participants (94.6%). Average annual costs (excluding medications) per person in Vancouver, Winnipeg, Toronto, Montréal and Moncton were $53 144 (95% confidence interval [CI] $46 297-$60 095), $45 565 (95% CI $41 039-$50 412), $58 972 (95% CI $52 237-$66 085), $56 406 (95% CI $50 654-$62 456) and $29 610 (95% CI $24 995-$34 480), respectively. Net costs ranged from $15 530 to $341 535. Distributions of costs across categories varied significantly across cities. Lower functioning and a history of psychiatric hospital stays were the most important predictors of higher costs. INTERPRETATION: Homeless people with mental illness generate very high costs for society. Programs are needed to reorient this spending toward more effectively preventing homelessness and toward meeting the health, housing and social service needs of homeless people. Copyright 2017, Joule Inc. or its licensors.
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