Assessing homeless mentally ill persons for permanent housing: Screening for safety

Although placement in community housing is a frequent intervention with populations of seriously mentally ill homeless individuals, there has been little formal investigation of the criteria used by clinicians in screening individuals for such placement. In this paper, we describe screening a population of 303 homeless people with severe mental illness for placement in independent apartments. We assess subjects' level of risk along multiple dimensions and determine the contribution of each risk dimension to the final safety decision. In addition, we evaluate the validity of the risk measures with other measures of clinical condition. Two-thirds of the sample were judged as safe for independent living. Assaultiveness was the most frequent risk identified, followed by self-destructiveness, substance abuse, and medication non-compliance. The final safety decision was associated most strongly with assaultiveness, self-destructiveness, and medication non-compliance. We conclude that it is possible to assess risk with measures that are available from shelter and medical records, and call for more research on the role of medication non-compliance in safety decisions and for longitudinal research to validate risk assessments.This research was funded by NIMH McKinney Grant #1R18MH4808001.Stephen M. Goldfinger, M.D., is affiliated with the Massachusetts Department of Mental Health and the Department of Psychiatry, Harvard Medical School. Russell K. Schutt, Ph.D., is affiliated with the Department of Sociology, University of Massachusetts, Boston and the Department of Psychiatry, Harvard Medical School. Winston M. Turner, Ph.D., is affiliated with the Addictions Service, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School. George S. Tolomiczenko, Ph.D., is affiliated with the Department of Psychiatry, Harvard Medical School. Mark Abelman, M.S.W., is affiliated with the Solomon Carter Fuller Mental Health Center, Boston, MA.