Abstract
PurposeUp to now there are only few studies and no RCT comparing efficacy or effectiveness of supported housing (SH) versus residential care (RC) in severe mental illness (SMI) without homelessness. Here we present an observational follow-up study in SMI subjects, who entered SH or RC, to compare clinical and functional outcomes 2 years later.MethodsIn this prospective study in more than 30 locations throughout a German federal state, we included SMI subjects, who entered SH (n = 153) or RC (n = 104). About one quarter suffered from each substance use, psychotic, affective, or other disorders. To avoid sampling bias, we used the propensity score matching method to establish a quasi-experimental design. Outcome measures were social functioning (SFS), the number of psychiatric hospitalisations, psychopathology (SCL-9-K), and quality of life (MANSA). Apart from descriptive methods we analysed primarily using repeated-measures ANOVAS.ResultsOur analyses revealed significant effects of time for all outcomes in both study groups. However, there were not any group differences of outcome measures, i.e., not any significant effects of group or interactional effects of group x time. Moreover, these results hold true for intent-to-treat and per-protocol sample analyses.ConclusionThe results show, that SH and RC for non-homeless people with SMI achieve the same clinical and psychosocial outcomes across a 2-year period. Taking into account the users’ preferences, the present findings should give reason to ensure the availability of affordable housing and to support the expansion of supported housing approaches.
Highlights
Different forms of supported accommodation services for persons with a severe mental illness (SMI) have been established as a regular standard of psychiatric care since the deinstitutionalization processes of the last century [1]
Despite the wide spread of these different housing services for non-homeless people with SMI in recent decades, there is still an urgent need of research on how efficious and effective residential care (RC) and supported housing (SH) are in terms of social functioning, quality of life, psychopathology and hospitalisation
In the naturalistic ITT sample, the two study groups were comparable at study entry with respect to age, social functioning (SFS) and quality of life (MANSA)
Summary
Different forms of supported accommodation services for persons with a severe mental illness (SMI) have been established as a regular standard of psychiatric care since the deinstitutionalization processes of the last century [1]. Despite the wide spread of these different housing services for non-homeless people with SMI in recent decades, there is still an urgent need of research on how efficious and effective RC and SH are in terms of social functioning, quality of life, psychopathology and hospitalisation. The authors conclude that “there is still a lack of high-quality studies on non-homeless people that could inform social policy and funding bodies in countries where the main problem is not homelessness but the allocation of resources to the most effective and efficient housing settings” McPherson et al [1] summarized their recent systematic review of mental health supported accommodation services by indicating a clear need for high quality effectiveness research
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