Emergency department utilization among formerly homeless adults with mental disorders after 1-year of housing first: a randomized controlled trial

Homeless individuals represent a disadvantaged and marginalized group who experience increased rates of physical illness, mental and substance use disorders. Compared to housed individuals, homeless adults use emergency departments (ED) and other acute healthcare services at a higher frequency. Housing First (HF) has been identified as an effective means of facilitating acute health service reductions among homeless populations. The present analysis is based on (n=297) participants enrolled in the Vancouver At Home Study (VAH) randomized to one of three intervention arms: HF in a congregate setting (CONG), HF in scattered site apartments (SS), or to treatment as usual (TAU), and incorporates linked data from a regional database representing six urban ED’s. Compared to TAU, significantly lower ED utilization was observed during the post-randomization period in the SS arm. Our results suggest that HF, particularly the SS model, produces significantly lower ED visits among homeless adults with a mental disorder.