New research highlights the benefits of permanent supportive housing in ending homelessness
January 4 2017
New research has highlighted the benefits of permanent supportive housing in ending homelessness for people living with a psychotic illness and reducing their use of mental health inpatient units.
The findings are from one of the first studies to test this innovative approach to housing in Australia. The study focused on a group of people who have experienced long-term (or chronic) homelessness with co-occurring psychotic illness.
The study looked at people who were living in or had recently moved out of Elizabeth Street Common Ground (ESCG), a unique purpose built building providing permanent supportive housing. ESCG was developed and is managed by Launch Housing (formerly Homeground).
What is housing first?
Housing first is the rapid and direct placement of people experiencing homelessness into permanent housing. It typically has supportive services available, but no requirement to use those services as a condition of living there.
This is a new approach that rejects the idea that people with a long-term experience of homelessness, even when experiencing complex mental health issues, need to be ‘housing ready’, an approach that requires other issues to be addressed or resolved prior to being considered suitable for housing.
Through ESCG, Launch Housing offers a ‘housing first’ model to people who have experienced chronic homelessness.
What is ‘permanent supportive housing’?
Permanent supportive housing either co-locates support services on-site or ensures that support is available as and when required, but is usually delivered by outreach workers based at other locations. It can take the form of multiple ‘cluster’ housing sites, with small groups of people living together, in typical suburban houses. Or it can be provided in group settings, where many tens of people share one, usually purpose built, building.
Elizabeth Street Common Ground is such a building. It has 60 single self-contained units over multiple floors with 24 hours support provided on-site and built in security features such as a concierge to ensure only approved people enter the building.
What were the findings of the research?
The findings of this study were that residents of Elizabeth Street Common Ground were far less likely to use mental health inpatient units than they had prior to being housed.
The study also found that people who were housed in Elizabeth Street Common Ground were admitted to mental health inpatient units at half the rate of those who had left. Those who left ESCG were more likely to have additional complexities, including diagnoses of personality disorder, substance use disorder or significant links to the criminal justice system.
In addition to a decrease in the use of inpatient units, the study found that being housed did not lead to increased use of mental health services over and above what had previously occurred; a somewhat surprising finding.
Why does it work?
The reduction in mental health admissions is likely to be a result of housing stability which supports the development of long term, trusted relationships between clients and clinicians and this means that residents of supportive housing are more likely to stick with their treatment plans. Most people in this study were very happy with the quality of their housing, indicated by their high wellbeing scores shortly after moving in to Elizabeth Street Common Ground. The findings suggest that maintaining treatment in a setting that the person enjoys living in improves their mental health. This was further enhanced by the support provided by a team of workers based on-site who were able to develop long-lasting relationships with individuals.
Difficulties can and do arise in these group settings where many people with complex experiences of life are housed together. However the provision of permanent supportive housing provides a secure foundation for the development of relationships with support staff who have an understanding of the person and their strengths and difficulties.
In particular, when difficulties arose, admission to hospital or eviction was not seen as the default option, as might have occurred under other housing models.
Learnings from the model
Group living does not work for everyone. A number of people were unable to stay despite the best efforts of their care teams. The absence of other permanent supportive housing models meant that many of these people re-experienced homelessness. This led to a worsening in their mental health and an increase in their hospital admissions.
Permanent supportive housing developments, from group to much smaller ‘cluster’ models, provides sustainable housing and we desperately need more of it to ensure that this highly vulnerable group of individuals is provided with the housing and care they need to successfully put an end to their homelessness.