This study will evaluate the effectiveness of a psychosocial treatment, Critical Time
Intervention, in easing the transition from hospital to community in people with severe
Severe mental illness (SMI) encompasses a wide range of mental disorders and disabilities,
but commonly includes disorders that involve symptoms of psychosis. Psychotic symptoms may
involve hallucinations, a lost sense of reality, or other distressing symptoms. About 6% of
people experiencing psychotic symptoms seek inpatient treatment at a psychiatric hospital.
Hospital treatment for a person with SMI often focuses on rapid improvement of negative
symptoms and promotion of the necessary skills to successfully return to the community after
leaving the hospital. Despite preparation for community integration, the transition from
hospital to community remains a difficult time for many people with SMIs, with those
affected having an increased chance for suicide, homelessness, and relapse. Critical Time
Intervention (CTI), a psychosocial treatment program that aims to restore skills for
community living and to assist in seeking service and support in the community, may be more
effective than usual care in preventing these adverse outcomes after hospital discharge.
This study will compare the effectiveness of CTI versus usual services in preventing
homelessness and other adverse outcomes after leaving a psychiatric hospital among people
with SMI and psychosis.
Participation in this study will last 18 months. Potential participants will undergo an
initial 15- to 30-minute interview that will include questions about current mental,
physical, and living conditions; history of psychiatric services; and alcohol and drug use.
Eligible participants will then undergo the first full interview, which will include a full
review of medical records and will last between 2 and 3 hours. After this interview,
participants will be assigned randomly to receive CTI or usual services. For participants
assigned to CTI, a CTI specialist will visit participants in the hospital and in their homes
and will stay in contact with participants for 9 months after hospital discharge. During
visits with the CTI specialist, participants will receive training in community living
skills and help finding service and support in the community. Participants assigned to usual
services will receive the usual care and community services offered to people recently
leaving a psychiatric hospital.
After leaving the hospital, participants in both groups will be asked to participate in 15
follow-up interviews, which will include repeat questions from the 2 initial interviews.
Interviews will be conducted once every 6 weeks until 18 months after hospital discharge and
will last between 60 and 90 minutes.
- Diagnosis of psychosis
- Homelessness during the 18 months before study entry
- English speaking