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)
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
2
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
3
Review of Supported Housing
Knowledge and Experiences
 Successes and Challenges
 Experiences with Supported Housing
 Characteristics of Supported Housing
4
Supported Housing Principles
5
Supported Housing Principles
 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.
6
Supported Housing Principles
 Housing is distinct and separate from other
services.

Housing and service agencies are legally and
functionally separate.
Rog, Debra J., (2004). The Evidence of Supported Housing. Psychiatric Rehabilitation Journal, 27 (4), 334-343.
7
Supported Housing Principles
 Housing is integrated into the community.

Apartments or houses are located among other
houses and apartments that one would find in
the community.
Rog, Debra J., (2004). The Evidence of Supported Housing. Psychiatric Rehabilitation Journal, 27 (4), 334-343.
8
Supported Housing Principles
 Housing is affordable.

No more than 40% of the individuals adjusted
gross income is required for rent or mortgage
payments.
Rog, Debra J., (2004). The Evidence of Supported Housing. Psychiatric Rehabilitation Journal, 27 (4), 334-343.
9
Supported Housing Principles
 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.

Rog, Debra J., (2004). The Evidence of Supported Housing. Psychiatric Rehabilitation Journal, 27 (4), 334-343.
10
Supported Housing Principles
 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.

Rog, Debra J., (2004). The Evidence of Supported Housing. Psychiatric Rehabilitation Journal, 27 (4), 334-343.
11
Supported Housing Principles
 Services are community based.

There are no live in staff.
Rog, Debra J., (2004). The Evidence of Supported Housing. Psychiatric Rehabilitation Journal, 27 (4), 334-343.
12
Supported Housing Principles
 Crises services are available.

Crises services are available 24 hours per day,
7 days a week.
Rog, Debra J., (2004). The Evidence of Supported Housing. Psychiatric Rehabilitation Journal, 27 (4), 334-343.
13
Factors that Positively Impact
Supported Housing Outcomes
14
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)
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)
15
Factors that Appear to Positively
Impact Supported Housing Outcomes
 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)
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)
16
Factors that Appear to Positively
Impact Supported Housing Outcomes
 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)
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)
17
Factors that Appear to Positively
Impact Supported Housing Outcomes
 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)
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)
18
Factors that Appear to Positively
Impact Supported Housing Outcomes
 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)
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)
19
Factors that Appear to Positively
Impact Supported Housing Outcomes
 Practical services

Help with day to day tasks, e.g., house keeping, shopping,
budgeting, is needed to increase housing stability.
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)
20
Supported Housing Benefits
for the Individual
21
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)
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)
22
Supported Housing Benefits to the
Individual
 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.
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)
23
Supported Housing Benefits to the
Individual
 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)
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)
24
Supported Housing Benefits to the
Individual
 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)
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)
25
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)
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)
26
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).
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)
27
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36