The development of relationships between people who are homeless and have a mental disability and their case managers

Abstract

Using data collected from people who are homeless and bave a mental disability and who participated in the first 2 years of the Center for Mental Health Services' Access to Community Care and Effective Services and Supports (ACCESS) national demonstration project, we assessed which person-related characteristics predicted the formation and the strength (therpeutic alliance) of a relationship with a clinical case manager. Although all persons were assigned a case manager, those people who reported forming a relationship with a case manager were more likely to be men and African-American, bad more social support, received more public support and education, and subjectively reported more psychological problems. People who were less likely to report forming a relationship with a case manager spent more days intoxicated in the past 30 and more days homeless in the past 60, and were more overtly psychotic. Among clients who reported forming a relationship with a case manager, the alliance was strongest for women, Whites, those who had spent more days homeless in the past 60, and those who reported subjective psychological problems. The results are organized into a framework for understanding the development of a clinical case manager relationship. Implications for outreach to clients who are homeless and bave a mental illness are discussed.