The effects of housing stability on service use among homeless adults with mental illness in a randomized controlled trial of housing first

Nick Kerman, John Sylvestre, Tim Aubry, Jino Distasio, Nick Kerman, John Sylvestre, Tim Aubry, Jino Distasio

Abstract

Background: Housing First is an effective intervention to stably house and alter service use patterns in a large proportion of homeless people with mental illness. However, it is unknown whether there are differences in the patterns of service use over time among those who do or do not become stably housed and what effect, if any, Housing First has on these differing service use patterns. This study explored changes in the service use of people with mental illness who received Housing First compared to standard care, and how patterns of use differed among people who did and did not become stably housed.

Methods: The study design was a multi-site randomized controlled trial of Housing First, a supported housing intervention. 2039 participants (Housing First: n = 1131; standard care: n = 908) were included in this study. Outcome variables include nine types of self-reported service use over 24 months. Linear mixed models examined what effects the intervention and housing stability had on service use.

Results: Participants who achieved housing stability, across the two groups, had decreased use of inpatient psychiatric hospitals and increased use of food banks. Within the Housing First group, unstably housed participants spent more time in prison over the study period. The Housing First and standard care groups both had decreased use of emergency departments and homeless shelters.

Conclusions: The temporal service use changes that occurred as homeless people with mental illness became stably housed are similar for those receiving Housing First or standard care, with the exception of time in prison. Service use patterns, particularly with regard to psychiatric hospitalizations and time in prison, may signify persons who are at-risk of recurrent homelessness. Housing support teams should be alert to the impacts of stay-based services, such as hospitalizations and incarcerations, on housing stability and offer an increased level of support to tenants during critical periods, such as discharges.

Trial registration: ISRCTN. ISRCTN42520374 . Registered 18 August 2009.

Keywords: Homelessness; Housing first; Mental disorders; Service use.

Conflict of interest statement

Ethics approval and consent to participate

The original trial was reviewed and approved by the research ethics board of the Centre for Addiction and Mental Health where the coordinating centre for the trial was based. Ethics approval was also provided by local institutions at the five sites where the trial was conducted. All trial participants provided written consent. Analysis of secondary data for this study was approved by the research ethics board of the University of Ottawa (H04–16-14).

Consent for publication

Not applicable.

Competing interests

The authors declare that they no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Screening, randomization, and analysis procedures of participants for RCT and current study
Fig. 2
Fig. 2
Mean time in prison by intervention and housing stability

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