Long-term effects of a housing support intervention in homeless people with severe mental illness

Abstract

Abstract Objectives Recent studies have suggested that the Housing First model is a promising strategy for providing effective services to homeless people with mental illness at a short-term horizon. The paper assesses the long-term effects of an independent housing with a recovery-oriented approach in homeless people with severe mental illness on social recovery, mental symptoms and quality of life among homeless adults with high support needs for mental and physical health services. Design and methods “Un Chez Soi d’Abord” was a randomized controlled trial conducted in 4 French cities: Lille, Marseille, Paris and Toulouse. From August 2011 to April 2014, homeless participants with a DSM-IV-TR diagnosis of bipolar disorder or schizophrenia (N = 703) were randomly assigned to Housing First (n = 353) or Treatment as Usual (n = 350). Mental symptoms (MCSI), social recovery (RAS), global physical and mental status (SF-36), subjective quality of life (S-QoL) and addictions (MINI) were collected every 6 months over 48 months. Mixed models using a longitudinal and cluster design were performed, and adjusted to age on the street, gender and mental disorder diagnosis and testing for time*group and site*time interactions. Results HF patients exhibited higher recovery (β = 3.6, 95%CI: 0.4 to 6.9), higher S-QoL (4.7, 1.1 to 8.3) such as the self-esteem (10.9, 5.8 to 15.6) and physical well-being (8.4, 3.1 to 13.8) sub-dimensions, and improved mental health symptoms (-3.1, -5.4 to -0.9) over the 4-year follow-up. No significant differences were observed for SF36 scores. HF and TAU participants experienced similar alcohol or substance dependence evolution between baseline and 48 months. Conclusions HF is a highly effective intervention associated with improved relational environment, enhancing recovery and quality of life in homeless people with schizophrenia or bipolar disorders. Addiction issues have been identified and should be targeted so as to further improve the Housing First approach. Key messages Housing First model is a highly effective intervention. Housing First model enhances recovery and quality of life in homeless people.