Supported Housing Facilities Research Articles

Stories of Rediscovering Agency

As part of a larger study, we offered Everyday Life Rehabilitation (ELR) as a model for integrated occupational therapy in sheltered or supported housing facilities, to enable meaningful daily occupations for people with psychiatric disabilities. Our aim with this study was to understand how participants made sense of their occupational transformations in the context of their everyday life and life history. We carried out qualitative interviews and field observations with 16 participants with psychosis-related disorders. We used narrative analysis and disclosed stories of "rediscovering agency," referring to occupational and identity transformations. A parallel outcome study has shown positive results for participants, and by using narrative inquiry we contribute with a deeper understanding of the meaning making of their transformations and mechanisms of the intervention; i.e., hope, extended value of reaching goals, reentering the majority world, transparency of process, and attunement to the individual. The findings support the use of the ELR intervention.

The Influence of Physical Environmental Qualities on the Social Climate of Supported Housing Facilities for People with Severe Mental Illness

The study investigates the extent to which the perceived physical environmental quality of housing facilities for people with severe mental illness accounts for perceived social environmental quality. Twenty facilities were assessed by people with psychiatric disabilities (residents), staff, and experts with regard to the physical environmental aspects of visual pleasantness, indirect environmental effects, overall physical quality, and the social environmental indicator of social relationship. The results suggest that residents’ and staff's physical environmental quality perception accounts for social relationship quality perception, whereas experts’ environmental assessment does not. Moreover, the staff reported a more positive social relationship perception than the residents.

Validation of the Verbal and Social Interaction questionnaire: carers' focus in the carer–resident relationship in supported housing facilities for persons with psychiatric disabilities (VSI‐SH)

A questionnaire to measure the verbal and social interactions between carers and residents in supported housing facilities for persons with psychiatric disabilities has been developed. It is an adaptation of a questionnaire originally used in a forensic psychiatric setting. The aim of the present study was thus to investigate the construct validity and the reliability of this new version of the Verbal and Social Interactions questionnaire for use in supported housing facilities (VSI-SH). Two hundred and twenty-three carers from municipal and privately run housing facilities completed the questionnaire. A factor analysis was performed, which resulted in six factors. The number of items was reduced from the original 47 to 30 in order to minimize factorial complexity and multiple loadings. The reliability was tested with Cronbach's alpha and good internal consistency for the questionnaire and five of the six factors was found. The resulting six factors and the items were compared to the conceptual model and four of the six factors corresponded well with the categories in this original theoretical model. The questionnaire can be a useful contribution to the study of interactions between carers and residents in supported housing facilities for persons with psychiatric disabilities.

The Physical Environment of Purpose-Built and Non-Purpose-Built Supported Housing for Persons with Psychiatric Disabilities in Sweden

The primary aim of the present study was to investigate if methods derived from environmental psychology can be used to study the qualities of the physical environment of supported housing facilities for persons with psychiatric disabilities. Three units of analysis were selected: the private area, the common indoor area, and the outdoor area. Expert assessments of 110 features of the physical environment in these units and semantic environmental description of the visual experience of them consistently showed that purpose-built supported housing facilities had more physical features important for high quality residential environments than the non-purpose-built supported housing facilities. The employed methods were thus seen to be able to describe and discriminate between qualities in the physical environment of supported housing facilities. Suggestions for the development of tools for the assessment of the physical environment in supported housing are made.

A Suggested Revision of the Community Oriented Program Environmental Scale (COPES) for Measuring the Psychosocial Environment of Supported Housing Facilities for Persons with Psychiatric Disabilities

The aim of the present study is to address issues of construct validity and reliability of a revised short version of the COPES instrument to measure the psychosocial environment of supported housing facilities for persons with psychiatric disabilities. The results revealed that the division into subscales is not sufficiently reliable for use in measuring the psychosocial environment, although the three higher order dimensions can possibly be used for the descriptive and comparative purposes. A factor analysis based on the revised short version generated new factor solutions, differing from the COPES subscales, but with sufficient psychometric properties.

The new asylums in the community: severely ill psychiatric patients living in psychiatric supported housing facilities. A Danish register-based study of prognostic factors, use of psychiatric services, and mortality

Reorganization of psychiatric treatment in Denmark involved a declining number of psychiatric long-stay beds and an increasing number of psychiatric supported housing facilities in the community. Very few studies have focused on the population in such facilities. Information was generated combining addresses of supported psychiatric housing facilities with information from the Danish Civil Registration System to create a case register of persons living in supported psychiatric housing facilities. Through linkage with the Danish Psychiatric Central Register, we examined predictors of becoming a resident in a psychiatric housing facility, use of psychiatric services around the time of entrance to a supported psychiatric housing facility, and mortality rates for residents in a psychiatric housing facility compared to non-residents and to persons in the general population who never experienced a psychiatric admission. We identified schizophrenia as the strongest diagnostic predictor of becoming a resident in a supported psychiatric housing facility, followed by organic mental disorders, substance abuse, and affective disorder. In addition, the higher the number of psychiatric bed days, the higher the risk. Compared to the years before the first entrance to a supported psychiatric housing facility, the number of bed days in the year following the first entrance dropped more among residents than among comparable psychiatric patients. Mortality rates were slightly higher among residents in a supported psychiatric housing facility than among comparable psychiatric patients, but more than tenfold higher when compared to the general population of Danes. The vast majority of persons who became residents in supported psychiatric housing facilities had previously been diagnosed with schizophrenia, schizophrenia-like disorders, and organic mental disorders, and a large proportion had substance abuse and a high use of bed days. Moving into such a facility reduced the number of bed days.

Influence of a lifestyle intervention among persons with a psychiatric disability: a cluster randomised controlled trail on symptoms, quality of life and sense of coherence

The aim of this study was to investigate how a lifestyle intervention programme influences psychiatric and psychosocial factors among persons with psychiatric disabilities. Persons with psychiatric disabilities often suffer from a simultaneous physical health problem, where circulatory disorder, hyperlipideamia, digestive disease, diabetes mellitus and obesity are prevalent. Studies have also shown a relationship between physical activity and mental health. But few randomised controlled trails have been aimed specifically at lifestyle interventions and their effect on psychiatric health and quality of life among persons with psychiatric disabilities. A cluster randomised controlled trail. Forty-one persons with a DSM-IV diagnosis in eight supported housing facilities and two housing support programmes and their carers were on cluster level randomly assigned to a 12-month health intervention programme in the form of study circles with diet sessions and physical activities or a control programme. The changes in the mean of quality of life, level of functioning, psychiatric symptoms and sense of coherence was investigated and its relationship to physical health and attendance. A significant increase in the sense of coherence was seen in both programmes but also significant improvements in the intervention group compared to controls at the follow-up. Structured activities in the form of lifestyle intervention programmes with a sufficient level of challenge that encourage persons with psychiatric disabilities to participate in activities in a social context may contribute to a significant increase in the sense of coherence. Improving physical health with lifestyle programmes in the form of study circles and when involving their cares will in addition to increased physical health end in improved sense of coherence.

The Impact of Supportive Housing on Surrounding Neighborhoods

Communities across New York City and around the nation commonly oppose proposals to open supportive housing in their neighborhoods because of fear that the housing will decrease the quality of life in the neighborhood, and lead to reductions in property values. This study aims to give supportive housing providers and local government officials the objective, credible information they need to guide policy decisions and to respond to opponents' fears and arguments. Using a difference-in-difference regression model to isolate the effect of supportive housing from more general macro and micro market trends and neighborhood variations, this paper examines the impact that almost 14,000 units of supportive housing created in New York City over the past twenty five years have had on their host neighborhoods over time. In a preliminary analysis, we find little evidence that supportive housing facilities diminish the value of surrounding properties. We find evidence that prices of properties surrounding supportive housing facilities are lower than comparable properties in the same neighborhood prior to the opening of the facility, and that this gap tends to narrow following the opening of a facility. Specifically, the preliminary analysis suggests that modestly-sized supportive housing developments (which are typical in New York City) may have small, positive impacts on neighboring property values, though these positive impacts decline as project size increases. Very large facilities may have negative impacts on the surrounding neighborhood.

Physical health—a cluster randomized controlled lifestyle intervention among persons with a psychiatric disability and their staff

The objective was to explore the impact on physical health of a lifestyle programme among persons with psychiatric disabilities, and their caregivers. Their satisfaction with the intervention was also assessed. Somatic comorbidity and an increased mortality related to the lifestyle among persons with psychiatric disabilities are well known. Few randomized controlled trials have been aimed specifically at lifestyle issues among persons with a psychiatric disability. This trial includes clients with psychiatric disabilities living in supported housing and their staff. Forty-one persons with a DSM-?V diagnosis of severe mental illness from psychiatric disability from 10 supported housing facilities and 41 of their caregivers participated in this 12-month study during 2005–2006 in Sweden. The supported housing facilities with residents and staff were randomly assigned to either a health intervention programme or a control programme with an aesthetic content. The presence of metabolic syndrome and changes in the mean of physiological parameters such as Hba1c, P-glucose, P-insulin, lipids, blood pressure, physical working capacity, body mass index, Heart Score were investigated and participants’ satisfaction assessed. There was a significant reduction in the mean of metabolic syndrome criteria in the intervention group compared with the control group at the follow-up. The participants expressed satisfaction with the programme. The results indicate that health interventions on lifestyle issues when involving carers are appreciated, feasible and could be successful in reducing some health-related risk factors among persons with psychiatric disabilities.

Supportive Housing and Neighborhood Property Value Externalities

<i>We analyzed impacts on single-family home prices of eleven, small-scale supportive housing facilities announced in Denver during 1989–1995.Using a difference in differences econometric specification, we found that these facilities produced a positive impact on house prices within 1,001 to 2,000 feet. We attributed this effect to countervailing externalities (building rehabilitation vs. resident behaviors) that vary in their spatial extent. Supportive housing facilities were systematically sited in neighborhoods with declining relative prices compared to elsewhere in the census tract. This location bias led a conventional econometric specification to erroneously estimate a negative property value impact from supportive housing.</i> (JEL R11, R31)

The Impact of Supportive Housing on Neighborhood Crime Rates

Quantitative and qualitative methods are employed to investigate the extent to which proximity to 14 supportive housing facilities opening in Denver from 1992 to 1995 affects crime rates. The econometric specification provides pre– and post– controls for selection bias as well as a spatial autocorrelation correction. Focus groups with homeowners living near supportive housing provide richer context for interpreting the econometric results. The findings suggest that developers paying close attention to facility scale and siting can avoid negative neighborhood impacts and render their supportive housing invisible to neighbors. Implications for structuring local regulations and public education regarding supportive housing facilities follow.

Residential care and regional psychiatric care:

In Linz, capital of the province of Upper Austria, there is a considerable shortage of supported housing. Yet the rate of places available reaches 0.9/1000 inhabitants, thus already exceeding the recommended number. A comprehensive investigation was started concerning all persons living in supported housing facilities. Services for psychiatric patients (n = 190) were included as well as services for homeless persons (n = 159). Only 41 % of the psychiatric patients and 31 % of the homeless people actually belonged into the region. Also among those who have been living less than one year in the facility, 45 % of the psychiatric and 67 % of the homeless persons come from outside, thus indicating, that the migration of patients is still going on. Among the homeless 69 % were mentally ill. While in the psychiatric services schizophrenic and affective psychoses were predominant, addictive disorders prevailed in the services for the homeless. It is the aim of mental health services in Upper Austria to care for the patients within their home regions. All regions are providing a fair amount of places for supported housing. Despite this a considerable number of patients keeps coming to the provincial capital. The causes and consequences of this process are discussed.

Medication supervision and adherence of persons with psychotic disorders in residential treatment settings: a pilot study.

Little is known about risk factors for and predictors of medication nonadherence within residential facilities. This pilot study examined the association between medication adherence and level of supervision and other environmental and clinical variables among patients with schizophrenia and related psychotic disorders living in supported housing. A convenience sample of 74 adult residents with schizophrenia and related psychotic disorders (DSM-IV criteria) living in 4 supported housing facilities in New York City were assessed by their treating psychiatrist for medication cessation during the previous month. Demographic characteristics, medications, supervision, global function as measured by the Global Assessment of Functioning (GAF), and substance abuse were also assessed. A priori hypotheses were that regimen complexity would be directly and medication supervision would be inversely related to medication nonadherence. In multivariate models, lack of direct medication supervision, negative medication attitude, and lower GAF score were associated with increased medication nonadherence in the recent past. This pilot study suggests that direct supervision of medication is associated with better adherence in residential treatment settings. This finding is relevant for mental health service planners and clinicians working in these settings.