Abstract
For centuries, treatment and accommodation for people with significant mental health conditions in many countries, including the United States, have been viewed as necessarily inseparable elements, first in asylums and then, with deinstitutionalization, in community care models. The advent of psychiatric rehabilitation and later, recovery, helped to shift the paradigm of mental health services and the role of housing, to one focused on promoting the ability of individuals to achieve not only a life located in the community, but one that reflects a meaningful life as part of a community. In this context, supportive housing emerged as a model based on integrated, permanent, affordable housing, selected by the person, with flexible supports that are functionally separate, but available as needed and wanted. This model of housing has been predominant in American mental health services for over 20 years, and evidence now exists for its outcomes in terms of housing stability, symptom reduction, and psychosocial variables. Current challenges, both at the societal and the individual level, confront the sustainability of supportive housing, with some efforts being made by housing groups to address these challenges. This article reviews the evolution of supportive housing and its basic tenets, identifying the challenges and some efforts to address them. In addition, the article discusses the current social and economic climate, which appears to be shaping opposing trends, and makes a call to action, to mitigate the possible risks to the future of this value-based housing approach.
Highlights
Access to shelter is a right enshrined in the International Convention on Human Rights [1]
This article presents the experience of the American response to the question of housing for people with significant mental health conditions, to highlight the need for continued vigilance and efforts to expand and sustain supportive housing, in the face of current challenges and potential retrenchment
The American experience may provide an optimistic, albeit cautionary tale about sustaining supportive housing. It is a well-established service in the array of U.S mental health service systems, with documented outcomes for homeless and deinstitutionalized populations, as well as moderate but growing evidence of effectiveness for other groups with mental health conditions [53]
Summary
Access to shelter is a right enshrined in the International Convention on Human Rights [1]. For at least the past 200 years, mental health and rehabilitation treatment providers, advocates, and government entities alike have struggled to provide places to live for people with significant mental health conditions. Adults with significant mental health conditions have often encountered barriers. Residential Care to Supportive Housing ranging from, but not limited to, discrimination, poverty, a paucity of available housing, lack of supports oriented to their recovery and social isolation when trying to succeed in living with family or in another residence. This article presents the experience of the American response to the question of housing for people with significant mental health conditions, to highlight the need for continued vigilance and efforts to expand and sustain supportive housing, in the face of current challenges and potential retrenchment
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