Outcomes Associated with Providing Secure, Stable, and Permanent Housing for People Who Have Been Homeless: An International Scoping Review

As governments and service agencies across the world grapple with chronic rates of homelessness and housing instability, there is a growing need to understand the value that providing secure, stable housing brings to the lives of people who are homeless and the broader community. The complex nature of homelessness is revealed across a variety of academic fields including planning, pharmacology, urban affairs, housing policy, nutrition, psychiatry, sociology, public health, urban health, and criminology. We undertook a scoping review according to PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-analysis) that mapped the breadth and scale of the evidence-base and identified themes and gaps. We identified 476 reports and after excluding duplicates and ones that did not relate to our criteria, were left with 100 studies from eight countries. Each of them identified benefits and/or changes that occurred when people experiencing homelessness or housing insecurity transitioned into a secure, stable home. Outcomes measured were distributed across a range of domains including physical and mental health, well-being, mortality rates, criminal justice interaction, service use, and cost-effectiveness. Findings varied by degree but overwhelmingly found improvements in all domains once people were permanently housed. Housing provided a foundation for people to envisage a better life and make plans for the future. As one woman who had fled a violent home was quoted as saying: “housing made everything else possible.” The research identified savings for taxpayers and the wider community once people left homelessness for the stability of a permanent home, even after factoring in the cost of housing and rental help. We found numerous gaps. For example, there was a prevalence of studies that focused on those who are visibly homeless, in particular chronically homeless men with mental illness and/or substance use issues. Much less research looked at women whose patterns of homelessness are more varied and even less at homelessness involving children and families. Women who had left domestic and family violence were investigated in a very small number of studies and sample sizes were small. Few reports undertook the complex task of quantifying and comparing cost savings. Other notable gaps were older women, older people more generally, refugees, recent migrants, veterans, Indigenous people and those with a disability.

Insights from homeless men about PRISM, an innovative shelter-based mental health service

PRISM (Projet Réaffiliation Itinérance Santé Mentale–mental health and homelessness reaffiliation project), is a new shelter-based mental health service in Montreal, Canada. It offers short-term residential services in a shelter with the aim of housing and connecting the person to the appropriate services in the community. This qualitative research project was designed to gain a rich understanding of service-user experience within this program, and to apply these impressions to a broader reflection concerning how to best serve the needs of homeless people living with severe mental illness. We conducted in-depth interviews with 20 clients from the all-male PRISM-Welcome Hall Mission at program intake and departure between May 2018 and March 2019. We used methods stemming from grounded theory to analyze themes emerging from the interviews. Analysis revealed three core aspects endorsed by PRISM clients as helpful to their recovery: first, the community-based and flexible PRISM structure allows for continuity in daily routine through the preservation and expansion of the client’s existing informal resource network; second, the secure environment is conducive to improving one’s physical and mental health; and third, the multimodal mental health and social service approach used at PRISM is appreciated and stands in contrast to what most have experienced during other inpatient experiences. This led us to reflect more broadly on the benefits of a shelter-based intervention, as a catalyst to the achievement of longer-term goals such as housing, as well as flexible care adapted to the specific needs of these individuals. Even though this study took place in a specific program in Quebec, it sheds light more broadly on how to best meet the needs of individuals with mental illness living in homeless situations and contributes to the growing literature on men’s mental health.

The Nexus of Homelessness and Incarceration: The Case of Homeless Men in Trenton, NJ

This article explores the nuanced connections between homelessness and incarceration as told through life stories of homeless men in Trenton, New Jersey. A recurrent theme in the stories was the experience of incarceration. This cycle of male homelessness and incarceration has its origins in the structural conditions of poverty, discrimination, and unemployment in Trenton. It is self-replicating because of a cultural process in which people learn and repeat how to engage with the world. Men copy other men; this is how they learn gender. If fathers or other positive male role models are absent, men are prone to learn gender from idealized, hypermasculine images that feed into the cycle of male homelessness and incarceration. When incarcerated men leave prison and return home to fatherless families and impoverished inner city neighborhoods, this has an adverse impact on them, which has an impact on the dynamics of those families and neighborhoods.

Litigation for the Homeless in the 1980s

Crises typically involve a sense of suddenness. Many are natural in their origin. A tornado fits both. The mass homelessness that began in New York City (and nationwide) in the late 1970s was neither. Yet lawyers advocating for the homeless approached the problem in much the same way as their peers working on more traditionally defined crises. In New York it began with litigation—establishing the right to shelter for homeless men, then women, then families. From there, it moved on to subpopulations such as mentally ill individuals, as housing is not a right recognized by any court. Throughout the late 1970s and into the 1980s, litigatory and nonlitigatory efforts by the Coalition for the Homeless had many important victories, unintended consequences—both good and bad—and provided many valuable lessons for legal practitioners, such as defining the crisis, forming partnerships, and recognizing the limits of litigation.

Destitute and vulnerable- Fear of crime and victimisation among the homeless in urban and rural settings in South Africa

In 2019, the murders of five homeless men in Pretoria drew attention to the vulnerability of people living on the street. Despite more than two decades of democracy, social injustices and inequality continue to characterise post-apartheid South Africa. In addition to rampant poverty burgeoning informal settlements and poor housing, homelessness forms an integral part of the country’s urban and rural landscapes. However, homelessness is often accompanied by victimisation, racial and social injustices, and human rights violations. This paper reports on the victimisation of homeless people in South Africa, their patterns of reporting such incidences, and interactions with criminal justice agents. The paper also contextualises a fear of crime among the homeless and evaluates the limitations of the lifestyle exposure, routine activities, and deviance place theories to adequately explain injustices committed against the homeless. Implications for context-specific and global realities regarding homeless people are discussed. Quantitative data was obtained through non-probability sampling strategies from 40 urban and 30 rural homeless people. More than half of respondents felt unsafe while living on the streets (55.8%), feared becoming a victim of crime in the next year (54.5%) and the greater proportion of respondents (57.1%) had fallen victim to crime in the past. Statistically significant differences (p<0.05; r>0.4) featured between urban and rural respondents in terms of theft and harassment and anticipating victimisation. The findings highlight the social injustices suffered by homeless people, often at the hand of those who are supposed to protect vulnerable groups.

Why are black adults over-represented among individuals who have experienced lifetime homelessness? Oaxaca-Blinder decomposition analysis of homelessness among US male adults

BackgroundNon-Hispanic black adults experience homelessness at higher rates than non-Hispanic white adults in many studies. We aim to identify factors that could account for this disparity.MethodsWe used national survey data on non-Hispanic black and white men with complete data from the National Epidemiological Survey on Alcohol and Related Conditions Wave III. Using the Oaxaca-Blinder decomposition analysis, we examined race-based disparities in correlates of risk for lifetime homelessness.ResultsIn our analysis, 905 of 11 708 (7.7%) respondents, representing 6 million adults nationwide, reported lifetime homelessness. Black adults were 1.41 times more likely to have been homeless than white adults (95% CI 1.14 to 1.73; p=0.002). Overall, 81.6% of race-based inequality in lifetime homelessness were explained by three main variables with black adults having: lower incomes, greater incarceration histories since age of 18 and a greater risk of traumatic events (p<0.01 for each). They also had more antisocial personality disorder, younger age and parental drug use (p<0.05 for each).ConclusionAlthough previous studies suggested that black homeless men have higher rates of drug abuse than white homeless men, our findings highlight the fact that black–white disparities in lifetime homeless risk are associated with socio-structural factors (eg, income and incarceration) and individual adverse events (eg, traumatic events), and not associated with psychiatric or substance use disorders.

Homeless men with psychosis are spending more time shelterless

Objective: The objective of this study was to determine if homeless men with psychosis in central Melbourne have spent a greater proportion of the past 12 months in homeless settings as compared with the same group 15 years previously. Method: A 12-month accommodation history was collected from all men with psychosis assessed by a homeless outreach mental health team over a 12-month period commencing 2018 and compared with data from 2006. Results: Between 2006 and 2018, the percentage of time spent homeless in the previous 12 months rose from 50% to 80% ( p = 0.0001). The mean time spent shelterless increased from 72 days to 149 days ( p = 0.0001). Conclusions: The amount of time spent homeless has increased in men with psychosis assessed in central Melbourne. This finding suggests that men with psychosis are becoming increasingly entrenched in homeless settings. Addressing this trend requires an increased emphasis on assertive outreach, greater access to acute inpatient and long-term rehabilitation units, and more low cost affordable housing, including housing first facilities.