The extent to which non-conditional housing programs improve housing and well-being outcomes: a systematic review

Purpose To reduce rates of homelessness, recent efforts have been directed toward developing non-conditional supported housing programs that prioritize the delivery of housing support and individual services, without tenancy conditions (i.e. maintaining sobriety and adhering to mental health treatment). As promising as these programs are, findings generally show that while housing stability is improved, other individual outcomes remain largely unchanged. No review to date has synthesized the collective evidence base of non-conditional housing programs, rather the focus has been on specific programs of delivery (e.g. Housing First) or on specific population groups (e.g. those with mental illness). The purpose of this paper is to evaluate the extent to which non-conditional housing interventions improve housing and well-being outcomes for all persons. Design/methodology/approach A systematic search of the literature was conducted for randomized controlled studies that evaluated the effectiveness of a non-conditional housing intervention in improving housing and health outcomes among any participant group. Findings A total of 31 studies were included in this review. Non-conditional supported housing programs were found to be most effective in improving housing stability as compared to health and well-being outcomes. Policymakers should consider this when developing non-conditional supported housing programs and ensure that housing and other health-related outcomes are also mutually supported. Originality/value This is the first review, to the authors’ knowledge, to synthesize the collective impact of all non-conditional supported housing programs. The current findings may inform the (re)design and implementation of supported housing models to prioritize the health and well-being of residents.

Clinical and psychosocial profile of persons with mental illness living in non-hospital residential facilities in a district in Kerala, India: A cross-sectional survey

Background: Clinical and psychosocial profiles of persons living with mental illness (PMI) in non-hospital settings in India have not been adequately studied. Aim: This study describes the profile of PMI living in non-hospital settings by focussing on variables like functioning and social networks. Method: Residents of all available residential facilities in one district area were surveyed and descriptive data was obtained. Socio occupational functioning was assessed using the Social and Occupational Functioning Scale (SOFS) and social network was measured by modified Lubben Social Network Scale-6 (LSNS-6). Results: A total of nine centres housing 491 residents (7–128) were surveyed via field visits. The mean age of the residents was 49 ± 14.0 years. Fifty per cent of them were never married, 22% were separated or widowed. Almost half of the people had psychotic disorders, while diagnosis could not be delineated in a quarter of the population. Almost half the people reached the facilities with the help of their families, while 40% were brought by police or volunteers who found them wandering. Impairment in socio-occupational functioning was only mild in 90% of residents, while 60% did not contact relatives or friends in the past 3 months. Conclusion: PMI living in non-hospital residential facilities were on average in their middle age and were deficient in marital bonds and other social support. They had reached the centres with the help of extended family or by police/volunteers who rescued them from wandering status. Nevertheless, most of them had only mild to moderate levels of impairment, and their functional capacity was good for independent living in the community with support. Hence, newer models of supported housing that provide greater community reintegration, like independent shared housing within regular neighbourhoods, can be tried. In persons with residual family ties, providing continuous community-based support may help re-establish family integration.

A Mirror-image Analysis of Psychiatric Hospitalisations among People with Serious Mental Illness using Independent Supported Housing

PurposeEvidence on the effectiveness of Independent Supported Housing (ISH) for non-homeless people with mental illness primarily comes from observational cohort studies, which have high risk of bias due to confounding by time-invariant sample characteristics. The present study proposes an alternative study design known from pharmacology to overcome this bias and strengthen evidence. MethodsWe conducted a retrospective mirror-image analysis with medical records of 144 ISH service users to assess the effectiveness of ISH in reducing the number and duration of hospitalisations. Outcomes occurring in equal periods before and during ISH utilisation were compared for every ISH user. Differences between the periods were tested with incidence rate ratios (IRR). ResultsIncluded service users were on average 38.2 years old, female (54%) and predominately had an affective (28.5%) or a schizophrenic or psychotic (22.9%) disorder with ISH utilisation days ranging from 36-960. Fewer admissions (IRR=0.41, 95%-CI 0.27-0.64) and fewer person-days hospitalised (IRR=0.38, 95%-CI 0.35-0.41) were observed during utilisation period compared to prior to their ISH utilisation. While the reduction in psychiatric admissions may be somewhat confounded by time-variant characteristics, the substantial reduction in hospitalised bed-bays represents at least partially an intervention effect. ConclusionsThe mirror-image study design allowed for a cost-effective investigation of ISH effectiveness in reducing hospitalisation without confounding by time-invariant sample characteristics. We provide recommendations for the design’s application and suggest further research with larger samples.

Deinstitutionalisation and ‘Home Turn’ Policies: Promoting or Hampering Social Inclusion?

By the end of the twentieth century, caring for vulnerable adults in the community had become a pervasive policy trend in the Western world. In this article, this policy is described in two phases: deinstitutionalisation and the ‘home turn’ that are reflected from the perspective of social inclusion. Deinstitutionalisation has meant large institutions and asylums being replaced by group homes and communal‐supported housing units in the community. In the second and current phase, the ‘home turn’ emphasises well‐developed community care, home‐based services, everyone’s right to have their own home, and having a valued place in the community. In this semi‐systematic narrative review, the widely shared incentives, premises, and criticisms of deinstitutionalisation and the ‘home turn’ are mapped from the research literature. The special focus is on the possibilities of and hindrances to social inclusion in both policy phases. The research results are mixed and conflicting concerning social inclusion, but there exists a wide consensus that small housing units and supported housing with devoted workers enhance social inclusion better than big institutions. However, the prevalent view is that deinstitutionalisation has not fulfilled its promise of social inclusion, and although the ‘home turn’ is a step in the right direction, there are still problems in strengthening service users’ involvement and creating inclusive and accepting communities.

Human-Animal Relationships in Supported Housing: Animal Atmospheres for Mental Health Recovery

Being in a relationship with an animal can promote the well-being of people. For many individuals, this usually takes place at home. This study reports about homes for people with mental health problems (with or without co-occurring substance use), who live in supported housing operated by public landlords, entailing tenancies that are usually stricter regarding their pet policies than ordinary homes. We thus addressed the following research questions through ethnographic fieldwork at seven distinct places: which types of human–animal relationships occur in supported housing, and how do they affect the tenants? We analyzed the collected data informed by the Grounded Theory approach and found three types of human–animal relationships within supported housing affecting the tenants differently, namely, “no animals,” “visiting animals,” and “shared/sole ownership of animals.” Animals in the buildings can stage atmospheres that promote solidarity and connectedness among people. In contrast, situations in which animals are forbidden can create emotional tensions between tenants and staff or landlords. When discussing fostering animal atmospheres and limits to keeping pets, we concluded that animals can contribute to the mental health recovery of tenants by creating acknowledgment and rootedness. Therefore, public housing services need to guarantee equal rights to the tenants as they do with every citizen, including the right to keep a pet.

Restorative Practices in Institutional Settings: The Challenges of Contractualised Support within the Managed Community of Supported Housing

Supported housing services provide help to some of the most vulnerable in society, yet across the world face increasing pressures from residualisation in the form of service reduction and stretched budgets. In response to these challenges, providers of supported housing and other similar community-focused services have sought alternative and innovative methods of engagement. This paper reports on one such example, the Restorative Communities Programme, which took place in 2018 in a residential supported housing setting for males aged 16–25. Designed as a five-week programme, it aimed to offer a proactive intervention promoting the benefits of restorative thinking. The research team observed the sessions and conducted follow-up qualitative interviews after two weeks and one year. This paper considers the challenges and success of the programme, reflecting particularly on issues of contractualised support and its impact on participation, and the dynamics of running such programs within the ‘managed community’ of a supported housing project. As such, the paper provides a useful analysis for others exploring the development and use of restorative projects in institutional settings, such as prisons, probation, and schools, and particularly those services struggling with the pressures of residualisation.