Cognitive-behavioral therapy and support services for people with serious mental illness who were experiencing homelessness

OBJECTIVE: This study examined the delivery of cognitive-behavioral therapy (CBT) combined with linkages to supportive services among 508 participants enrolled at multiple homeless service settings in a large urban area. 

METHODS: Longitudinal residualized change via random-effects models was used to examine changes in trauma symptoms and perceptions of mental health recovery from baseline through the 12th CBT session. Factors associated with treatment retention were examined via machine learning by using elastic net regression. 

RESULTS: Statistically significant improvements were observed in both self-reported trauma symptoms and perceptions of mental health recovery through the 12th CBT session. At baseline, greater self-reported community belonging, restlessness, past 30-day emergency department use, and higher alcohol use were associated with higher treatment retention. In contrast, having a mood disorder, cocaine use, and stronger social connections to family and friends were associated with lower retention. 

CONCLUSIONS: Delivery of a 12-session CBT intervention, combined with supportive service linkages, was associated with reduced trauma symptoms and improved perceptions of mental health recovery among people with serious mental illness and experiencing homelessness. Baseline factors linked to treatment retention point to potential targets for adapting CBT to improve treatment retention among this underserved population.