Homeless people with mental illness fare better if they live in cities and towns with high levels of community activism, according to a landmark study

"This is the first study to demonstrate that community matters in the delivery of mental health services to homeless people," says lead study author Robert Rosenheck, M.D., of the VA Medical Center in West Haven, Connecticut.

During the course of one year, Rosenheck and colleagues tracked the progress of more than 2,500 mentally ill homeless people from 18 towns and cities in the United States.

The researchers analyzed community voting records, participation in volunteer work or community projects, the cohesiveness of the various agencies that help homeless people in each community -- for example, whether agencies refer clients to one another or share information or funds.

At the end of the one-year study period, about 40 percent of the study participants were living in stable housing. These no-longer-homeless individuals were more likely to be from cities or towns with high levels of community activism, the researchers found.

The study results are published in the August issue of Health Services Research.

How does community activism help people escape homelessness? It has to do with trust, say the researchers. The more community residents vote, participate in volunteer activities and attend meetings in their communities, the more they build trusting relationships that help agencies throughout the community cooperate with each other.

According to the study, these trusting relationships are especially beneficial to agencies that usually have little interaction and limited experience working together -- such as mental health agencies and public housing agencies.

Previous studies have found that agencies with separate funding are generally not motivated to collaborate, even when they deliver overlapping services to the same population. Community activism may help bridge this gap.

"This study suggests that characteristics of broader civic culture and participation in the public life of the community may have an important impact on cooperation among agencies and that this cooperation yields substantial benefit to clients," says Rosenheck, who is also a Professor of Psychiatry and Public Health at Yale University.

This study was funded by the Center for Mental Health Services of the Department of Health and Human Services and the Substance Abuse and Mental Health Services Administration. The study was carried out by the VA’s Northeast Program Evaluation Center, R.O.W. Sciences, Inc., and the Cecil G. Sheps Center for Health Services Research at the University of North Carolina and the University of Maryland.

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Health Services Research is the bimonthly peer-reviewed journal of the Association for Health Services Research and is owned by Health Research and Educational Trust. For information about the journal, contact Alice Schaller at (510) 643-5439 or email alices@uclink4.berkeley.edu. For copies of the article, contact the Center for the Advancement of Health at 202-387-2829 or e-mail press@cfah.org