Benefits of Supported Housing for People with Psychiatric Disabilities

Benefits of Supported Housing for People with Psychiatric Disabilities

Conclusions based on a systematic review of published research studies

Compiled by the Supported Housing Study Group at Boston University Center for Psychiatric Rehabilitation. Innovative Knowledge Dissemination & Utilization Project for Disability & Professional Stakeholder Organizations/ NIDRR Grant # (H133A050006)

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Learning Objective: Increased Understanding About….

Characteristics and principles of supported housing

Factors that contribute to positive supported housing outcomes

Positive outcomes for people with psychiatric disabilities who receive supported housing services

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Learning Activities

Review of Trainee Supported Housing Knowledge and Experiences

Presentation & Exercise: Supported Housing Principles

Presentation and Exercise: Factors that Positively Effect Supported Housing Outcomes

Presentation and Exercise: Supported Housing Benefits to the Individual

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Review of Supported Housing Knowledge and Experiences

Successes and Challenges

Experiences with Supported Housing

Characteristics of Supported Housing

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Supported Housing Principles

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Housing is permanent. Individuals either own their homes or have a lease in their own name. Permanence has the same meaning as it does for anyone else

renting a house or apartment in the community.

Rog, Debra J., (2004). The Evidence of Supported Housing. Psychiatric Rehabilitation Journal, 27 (4), 334-343.

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Housing is distinct and separate from other services. Housing and service agencies are legally and functionally separate.


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Housing is integrated into the community.

Apartments or houses are located among other houses and apartments that one would find in the community.


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Housing is affordable.

No more than 40% of the individuals adjusted gross income is required for rent or mortgage payments.


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Mental health services are offered, not mandated.

The individual does not have to avail her/himself of any services, including medication, in order to participate in the program. Services are flexible, individualized, and voluntary that come and go depending on the individual’s needs and preferences.


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The individual chooses the housing and mental health services. Individuals are offered options about where s/he wants to live and from whom s/he wants services, if any. Although the person’s ideal choice can’t be guaranteed, the place that s/he lives in must be based on whether s/he chooses to live there or not.


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Services are community based.

There are no live in staff.


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Crises services are available.

Crises services are available 24 hours per day, 7 days a week.


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Factors that Positively Impact Supported Housing Outcomes

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Factors that Appear to Positively Impact Supported Housing Outcomes

Choice of housing

Having more than one housing option increases the individual’s desire to stay and leads to a better functional match between the person and the housing. (Srebnik et al, 1995)

Greater information about housing options during the process of choosing housing is related to desire to stay in residence. (Srebnik et al, 1995)


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Rapid entry into housing

Facilitating entry into housing quickly increases the likelihood that the individual will stick with services and achieve independent housing. (Mares, Kasprow, & Rosenheck, 2004)


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Housing subsidies and vouchers

When housing is affordable, there is a more direct and quicker exit from homelessness and stable independent living is more likely . (Hurlburt, et al., 1996)

Subsidies and vouchers enable individuals access to higher quality housing, which positively impacts keeping people housed and satisfied with their housing. (Hurlburt, et al., 1996)


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Intensive services Regular case management is no better than services as usual – intensive services are needed. (Rosenheck, et al., 2003)

ACT case management leads to greater satisfaction, greater contact with service providers, reduced symptoms, and greater stability in the community. (Morse, et al., 1997; Fletcher, et al., 2008)

Individuals receiving intensive case management are less likely to terminate services, which can lead to better housing outcomes. (Clark & Rick, 2003)


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Integrated services

A nine site, four year study found that agencies with improved inter-organization integration of services had greater improvement in housing status outcomes than those that did not. . (Rosenheck, 2002)


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Practical services

Help with day to day tasks, e.g., house keeping, shopping, budgeting, is needed to increase housing stability.


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Supported Housing Benefits

for the Individual

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Supported Housing Benefits to the Individual

Residential status can be significantly improved.

Living situations for individuals who are psychiatrically disabled, with a psychiatric disability and homeless (or at risk of becoming homeless) and with substance abuse problems can be significantly improved. (Tsemberis, et al., 2004; Gulcur, et al., 2003; Shern et al., 1997; Rosenheck, et al., 2003; Goldfinger, et al., 1999; Morse, et al., 2006)

Experimental studies have found that the proportion of individuals who were housed in a community setting (not the streets, a shelter, or an institution) was higher by an average of 15% than those in control groups. (Tsemberis, et al., 2004; Gulcur, et al., 2003; Shern et al., 1997; Rosenheck, et al., 2003; Goldfinger, et al., 1999; Morse, et al., 2006).

Studies have shown significantly faster decreases in homelessness for individuals participating in supported housing. (Tsemberis, et al., 2004)


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Housing stability can be improved to rates of 80% or more. (Goldfinger, et al., 1999) Individuals in supported housing tend to have significantly fewer moves and thus less disruption in their lives.

More than one controlled study measuring the % of time individuals remained housed during follow-up attained the 80% rate.

Follow-up periods ranged from 90 days to over 1 year , in one case, 5 years.


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Quality of life can be increased. (O’Connell, et al., 2008)

Living in a place of preference is correlated with the individual’s rating of quality of life. (Nelson, et al., 1998)

Individuals with psychiatric disabilities report wanting independent housing, in non-congregate settings by a wide margin. (Middelboe, et al., 1998)

Clinicians are more likely to recommend settings with higher levels of supervision than individual’s prefer, e.g., group homes versus independent housing. (Goldfinger & Schutt, 1996)


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Psychiatric hospitalizations are less likely.

Several studies show a reduction of hospitalization while individuals were housed even though clinical outcomes are more difficult to affect than housing outcomes. (Lipton, et al., 1988; Culhane et al., 2002)


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Other Conclusions Provision of supported housing services may reduce other service-related costs. (Culhane, et al., 2002)

Supported housing approaches may be more expensive than other residential service delivery, but the cost offsets may make the cost benefit equation more palatable when compared to other options. (Culhane, et al., 2002)

Substance abuse, unsuccessful housing history, and criminal arrests are associated with poorer housing outcomes. (Hurlbert, et al, 1996; Kenny, et al., 2004)


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Other Conclusions It is unclear whether substance abuse and psychiatric symptoms are positively effected by successful supported housing outcomes. (O’Connell, 2008)

Some studies suggest that psychiatric diagnosis is not a factor in residential stability and some suggest that it is (Rosenheck, et al., 2003, Hurlbert, et al., 1996).


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ReferencesDickey, B., Gonzalez, O., Latimer, E., Powers, K., Schutt, R., & Goldfinger, SM, 1996. Use of mental health services by formerly homeless adults residing in group and independent housing. Psychiatric Services, 47: 152.

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Goldfinger, S., & R. Schutt, 1996. Comparison of Clinicians' Housing Recommendations and Preferences of Homeless Mentally Ill Persons. Psychiatric Services, 47: 413-415.

Goldfinger, S. M., R.K., Tolomiczenko, G.S., Seidman, L., Penk, W.E., Turner, W., & Caplan, B., 1999. Housing placement and subsequent days homeless among formerly homeless adults with mental illness. Psychiatric Services, 50: 647-679.

Greenwood, R.M., Schaefer-McDaniel, N., Winkel, G., & Tsemberis, S, 2005. Decreasing psychiatric symptoms by increasing choice in services for adults with histories of homelessness.. American Journal of Community Psychology, 36: 223-238.

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ReferencesBurnam, A., Morton, S., McGlynn, E., Petersen, L., Stecher, B., Hayes, C. & J. Vaccaro, 1995. An Experimental Evaluation of Residential and Nonresidential for Dually Diagnosed Homeless Adults: The Effectiveness of Social Interventions for Homeless Substance Abusers. Journal of Addiction Disorders, 14: 111-134.

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ReferencesGulcur, L., Stefanicic, A., Shinn, M., Tsemberis, S., & S. Fischer, S.N., 2003. Housing, Hospitalization, and Cost Outcomes for Homeless Individuals with Psychiatric Disabilities Participating in Continuum of Care and Housing First Programs. Journal of Community & Applied Social Psychology, 13: 171-186.

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ReferencesKallert, T., Leisse, M. & P. Winiecki, 2007. Comparing the Effectiveness of Different Types of Supported Housing for Patients with Chronic Schizophrenia. Journal of Public Health, 15: 29-42.

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ReferencesMartinez, T. B. & M. R. Burt, 2006. Impact of permanent supportive housing on the use of acute care health services by homeless adults. Psychiatric Services, 57: 992-999.

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Middelboe, T., 1997. Prospective study of clinical and social outcome of stay in small group homes for people with mental illness. British Journal of Psychiatry, 151: 251-255.

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ReferencesNelson, G., Hall, B. & R. Walsh-Bowers, 1998. The Relationship Between Housing Characteristics, Emotional Well-

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ReferencesRosenheck, R., Morrissey, J., Lam, J., Calloway, M., Johnsen, M., Goldman, H. Randolph, F. , Blasinsky, M., Fontana, A., Calsyn, R. & G. Teague, 1998. Service system integration, access to services, and housing outcomes in a program for homeless persons with severe mental illness. American Journal of Public Health, 88: 1610-1615.

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Benefits of Supported Housing for People with Psychiatric Disabilities