Transitional Living and Mental Health Benefits

Mental illness is strongly related to issues with housing and problems with housing

stability. Around 30% to 50% of homeless people have mental illness, and many

suffer from disorders that cause severe dysfunction, such as psychoses, acute distress,

and personality disorders. In 20% of the homeless, mental illness co-occurs with

substance abuse problems, and many people find themselves without reliable housing

after being deinstitutionalized (Scott, 1993). Adults with serious mental illness are 10

to 20 times more likely to experience an unstable housing situation and homelessness,

and substance abuse exacerbates that risk (Kuno, Rothbard, Averyt, & Culhane,

2000).


Housing issues and mental health have a close, two-way relationships. It’s not just

about the homelessness but also about living in an unstable and an unsafe

environment that can make the individual’s mental health worse and serve as a

constant source of stress.


Housing First approaches have tried to address these concerns by offering housing

with options for treatment and permanent rather than temporary residency options, so

the person has long-term stability (Gabriellan et al., 2018). Before examining the

positive impact of programs that provide housing alongside treatment, it’s worth

examining what happens when this is not done.


Many services provide support for individuals struggling with mental health issues

and housing issues as well. While there are resources to support individuals in

precarious situations, many of them fail to help individuals. As mentioned above, one

of the causes of homelessness is deinstitutionalization where the person is released

from the hospital, a rehabilitation facility, or a prison but have no place to go instead

(Scott, 1993). Many individuals with mental illness are not able to stay in programs

that support housing initiatives, often going to prison or becoming homeless, or

maintain low rates of social integration (Gabriellan et al., 2018). Without housing, a

person is subject to a variety of negative influences that undermine their health and

make it difficult for them to recover, maintain a good health, and protect themselves.

Mentally ill people without proper housing can experience a worsening of their physical and mental health, be victims of violence, and more (Henwood et al., 2013)


In an unstable environment, a person cannot improve their lifestyle, take medication

reliably, watch their nutrition, and engage in other behaviors that can make their

condition better and reduce the risk of severe symptoms (AHURI, 2018).

In general, many countries identify a shortage of affordable long-term housing for

people with mental illness, which has led to people overstaying in mental hospitals or

lapsing/relapsing into homelessness (AHURI, 2018).


Housing issues have a bi-directional relationship with mental health issues. Mental

health problems can lead to a precarious housing situation and viceversa. People with

mental illness tend to have higher risk factors for issues that contribute to said

precariousness, such as domestic violence, family violence, unemployment, and more

(AHURI, 2018).

What can be achieved with secure housing? First, people can focus on treatment and

rehabilitation while they have their basic needs met. They can improve their well-

being and quality of life. A review of housing first programs for people with psychiatric disabilities found that housing programs for people with severe and persistent mental illness could achieve

large effects in terms of housing outcomes, significantly reducing the number of

homeless individuals. It also led to quicker and improvements in community

functioning and improved quality of life (Aubrey, Nelso, & Tsemberis, 2015).

Stable housing can offer alternatives to hospital-based environments and is more

sustainable on the long term. Community-based services better address the needs of

varying populations and help increase quality of life. They reduce stigmatization and

are more compliant with human rights and with a respect for the individual’s

autonomy. Community-based programs are associated with better treatment

adherence, lower clinical symptoms, more stability, and vocational rehabilitation

(Padmakar et al., 2020). Another review found that ensuring adequate housing should be a treatment priority, as providing stable, permanent housing reduces harm and enables people to seek treatment voluntarily. For severe mental illnesses, an unlimited length of stay is recommended because the issue is likely to be chronic and change with time. Quality

of life deteriorates when people are moved from housing that is appropriate to their

needs and capacities. Stable housing leads to reduced hospital stays and allows the

person to seek treatment when they need it and not try to work through the symptoms

on their own for fear of becoming homeless. Stable housing in individuals with

mental illness can reduce psychiatric symptoms and increase well-being, so this

should not be considered as an afterthought or after medication. The authors of the

review go further to suggest that stable housing provides the cornerstone for a

successful treatment, enabling the person with mental illness not just to survive but to

thrive, seeking new life skills program and treatment for other issues, such as

addiction (Dunn & Kyle, 2007).


Overall, this suggests that housing is important and improves outcomes for people

with mental illness. However, further research has suggested that simply providing

housing is not enough. It is also important to provide transitional options.

People who were given transitional housing were found to had fewer hospital and

crisis admissions and fewer homelessness days than those who did not. They were

also more likely to be employed and living independently a year after completing the

transitional program (Roman, McBride, & Osborne, 2006). Transitional housing also

was found to lead to more positive outcomes for drug use, criminal activity, and

depression. People who engaged in a transitional housing program were more likely

to be later living stably and less likely to be hospitalized (Roman, McBride, &

Osborne, 2006).


In general, it is clear that there is a research-based paradigm shift for offering people

with mental illness transitional and then stable housing within a community with the

necessary support. This appears to improve their outcomes, reduce homelessness, and

enhance quality of life and community integration.


There are significant issues in providing housing, and a common one is the issue of

people with comorbid disorders and substance abuse problems and those who do not

have substance abuse problems. Many of the existing community services and

housing options are oriented towards people with addiction, and it may be assumed

that many individuals who are homeless or require housing support also have some

form of substance abuse problem.


It is important to note that substance abuse problems have a high correlation with

schizophrenia, mood disorders (like depression and bipolar), and other disorders, in

particular, anxiety problems, phobias, and post-traumatic stress disorder. However, it

is true that there are also people who only show one of these conditions or who

present severe mental illness without having substance abuse problems and viceversa

(Quello et al., 2005, Winklbaur et al., 2006).


When a person with mental illness receives a diagnosis, having a comorbid illness can

make it more complicated. Comorbid disorders may be underdiagnosticated (Oiesvold

et al., 2013) and, as a result, not addressed in treatment and not taken into account

when finding a housing or support program for the patient. For example, a person

might be immediately diagnosed with a substance abuse problem but the comorbid

depression may not be noticed, so the person will not receive specific treatment as

they enter into a new system. In addition, they might be directed to services that are

focused on substance abuse problems but not really able to treat or accommodate the

special needs of a person with another diagnosis. So, the first issue that can be

identified in this case is that the person does not receive the treatment they need and

might help them.


If the problem is not diagnosed further down the road, there can be more issues in

regards to housing. The person might be offered options that are connected to the

diagnosis they do have and not provided with additional support or treatment to

address the needs for their other diagnosis, in particular, if they are placed in

transitional housing directed towards a specific population, for example, people with

substance abuse problems.


The second issue that might appear in this situation is that the person who does not

have a substance abuse problem might not be in the right community for them or the

best one. One of the useful aspects of supported and transitional housing is the

possibility to engage with other people who have similar experiences and hurdles.

Research suggests that a community of others can be significant for recovery, a

principle that helps form self-help and advocacy groups. Engaging with other people

who have a similar experience can help reduce symptoms, increase self-esteem,

facilitate recovery through building a community of people who understand and can

share ideas, advice, and informed support. Additionally, the individual can find

themselves also being able to help others, which is empowering (Markowitz, 2014).


This means that an individual placed with people who have different experiences and

needs might miss out, to a degree, on this community and see that what others feel or

think is not the same thing. Identifying comorbid disorders and taking them into

account can help people find a better housing option, as it is not the same thing to

have schizophrenia, to have a substance abuse problem, or to have both schizophrenia

and a substance abuse problem at the same time. It is important to note that different

problems require different types of support and treatment, and there are specific

evidence-based strategies for each disorder.


Housing and an adequate diagnosis and treatment are important for individuals with

mental health issues. Something that can be as significant is the support of their

families, especially in cases where the person is young.


People with severe mental illness identify families as a very significant presence in

their lives, more so even than mental health professionals, and this is true even among

individuals who live independently. Families can be instrumental in supporting

recovery by offering affection, belonging, emotional support, and an active

involvement. They can individuals with their independent living and be a positive

resource (Piat et al., 2011).


However, not all families are ready to assume the role of emotional support and be a

positive presence in the person’s life. Many individuals with mental health issues

have experienced abuse, neglect, or emotional difficulties within their families

(AHURI, 2018). If families want to become involved, they might first need to learn

new patterns and new ways of engaging with the person. The support of mental health

professionals can be especially important in this case through psychoeducation and

family therapy that changes the established dynamics and create better interactions.

Families might need to change to help the members with mental illness. If they are

motivated and willing to become involved, it is possible to help the person and

provide a lot of emotional support for recovery and supported living.

Mental illness may be chronic but it does not have to be severe. With the right

resources, stability, treatment, and support, individuals can live happier, healthier

lives and become independent. Quality of life can increase a lot for people who have

stable, long-term housing after a transitional program, who have the support of their

families, and who have received the correct diagnosis and treatment.


References

Aubry, T., Nelson, G., & Tsemberis, S. (2015). Housing First for People With Severe

Mental Illness Who Are Homeless: A Review of the Research and Findings From the

At Home-Chez soi Demonstration Project. Canadian journal of psychiatry. Revue

canadienne de psychiatrie, 60(11), 467–474.

https://doi.org/10.1177/070674371506001102

AHURI. (2018). Housing, homelessness and mental health: towards systems change

Retrieved from https://www.ahuri.edu.au/__data/assets/pdf_file/0023/29381/Housing-

homelessness-and-mental-health-towards-systems-change.pdf

Dunn, M. & Kyle, T. (2007). Effects of Housing Circumstances on Health, Quality of

Life and Health Care Use for People with Severe Mental Illness: A Review. The

Wellesley Institute – Enabling Grant Final Report. Retrieved from

https://homelesshub.ca/sites/default/files/qce1mc1v.pdf

Gabrielian, S., Young, A. S., Greenberg, J. M., & Bromley, E. (2018). Social support

and housing transitions among homeless adults with serious mental illness and

substance use disorders. Psychiatric rehabilitation journal, 41(3), 208–215.

https://doi.org/10.1037/prj0000213

Henwood, B. F., Cabassa, L. J., Craig, C. M., & Padgett, D. K. (2013). Permanent

supportive housing: addressing homelessness and health disparities?. American

journal of public health, 103 Suppl 2(Suppl 2), S188–S192.

https://doi.org/10.2105/AJPH.2013.301490

Kuno E, Rothbard AB, Averyt J, Culhane D. Homelessness among persons with

serious mental illness in an enhanced community-based mental health

system. Psychiatric Services (Washington, D C) 2000;51(8):1012–1016. 

Markowitz F. E. (2015). Involvement in mental health self-help groups and

recovery. Health sociology review : the journal of the Health Section of the Australian

Sociological Association, 24(2), 199–212.

https://doi.org/10.1080/14461242.2015.1015149


Oiesvold, T., Nivison, M., Hansen, V., Skre, I., Ostensen, L., & Sørgaard, K. W.

(2013). Diagnosing comorbidity in psychiatric hospital: challenging the validity of

administrative registers. BMC psychiatry, 13, 13. https://doi.org/10.1186/1471-244X-

13-13

Padmakar A, de Wit EE, Mary S, Regeer E, Bunders-Aelen J, Regeer B (2020)

Supported Housing as a recovery option for long-stay patients with severe mental

illness in a psychiatric hospital in South India: Learning from an innovative de-

hospitalization process. PLoS ONE 15(4): e0230074.

https://doi.org/10.1371/journal.pone.0230074

Piat, M., Sabetti, J., Fleury, M. J., Boyer, R., & Lesage, A. (2011). "Who believes

most in me and in my recovery": the importance of families for persons with serious

mental illness living in structured community housing. Journal of social work in

disability & rehabilitation, 10(1), 49–65.

https://doi.org/10.1080/1536710X.2011.546310

Roman, C., McBride, E.C., & Osborne, J.W. (2006). Principles and Practice in

Housing for Persons with Mental Illness Who Have Had Contact with the Justice

System. THe Urban Institute.

Scott, J. (1993). Homelessness and Mental Illness. British Journal of

Psychiatry, 162(3), 314-324. doi:10.1192/bjp.162.3.314

Quello, S. B., Brady, K. T., & Sonne, S. C. (2005). Mood disorders and substance use

disorder: a complex comorbidity. Science & practice perspectives, 3(1), 13–21.

https://doi.org/10.1151/spp053113

Winklbaur, B., Ebner, N., Sachs, G., Thau, K., & Fischer, G. (2006). Substance abuse

in patients with schizophrenia. Dialogues in clinical neuroscience, 8(1), 37–43

14 views0 comments