Most adults do not qualify for Medicaid, even those people who are homeless and living with mental illness.
Adults do not qualify for North Carolina Medicaid, even those people who are homeless, poor and living with mental illness, unless they have qualified for federal disability benefits. Photo courtesy Tom Brandt, flickr creative commons


People with mental health issues making the transition to more independent living will get a bit more help with a new program.

By Rachel Herzog

Sometimes people with mental health issues can have a hard time getting back on their feet when leaving a psychiatric hospital or being released from jail. But for the past two and a half years, the Critical Time Intervention program has helped these folks in Orange and Chatham counties transition to new homes.

The CTI team in Chapel Hill has served about 130 people during that time, said CTI project director Bebe Smith during an event to highlight CTI at NC State University’s McKimmon Center Wednesday morning.

Bebe Smith headshot
Bebe Smith brought CTI to Orange and Chatham Counties. Image courtesy Bebe Smith

CTI aims to help individuals with mental illness who need a little assistance navigating the world, Smith said. Now the program is expanding its reach across the state.

Productive practice

In North Carolina, CTI began as a pilot program out of UNC-Chapel Hill. Before that, it was a project pioneered in New York City.

Daniel Herman, a researcher at New York’s Hunter College, worked on developing the program.

He said that while New York City had opened housing programs to help homeless individuals with severe mental illness and started offering outreach services, many of these people would lose their housing within a matter of months or even weeks and be back in the shelter or on the streets. Herman called this the “revolving door” phenomenon.

“What CTI was intended to do was to try to provide a way to break that cycle by trying to think a little more carefully about how to help people get settled and situated in their community or their new housing place,” Herman told several dozen social workers and mental health advocates during Wednesday’s meeting.

The new centers, which will launch in June in North Carolina, are being run by the mental health managed care organizations Alliance Behavioral Healthcare, Coastal Care, Partners Behavioral Health Management and Cardinal Innovations Healthcare Solutions. The new Alliance center will serve Cumberland County, Cardinal will expand the UNC program’s work into Alamance County, CoastalCare will run the program in Onslow and New Hanover counties and Partners will create three new teams in Gaston County.

Different centers will adjust the CTI model to focus on different at-risk populations. The Alliance center will help individuals transitioning out of detention centers, Coastal Care will help individuals transitioning out of hospitals and Partners will help homeless individuals.

Filling the gaps

Smith doesn’t know how many people the new centers will serve yet, but it will be a lot, she said.

“I think we’ve had some pretty significant gaps in our mental health system,” she said. “I think that with CTI we can start filling some of those gaps and help people who are not connected to services in the community.”

Most adults do not qualify for Medicaid, even those people who are homeless and living with mental illness.
People with mental health issues being discharged from the hospital or released from jail often end up homeless without some help to make the transition. Photo courtesy Tom Brandt, flickr creative commons

The Washington, D.C. nonprofit Coalition for Evidence-Based Policy ranked CTI as a top-tier program. In one study, individuals who completed a CTI program retained their housing at a higher rate than people who didn’t get CTI services. In another, based on re-hospitalization data, the average cost saving for individuals who completed the CTI program was $24,000 over 18 months.

Smith cited the 2011 elimination of case management as a challenge that made transitioning people more difficult. Under case management, counselors did one-on-one work to help individuals meet their food, shelter and income needs, but the service was eliminated in favor of care coordination by MCOs.

Thava Mahadevan, director of operations at UNC’s Center for Excellence in Community Mental Health, is overseeing the expansion into Alamance County. He said the teams are getting to know the community and meeting with law enforcement officers, homeless shelter operators and hospital officials.

“The hope is that we should be able to build as a service division at some point,” Mahadevan said.

Training for the teams at all four centers will take place at the UNC School of Social Work.

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