Rent subsidies, mental health care tied to housing stability for homeless

(Reuters Health) – Mentally ill homeless adults may have an easier time finding and keeping stable housing when they receive rent supplements and mental health support services, a Canadian study suggests.

Researchers focused on the effectiveness of Housing First, a program in Toronto that’s different from traditional approaches to housing for homeless adults with mental illness that require aid recipients to achieve sobriety and or undergo psychiatric treatment. Housing First provides immediate access to housing and mental health services without any preconditions.

All 575 participants in the current study were homeless and mentally ill, and some of them also had substance use disorders. Researchers randomly assigned them to receive Housing First services with community treatment or with intensive case management, or to a control group that only received access to more traditional support programs.

Over the first year of the study, people assisted by Housing First spent 70% to 72% of their days in stable housing, whereas people who received traditional support services conditioned on sobriety and psychiatric treatment spent 23% to 30% of their days in stable housing, the study found.

And by the sixth year of the study, people assisted by Housing First spent 86% to 88% of their days in stable housing, compared with 60% to 78% of days in stable housing for individuals who received traditional support services.

Much of this difference might be due to the higher likelihood of unmet needs among homeless adults who received traditional support services instead of immediate assistance through Housing First, lead study author Dr. Vicky Stergiopoulos of the Center for Addiction and Mental Health in Toronto and colleagues write in Lancet Psychiatry.

“Participants with high support needs in the TAU group maintained persistent low levels of housing stability during the study period, exposing persisting access barriers to appropriate services for this population,” Stergiopoulos and colleagues write.

“These findings highlight the unmet needs of homeless adults with mental illness and high support needs, even within a resource rich service delivery context, and the limited effectiveness of usual services in supporting housing stability for this population,” the authors write.

The study is the first to suggest that Housing First is associated with lasting increases in the number of days homeless adults spend in stable housing, especially for individuals with more severe mental health needs, the study team notes.

Housing First wasn’t associated with improvements in quality of life, reductions in the severity of substance abuse problems, or better functioning in the community, the study found. But the program didn’t make any of these outcomes worse, either.

It’s also not yet clear what specific aspects of Housing First might have had the most positive impact on the lives of homeless adults, or how easily a program like this might be replicated.

Even so, the results add to the evidence suggesting that the Housing First program does meet the needs of many adults it serves, Emmy Tiderington of the Rutgers School of Social Work in New Brunswick, New Jersey, writes in an editorial accompanying the study.

“This study adds to an extensive body of literature that has already demonstrated the positive effect of Housing First on housing stability over time,” Tiderington writes. “The major contribution of this particular study is the documentation of the effect of the intervention over a 6 year period, which is the longest follow-up to date.”

SOURCE: bit.ly/2XKvj5o Lancet Psychiatry, online October 7, 2019.