Lehman‐Maryland1 1994.

Methods	Allocation: randomised. Design: single centre. Duration: 12 months. Country: Baltimore, Maryland, USA.
Participants	Diagnosis*: severe mental disorder (schizophrenia, schizoaffective disorder, or any other diagnosis axis I and extensive prior hospitalisation history, according to the DSM‐III‐R). N = 152. Setting: CMHCs. Age: 18 to 64 years, mean ˜ 37 years. Sex: 67% M (102M, 50F). History**: i. homeless***, ii. severe mental disorder****, iii. written consent given.
Interventions	1. ICM: Programme of Assertive Community Treatment (Stein and Test model). Caseload: 1:10‐12. N = 77. 2. Standard care: care from community mental health centres and emergency facilities, though also a small amount of non‐ICM. N = 75.
Outcomes	Service use: average number of days in hospital per month, admitted to hospital, average number of admissions to emergency room (mean adjusted for race as covariate). Global state: leaving the study early. Social functioning: not living independently, days in stable accomodation. Mental state: Colorado Symptom Index (CSI) (mean adjusted for race as covariate). Quality of life: Lehman's Quality of Life Index (QOLI), satisfaction with general well‐being (mean adjusted for race as covariate). Costs: direct cost of psychiatric hospital, direct costs of all health care. Unable to use ‐ Social functioning: days in prison (reported data are not complete). Quality of life: specific items reported from Quality of Life Scale (QOLS) (not global assessments). Social functioning: objective QOLS (no data), days homeless (split reporting of different types of homelessness, no SD). General health: Medical Outcomes Study 36‐Item Short Form Health Survey (SF‐36) (mean adjusted for race as covariate) (not listed as outcome of interest for the review).
Notes	*Schizophrenia‐like disorder: 58%, bipolar disorder 20%, major depression 8%, comorbid for substance use disorders 71%. **74% homeless for at least 1 year in total; 34% homeless for ≧ 4 years. ***Homeless defined as: on street or shelter for ≧ 5 days last 45 or ≧ 14 last 180, or in temporary accommodation with ≧ 2 residential moves in last 6 months. ****Severe mental disorder: defined as diagnosis of schizophrenia or schizophrenia‐like illness or receiving benefit because of mental disorder or had another axis I disorder and either: > 2 hospitalisations of > 21 days in past 3 years or a total of > 42 days prior to current hospitalisation or ≧ 90 days in psychiatric hospital or nursing home in past 3 years or mental disability lasting > 1 year during which unable to spend > 75% of time in some gainful activity. Note complex inclusion criteria.
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Randomised (stratified random assignment). No further details.
Allocation concealment (selection bias)	Unclear risk	No details
Blinding (performance bias and detection bias) All outcomes	Unclear risk	Primary outcome: clinician/participant mediated ‐ rating ‐ Unclear. Secondary outcomes: those interviewer rated ‐ rating ‐ Unclear. No details.
Blinding of participants and personnel (performance bias) All outcomes	High risk	Problematic to blind participants and those providing the intervention in studies comparing ICM intervention with standard care.
Blinding of outcome assessment (detection bias) All outcomes	Unclear risk	Source of data not reported for service use (hospitalisations, emergency room visits, outpatient visits for general medical care), social functioning (homelessness, incarceration). Blinding not reported for mental state. Quality of life and health survey self reported.
Incomplete outcome data (attrition bias) All outcomes	Unclear risk	Insufficient reporting of attrition/exclusion (no reasons for missing data provided).
Selective reporting (reporting bias)	High risk	Not all listed outcomes of interest are reported completely.
Other bias	Low risk	Publicly funded (Center for Mental Health Services, Maryland). No details. No evidence of the presence of other bias.