Abstract
BackgroundSocial inclusion is essential for an adequate rehabilitation process for people with serious mental illness (SMI). Various supported housing settings aim to promote housing competencies and social inclusion in service users. Nevertheless, there is a strong preference in service users for independent living. We aim to evaluate the effectiveness and efficiency of Independent Housing and Support (IHS) compared to institutionalised residential care settings and other treatment as usual conditions (RCS/TAU) in two cities in Switzerland.MethodsThis is a prospective multi-centre, four-arm, non-inferiority cohort study investigating the effectiveness and efficiency of IHS and RCS/TAU for people with SMI. Effectiveness will be measured by a standardised measure of social inclusion as primary outcome as well as by measures of functioning and well-being. Efficiency will be analysed on the basis of service usage and costs associated with the different housing settings. Participants will be consecutively recruited and subsequently enrolled between April 2019 and December 2020 and assessed at baseline and after six, twelve and after 24 months. At one study site, 56 participants will be randomly assigned to one of the conditions; the other study site will be conducted as an observational study investigating 112 admitted participants.DiscussionWhile the UN Convention of the Rights of People with Disabilities aims to promote the opportunity to choose one’s place of residence, the limited supply of alternative forms of housing does not guarantee genuine freedom of choice. Increased diversification and flexibility of housing support is essential. If IHS shows non-inferiority in terms of their effectiveness and efficiency, users should be allowed to choose their kind of housing support.Trial registrationClinicalTrials.gov: NCT03815604, December 04, 2019.
Highlights
Social inclusion is essential for an adequate rehabilitation process for people with serious mental illness (SMI)
Aims of the study Based on these findings, we aim to investigate both 1) a care-related and 2) a methodological goal with the current multi-centre study to answer the following research questions: 1. What are the effectiveness and efficiency of Independent Housing and Support (IHS) compared to residential care settings (RCS)/TAU for non-homeless persons with severe mental illness after 6, 12, and 24 months?
Effectiveness will be determined by social inclusion, proposed as a key outcome for individuals living with mental disorders and, in terms of research, a global priority measure [45]
Summary
Social inclusion is essential for an adequate rehabilitation process for people with serious mental illness (SMI). Various supported housing settings aim to promote housing competencies and social inclusion in service users. We aim to evaluate the effectiveness and efficiency of Independent Housing and Support (IHS) compared to institutionalised residential care settings and other treatment as usual conditions (RCS/TAU) in two cities in Switzerland. As a consequence, housing and housing rehabilitation of people with serious mental illness (SMI) and their social inclusion became major elements of mental health care. Article 19 in particular aims to enable people with SMI a) to “have the opportunity to choose their place of residence”, b) to “have access to a range of in-home, residential and other community support services” and c) that services and facilities are “available on an equal basis to persons with disabilities and are responsive to their needs” with the goal of social participation and inclusion. The implementation of the article has not advanced greatly since its passing, and allocation is more often driven by availability than by users’ choice or needs [4]
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