Article

The Paradigm Shift in Residential Services: From the Linear Continuum to Supported Housing Approaches

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Abstract

Describes a paradigm shift, beginning in the 1950s and reaching its zenith in the 1970s, toward supported housing models and deinstitutionalization of the mentally ill. The linear residential continuum model formed the basis for residential treatment and the provision of specialized environments that prepared patients/clients for life in the community. A supported housing paradigm shifts the primary role of the service recipient from patient to community and shifts the locus of control from staff to client. Other elements of the shift include an emphasis on (1) social integration rather than homogeneous grouping by disability and (2) the most facilitative environment and best functioning rather than the least restrictive environment and independence. (PsycINFO Database Record (c) 2012 APA, all rights reserved)

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... Along with the deinstitutionalization which has taken place since the 1960s, psychiatric care has made a shift from inpatient care to community based services [1]. As a consequence, housing and housing rehabilitation of people with serious mental illness (SMI) and their social inclusion became major elements of mental health care. ...
... In each of these settings, users are to become stabilised and learn specific housing skills. Once the client's level of functioning improves, he or she "graduates" to move to a more independent setting [1]. However, current state of research shows clearly that most people in question do not reach the goal of living independently and remain in institutionalised residential care settings [5][6][7]. ...
... In line with the UN Convention, there is another form of residential rehabilitation called the Supported Housing model [1]. The model aims to place a person without prior housing arrangements directly into accommodation in the community, even if the individual is in need of specialized psychiatric or psychosocial care. ...
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Background: Social inclusion is essential for an adequate rehabilitation process for people with serious mental illness (SMI). Various supported housing settings aim to promote housing competencies and social inclusion in service users. Nevertheless, there is a strong preference in service users for independent living. We aim to evaluate the effectiveness and efficiency of Independent Housing and Support (IHS) compared to institutionalised residential care settings and other treatment as usual conditions (RCS/TAU) in two cities in Switzerland. Methods: This is a prospective multi-centre, four-arm, non-inferiority cohort study investigating the effectiveness and efficiency of IHS and RCS/TAU for people with SMI. Effectiveness will be measured by a standardised measure of social inclusion as primary outcome as well as by measures of functioning and well-being. Efficiency will be analysed on the basis of service usage and costs associated with the different housing settings. Participants will be consecutively recruited and subsequently enrolled between April 2019 and December 2020 and assessed at baseline and after six, twelve and after 24 months. At one study site, 56 participants will be randomly assigned to one of the conditions; the other study site will be conducted as an observational study investigating 112 admitted participants. Discussion: While the UN Convention of the Rights of People with Disabilities aims to promote the opportunity to choose one's place of residence, the limited supply of alternative forms of housing does not guarantee genuine freedom of choice. Increased diversification and flexibility of housing support is essential. If IHS shows non-inferiority in terms of their effectiveness and efficiency, users should be allowed to choose their kind of housing support. Trial registration: ClinicalTrials.gov: NCT03815604, December 04, 2019.
... Adequate and stable housing conditions are well-known key components for successful psychiatric rehabilitation (1) and have become an important target in mental healthcare. As a consequence of the deinstitutionalization process, the number of people with serious mental illness (SMI) and long-term impairments requiring housing-related support increased (2). Broadly, there are three main types of support: residential care homes that provide intensive and longer-term support; supportive housing/sheltered housing with time-limited support; and independent supported housing (ISH) or floating outreach providing flexible and individual support in a permanent tenancy rented by the service users (3). ...
... Historically, the most common approach in psychiatric rehabilitation has proposed a stepwise approach. For housingrelated problems, individuals usually are admitted to a residential care home and graduate to more independent settings based on the individual's stabilization and adoption of housing skills (2). However, in practice, many service users do not move on within the expected time frame (5). ...
... Based on the UN Convention on the Rights of Persons with Disabilities (8), service users should also have the possibility to choose the type of accommodation and support. In this sense, ISH aims to place individuals directly into an independent accommodation of the users' choice, accompanied by flexible support provided by off-site professionals for an unlimited period of time (2). There are a variety of ISH models; most of them have been designed for homeless people, such as the "Housing First" approach, which demonstrably improves housing stability (9,10). ...
Article
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Background Independent supported housing (ISH)—services to support independent housing are recommended by current guidelines. However, there is little evidence of ISH models for non-homeless people with severe mental illness (SMI). The aim of this study was to examine the effectiveness of ISH by comparing the clinical outcomes of a newly implemented ISH service with regular housing and support services. Methods A total of 58 adults with a broad spectrum of mental disorders experiencing housing problems were randomly assigned to either the intervention group (IG) with the possibility to use the ISH service in Zurich providing targeted, individual and flexible support for housing problems or to the control group (CG) with regular housing and support services currently available (trial registration at ClinicalTrials.gov : NCT03815604). Results After 12 months, almost all participants of the IG were able to live independently and need for inpatient treatment could be significantly reduced. Service utilization varied between 2 and 79 h. In the CG, 70% of the participants wanted to join a waiting list for the ISH service. The results indicated that IHS was comparable to regular housing and support services in terms of social inclusion and other social and clinical outcomes such as quality of life, capabilities, needs, mental state and functioning ( p 's > 0.05). The costs of service utilization were on average 115 Swiss Francs (about 124 USD) per participant per month. Conclusions ISH is an effective service in housing rehabilitation in terms of social and clinical outcomes and costs. ISH is strongly preferred by service users. In line with the UN Convention on the Rights of Persons with Disabilities, access to ISH services for non-homeless people with SMI should be improved. Clinical Trial Registration ClinicalTrials.gov , identifier: NCT03815604, December 04, 2019.
... It is important to note that the majority of studies examining integration of this population have focused on those individuals with psychiatric disabilities who live in congregate housing programs. Recent service initiatives in North America have focused on supporting persons with psychiatric disabilities to live independently in regular housing with the assumption that it will facilitate greater integration (Carling, 1990;Ridgway & Zipple, 1990). No research to date has examined whether placing persons in these living contexts will indeed produce integration comparable to that of nondisabled community residents. ...
... Strong criticisms have recently emerged of specialized congregate housing that purports to integrate persons with psychiatric disabilities (Carling, 1990(Carling, ,1992Ridgway & Zipple, 1990). Specifically, it has been argued that this housing approach may actually serve as a barrier to the assumption of normal roles in the community by segregating and stigmatizing persons with psychiatric disabilities (Ridgway & Zipple, 1990). ...
... Strong criticisms have recently emerged of specialized congregate housing that purports to integrate persons with psychiatric disabilities (Carling, 1990(Carling, ,1992Ridgway & Zipple, 1990). Specifically, it has been argued that this housing approach may actually serve as a barrier to the assumption of normal roles in the community by segregating and stigmatizing persons with psychiatric disabilities (Ridgway & Zipple, 1990). ...
Chapter
This chapter provides an overview of conceptual and empirical research on the social integration of persons with development or psychiatric disabilities.
... Lze u nich rozlišit tři hlavní modely (Mowbray et al., 1993;Pettela et al., 1996): rehabilitace v oblasti bydlení Psychiatrická rehabilitace v oblasti bydlení má umožnit duševně nemocným samostatně a nezávisle bydlet, zlepšit potřebné dovednosti a sebedůvěru, pomoci jim vytvořit stálý domov a prostředí podporující proces úzdravy, umožnit separaci primární rodiny, vytvářet alternativu dlouhodobým hospitalizacím v psychiatrických léčebnách, umožnit využívat běžné veřejné služby. V prvních desetiletích deinstitucionalizace byla většina bývalých pacientů z ústavu propuštěna a navrácena do svých rodin nebo do opatrovnických domovů, nebo byli ponecháni, aby se o sebe postarali v prostředí tržního bydlení sami (Ridgway et al., 1990). S nárůstem podílu duševně nemocných mezi bezdomovci stoupal i tlak rodin pacientů na vznik podpůrných a rehabilitačních programů. ...
... Pacient postupuje podle kontinua od prostředí nejvíce omezujícího, s početným personálem, k méně omezujícím možnostem. Má být začleněn do prostředí, které nejlépe odpovídá jeho úrovni fungování a intenzity programu (Ridgway et al., 1990). ...
... Systém kontinua má však řadu nevýhod: málo jsou k dispozici kompletní kontinua služeb, a pokud k dispozici jsou, slouží jen zlomku potřebných (Ridgway et al., 1990); každý krok při rehabilitaci v oblasti bydlení je potenciální krizovou situací, ať už jde o změnu místa bydliště či rozdílné koncepce péče nebo definitivní ukončení rezidenční péče (Rahn et al., 1999). Vzhledem ke krizi bytové politiky se systém služeb ucpává, prodlužují se čekací lhůty na přijetí do služeb. ...
... Within international debates on the best response to homelessness there has been increasing attention given to both rights-based and housing-led approaches (Anderson et al., 2016;European Consensus Conference on Homelessness, 2010;FEANTSA, 2011FEANTSA, , 2012Fitzpatrick & Watts, 2010). Each has been promoted for increasing access to housing and empowering homeless people (Kenna, 2005;Ridgway & Zipple, 1990;Watts, 2013Watts, , 2014. On the rights front, Scotland has received international acclaim for its legislative framework which has extended entitlement to settled accommodation to nearly all homeless households since 2012. ...
... In contrast, Housing First, which is often seen as emblematic of a housing-led approach, has been hailed as a paradigm shift (Kresky-Wolff et al., 2010;Ridgway & Zipple, 1990). First developed within New York for those with complex support needs, it has become popular across the USA and gained attention internationally (Balogi & Feh er, 2014;Busch-Geertsema, 2014;Kennedy et al., 2016). ...
Article
Since devolution, Scotland has been perceived as an international trailblazer in homelessness policy. This is principally due to The Homelessness Etc. (Scotland) Act 2003 which led to the ‘priority need’ category being abolished in 2012, thus placing a statutory duty upon local authorities to provide settled accommodation to nearly all homeless households. This has been widely praised for extending citizenship rights to those experiencing homelessness. In contrast to this, this paper examines the experiences of young people (aged 16–24) where judgements on whether they were ‘housing ready’ delayed them being provided settled accommodation. Drawing on Bourdieu's writing on rites of institution, it is shown how the symbolic categories deployed by support services and landlords operated as a means of ‘vision and division’, creating new social positions that lengthened the pathway out of homelessness. In a complimentary move, there was a fusion of support with control mechanisms to determine a person's readiness for settled accommodation.
... The Staircase Model or the "linear residential continuum of care" (Ridgway and Zipple 1990) has been and continues to be the predominant national system-wide treatment-then-housing approach to homelessness in the United States, as well as in most other Western countries. Developed in the early 1980s when the number of homeless individuals with multiple disabling conditions was increasing, this model was not based on empirical evidence but instead on an emergency response to provide care based on the existing and long-standing traditions of the mental health and addiction treatment systems. ...
... After repeated failures to secure housing for service users through the Stairway approach, the group at the Center began a series of trial-and-error efforts to design a viable supported housing program that would be desirable to service users and worked collaboratively to develop the operational details of finding apartments, deciding who would sign the lease, policies about occupancy, the parameters of authority for the support services, and defining both program and service user fiscal responsibilities. The scattered site, independent apartment model where apartments are rented from community landlords, as described by Ridgway and Zipple (1990), was a model that met service users' requirements for normal housing, privacy, tenancy rights, and a funding mechanism that left sufficient discretionary funds after 30% of SSI was paid for rent. ...
Chapter
This chapter describes the Pathways Housing First (PHF) model. This program pioneered the practice of offering choices to individuals with co-occurring psychiatric and addiction diagnoses including the option to move directly from homelessness into a place of their own with supports. Pathways offered housing as a right, not something that must be earned through participating in psychiatric treatment or attaining a period of sobriety. Intensive treatment and support services are provided using community-based multidisciplinary teams that are mobile and make home visits. The program’s philosophy is guided by principles of self-determination and empowerment, and interventions are primarily directed by the service user. Participants are not discharged from the program if they relapse or if they are evicted from their housing; the support team services are continuous and assist with rehousing. The Pathways Housing First (PHF) program represents a 180-degree turn from traditional supportive housing or other group home programs serving this population which typically use a treatment-first approach and require participation in psychiatric treatment and a period of sobriety as a prerequisites for obtaining and maintaining housing. Research studies are presented comparing Housing First to Treatment First programs on measures of housing stability, quality of life, and cost-effectiveness. Results of these studies built an evidence base that influenced policy makers to advocate for implementing the Pathways Housing First model to address homelessness for individuals with complex needs which has led to the programs’ dissemination across the United States, Canada, and Europe.
... In relation to housing interventions, there is sound empirical evidence that supports the effectiveness of the supported housing approach in the field of mental health as an alternative response to institutional residential programs such as transitional halfway houses, group-homes, or congregate residential settings (Blanch et al., 1988;Carling, 1990;Kloos & Shah, 2009;Ridgway, Simpson, Wittman & Wheeler, 1994;Ridgway & Zipple, 1990). The housing-first (HF) approach, a form of supported housing, combines the access to independent and permanent housing in regular community settings with the provision of personalised and flexible support services that are consumer-driven and provided by an off-site team. ...
... To become effectively transformative, independent housing needs to be absolutely clear about the premise underlying the model concerning the separation of housing and treatment. The use of extensive professional teams associated with treatment (i.e., assertive community treatment, ACT) providing services to the residents with mental illness collides with the stated premise (Blanch et al., 1988;Carling, 1995;Ridgway & Zipple, 1990;Tsemberis, 1999). The implementation of a mental health treatment service keeps the people apart, recreating the separate service-delivery environments already described. ...
Article
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The present article first presents a critique about the current status of the community mental health (CMH) field. Second, based on theoretical and empirical literature, it presents a perspective inspired by the inception of community psychology, namely the empowerment and community integration principles to offer a challenging framework to inspire reforms in the CMH field. The article also discusses two promising CMH practices, supported employment and independent housing with support, determinant for the transformation of life conditions for people experiencing mental illness while promoting people's empowerment and integration in the community. The authors argue that CMH programs and practices focused on integration together with self-representation movements, organisations, or networks aligned with the community psychology acting principles have the potential to inform a renovated partnership within CMH stakeholders and bring about sustainable change focused on the active citizenship for people who experience mental illness.
... This path to housing "readiness" may involve moving homeless individuals from shelters to transitional housing, and supervised single-room occupancy (SRO), along a continuum from a more restrictive to a less restrictive environment. At each stage of the continuum, individuals experiencing homelessness must demonstrate adherence to treatment and obtain specific skills (Ridgway & Zipple, 1990). After homeless individuals completed all the required steps, agency staff determine their readiness to live independently (Tsemberis & Asmussen, 1999). ...
... After homeless individuals completed all the required steps, agency staff determine their readiness to live independently (Tsemberis & Asmussen, 1999). However, due to the multiple requirements associated with the LRT model, some homeless individuals never complete the program (Ridgway & Zipple, 1990). ...
Article
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The paper examines Housing First (HF) policy in the context of Homeless Emergency Assistance and Rapid Transition to Housing Act ([HEARTH], 2009) using a policy analysis framework. The analysis follows Ginsberg and Miller-Cribbs’ (2005) common elements of policy analysis and grounds the values and ethics in feminist ethic of care (Fisher & Tronto, 1990). The analysis examines both rational and moral considerations of HF in the context of the HEARTH Act. The values of the analysis are positioned in a feminist ethic of care framework that views caring as a moral and practical obligation. The paper argues that HF in the context of the HEARTH Act is responsive to a section of the homeless population. However, the paper points out inconsistencies in policy implementation. Based on the analysis, a broader definition of homelessness that encapsulates macro factors is recommended. In addition, participatory change strategies are recommended to effectively implement HF policy in communities.
... The Staircase Model or the "linear residential continuum of care" (Ridgway and Zipple 1990) has been and continues to be the predominant national system-wide treatment-then-housing approach to homelessness in the United States, as well as in most other Western countries. Developed in the early 1980s when the number of homeless individuals with multiple disabling conditions was increasing, this model was not based on empirical evidence but instead on an emergency response to provide care based on the existing and long-standing traditions of the mental health and addiction treatment systems. ...
... After repeated failures to secure housing for service users through the Stairway approach, the group at the Center began a series of trial-and-error efforts to design a viable supported housing program that would be desirable to service users and worked collaboratively to develop the operational details of finding apartments, deciding who would sign the lease, policies about occupancy, the parameters of authority for the support services, and defining both program and service user fiscal responsibilities. The scattered site, independent apartment model where apartments are rented from community landlords, as described by Ridgway and Zipple (1990), was a model that met service users' requirements for normal housing, privacy, tenancy rights, and a funding mechanism that left sufficient discretionary funds after 30% of SSI was paid for rent. ...
Chapter
This chapter describes the Pathways Housing First (PHF) model. This program pioneered the practice of offering choices to individuals with co-occurring psychiatric and addiction diagnoses including the option to move directly from homelessness into a place of their own with supports. Pathways offered housing as a right, not something that must be earned through participating in psychiatric treatment or attaining a period of sobriety. Intensive treatment and support services are provided using community-based multidisciplinary teams that are mobile and make home visits. The program’s philosophy is guided by principles of self-determination and empowerment, and interventions are primarily directed by the service user. Participants are not discharged from the program if they relapse or if they are evicted from their housing; the support team services are continuous and assist with rehousing. The Pathways Housing First (PHF) program represents a 180-degree turn from traditional supportive housing or other group home programs serving this population which typically use a treatment-first approach and require participation in psychiatric treatment and a period of sobriety as a prerequisites for obtaining and maintaining housing. Research studies are presented comparing Housing First to Treatment First programs on measures of housing stability, quality of life, and cost-effectiveness. Results of these studies built an evidence base that influenced policy makers to advocate for implementing the Pathways Housing First model to address homelessness for individuals with complex needs which has led to the programs’ dissemination across the United States, Canada, and Europe.
... Individer med en diagnostiserad allvarlig psykisk sjukdom betraktades inledningsvis som oförmögna att fungera på alla livets områden och ansågs därför behöva övervakning och stöd dygnet runt. Under 1980-talet började professionella verksamma inom nordamerikansk psykiatri ifrågasätta effek tiviteten hos insatser som byggde på dessa antaganden om allvarligt psykiskt sjuka människor (Ridgway & Zipple 1990). Boendetrappan blev emellertid i Nordamerika det etablerade sättet att hjälpa hemlösa personer med omfattande stödbehov. ...
... From psychiatric hospitals to supported housing. The mental health sector in Norway and other Western countries has been de-centralized since the 1960s with a move from psychiatric hospitals to new institutions spread throughout the community, resulting in new housing arrangements for people with mental health problems (Ridgway and Zipple, 1990). One goal of this change was to empower patients to become citizens in an inclusive society (Davidson et al., 2010). ...
Article
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Over the last few decades, various housing types for people with mental health problems have been developed for use in the community. These housing types differ in their objectives, staff support and design. In this study, we focus on how fire safety influences the lives of tenants in supported housing. The qualitative study was designed with a multi-sited ethnography approach. Fieldwork was conducted in seven different Norwegian supported housing settings in 2017 with 105 participants (29 tenants, 70 staff, five managers, and one planner). The empirical data consist of field notes, recorded interviews and pictures, which were analyzed with grounded theory and situational analysis. The analysis reconstructed how fire safety was organized and tenants' experiences of it. These experiences could be positive (such as feeling protected) or negative (such as feeling annoyed or under surveillance). The tenants coped differently with these situations, and fire safety sets boundaries for tenants. Overall, fire safety was organized differently in the supported housing settings we looked at comparison to in most of the common housing units in Norway. The influences of fire safety on daily life can be understood as ambiguous and can be interpreted as a normalizing factor in a risk society. Thus, we emphasize the need for appropriate and well-considered fire safety as a public health intervention in supported housing.
... However, additional attention and research are needed for veterans in the heavy multiple program use profile. The field of homelessness services has evolved beyond stepwise housing approaches in which clients start in restrictive, dependent housing settings and progress to increasingly less restrictive and independent settings (1). The current predominant housing approach for adults who experience chronic homelessness is the Housing First model, which aims to provide immediate, independent, permanent housing with no required prerequisites, such as sobriety or treatment adherence (2). ...
Article
Objective:: Although Housing First is the primary service model for housing chronically homeless adults, the Department of Veterans Affairs (VA) serves a heterogeneous population of homeless veterans and operates a continuum of models. This study examined longitudinally how various VA homelessness programs are used by type, timing, and sequence to identify utilization patterns and associated client characteristics. Methods:: Nationally linked administrative data from seven VA homelessness programs for 15,260 veterans who newly entered any VA homelessness program in 2015 and were followed for 2 years were analyzed with an innovative sequence and cluster analytic approach. Results:: The analysis found five main profiles: brief program use (59% of total sample), permanent supported housing plus (21%), heavy multiple program use (3%), transitional housing use (6%), and rapid rehousing program use (10%). The transitional housing use profile had the lowest proportion of women, and the brief use profile had the highest proportion of white veterans. Veterans in the supported housing plus profile used the most VA general medical and mental health services and were most likely to be in permanent housing by the end of the study period, although, notably, over 40% of veterans in the other profiles, except for the heavy multiple-use profile, were also in permanent housing by the end of the study. Conclusions:: Findings suggest that the VA's continuum of housing models is providing veterans who have diverse needs with an array of pathways for recovery. However, additional attention and research are needed for veterans in the heavy multiple program use profile.
... Although there is research to suggest housing model and social networks are associated, over time there has been an evolution in how people understand supportive housing model typologies, hence further research that incorporates the current characteristics of PSH models is needed. Initially, there was a distinction between supportive and supported housing (the former being people with SMI and/or histories of homelessness living together and the latter being a mainstreaming to 'normalized housing'; Carling, 1990;Hopper & Barrow, 2003;Ridgway & Zipple, 1990). For example, these studies that have examined the relationship between housing model and social network outcomes have compared scattered-site permanent residences to congregate and other non-permanent residences, which may be uniquely different than congregate and single-site housing settings that are intended to be permanent. ...
Article
Social integration is an indicator of programmatic success in supportive housing, yet is an ongoing challenge for residents. This study examines varying supportive housing models’ (i.e. congregate, single-site, scatter-site) and neighborhoods’ (i.e. Skid Row, Downtown Los Angeles [DTLA], Other) differential impact on social integration outcomes- measured by residents’ social networks (i.e. size, diversity, social support). Participants were formerly homeless English or Spanish speaking unaccompanied adults (N=405), aged 39 years or older, living in supportive housing for 3 months. Housing model and neighborhood were examined separately with social network measures in controlled multivariable linear regression models. Compared to Skid Row residents, DTLA residents reported less emotional support and less tangible support, while residents in Other neighborhoods reported less emotional support and less instrumental support. Findings suggest overall differing housing models may be less influential in social integration, while neighborhoods may facilitate social support.
... Fluctuations in the global economy (e.g. wages and rent), social paradigm shifts, amenities, city competitiveness, and the dramatic growth of property businesses will inevitably affect the quality of life of stakeholders and residents (Deller, Tsai, Marcouiller, & English, 2001;Kilbourne, McDonagh, & Prothero, 1997;Ridgway & Zipple, 1990;Roback, 1982;Rusk, 1993). As a result, building a strong corporate image and enhancing communication skills are essential to securing stakeholders' trust (Hansen, Dunford, Boss, Boss, & Angermeier, 2011;Lin & Lu, 2010;Pruzan, 2001), as well as that of the residential communities surrounding NHA premises. ...
Article
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The project output will assist with the strategic planning and determination of communication tactics, coupled with public relations, to establish a good corporate image under fluctuating global circumstances. Questionnaires and non-experimental, in-depth interviews were used for both quantitative and qualitative research, respectively. The main objective of this study is to explore stakeholder attitudes and satisfaction with the creation of corporate images by Thailand’s National Housing Authority (NHA). The investigation of NHA stakeholders’ attitudes and comments toward the building of this government entity’s corporate image strategy led to sustainable developments within the NHA by determining concepts and research methods, crafting a research plan, and identifying the characteristics of the target group. This study includes other sections related to measuring the attitude index, data collection and analysis, comparisons and interpretations of the target group and stakeholder perspectives. The target population is comprised of: Residents in 68 communities under the governance of NHA and Thai citizens, executive directors of the Ministry of Social Development and Human Security (MSDHS), board committee, executive directors, and general staff, companies, the private sector, entrepreneurs, and building contractors, public relations staff. Overall, 30 categories of stakeholders were interviewed. Secondary information, such as project documents, was collected and utilized for action planning, which reflects stakeholder opinions towards the NHA. The survey sample size of stakeholders was limited to 400 people from 12 districts, comprising 31,844 households under the 68 NHA projects in Bangkok.
... PSH also subsumes an earlier distinction between "supportive" and "supported" housing, where the former referred to a congregate living situations with on-site supervision that did not embrace a housing first approach and the latter referred to independent living in scattersite apartments with community-based supports that initially defined housing first (Ridgway & Zipple, 1990;Tsemberis & Eisenberg, 2000). ...
Article
Studies have often described a specific model or models of permanent supportive housing (PSH), yet few studies have systematically examined what services are typically offered to PSH tenants in any given service system and how those services are offered. Using telephone surveys from 23 PSH agency supervisors and qualitative data collected from 11 focus groups with 60 frontline providers and 17 individual interviews with supervisors from a subset of surveyed agencies—all of which were completed between July 2014 and December 2015—the goal of this study is to better understand what services are being offered in PSH organisations located in Los Angeles and what barriers frontline providers face in delivering these services. Survey findings using statistical frequencies suggest the existence of robust support services for a high-needs population and that single-site providers may offer more services than scatter-site providers. Qualitative thematic analysis of interview and focus group transcripts suggests services may be less comprehensive than they appear. If PSH is to be regarded as an intervention capable of more than “just” ending homelessness, further consideration of the provision of supportive services is needed.
... Ideally, a residential continuum (RC) with different housing options should be provided. RC ranges from round-theclock staffed sheltered homes to more independent and less staffed sheltered apartments which eventually allow individuals moving to independent housing in the community (25). Critics of RC contended that: a) up to date RC is rarely available in communities, b) RC does not meet the varying and fluctuating needs of persons with serious mental illnesses, and c) RC does not account for individuals' preferences and choices. ...
Chapter
Psychosocial rehabilitation (synonymously referred to as psychiatric rehabilitation) is a field and service within mental health systems that shifted the treatment focus from symptom control to social inclusion by functional recovery. It aims to help individuals with severe mental illness live in the community as independently as possible. Psychosocial rehabilitation (PR) developed in the 1970s, when psychiatric reform, including the process of deinstitutionalization, had already paved the way to more responsive and balanced provision of mental health care. This chapter outlines major developments in and obstacles to the reform in European and other high-income countries. It introduces the evolving principles of PR and presents evidence on important models of care, such as assertive community treatment (ACT) and individual placement and support (IPS), that share the objectives of PR to improve integration of people with severe mental illness into the labour market and society in general.
... The homeless person must be "housing-ready" if they are to move into independent housing. A basic prerequisite for this is to have previously resolved, with the help of social services, the problems that led to them becoming homeless in the first place (for a critical analysis, see Ridgway and Zipple, 1990). The basic idea of the staircase of transition is that different levels of progressive control and autonomy (for example, moderate requirements for shelter access, temporary accommodation or specialized hospitality facilities for social groups) are developed like a staircase that will lead to the stage of permanent housing (Busch-Geertsema, 2013, p.15). ...
Article
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Abstract_ The article attempts to explore the planning and implementation of the Housing and Reintegration Program through semi-structured interviews, as well as its influence on the philosophy of addressing homelessness policies in Greece. After outlining the main forms of housing support, an attempt is made to correlate them with Greek policies that focus on the changes ushered in by the Housing and Reintegration Program. The empirical section evaluates the pilot implementation of the Program as well as the broader impact of the features of homeless policies. It should be noted that, despite the various omissions and ambiguities, this is the first complete intervention made by the Greek state to tackle this particular social problem.
... To address the downsizing problems at the end of the twentieth century, new types of accommodation were established to support and integrate people with mental health problems in the community, often summarised under the term 'supported housing' (Carling, 1990). Some types of supported housing are custodial, while others are more supportive with on-site care professionals (Ridgway and Zipple, 1990) or characterised by off-site support (Nelson, 2010). Supported housing, described as custodial, can be understood as a new kind of institution in the community. ...
Article
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Places where people live are important for their personal and social lives. This is also the case for people with mental health problems living in supported housing. To summarise the existing knowledge, we conducted a systematic review of 13 studies with different methodologies regarding the built environment in supported housing and examined their findings in a thematic analysis. The built environment of supported housing involves three important and interrelated themes: well-being, social identity and privacy. If overregulated by professionals or located in problematic neighbourhoods or buildings, the settings could be an obstacle to recovery. If understood as meaningful places with scope for control by the tenants or with amenities nearby, the settings could aid recovery.
... The latter model refers to a broad range of housing with elements of time-limited support and skill working activities (Kirsh, Gewurtz, & Bakewell, 2011;Parkinson, Nelson, & Horgan, 1999;Tabol et al., 2010). Housing models with the function of preparing for the next step in skills development are criticized for not contributing to recovery processes (Ridgway & Zipple, 1990;Rog, 2004) and for normalizing residential instability (Rog, 2004). Non-intentional stability among the residents in transitional housing, combined with the complexity of their needs, may lead to the emergence of practices that stimulate a longer stay. ...
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This article focuses on the work conditions of health care workers in supported housing for people with severe mental health problems. It does so by exploring the workers’ experiences of their daily work situations. The article is based on data from a qualitative mental health project within a larger-sized Norwegian municipality. The findings from the study include two main themes and several subthemes that are discussed in light of institutional logic perspectives. One of the main themes is defined as “Time scheduled tasks and the quality of mental health work” with the three subthemes “The wish and need for more time,” “Lack of flexibility and changing appointments,” and “Managing daily expectations and challenges,” The other main theme is defined as “The implementation of skill training activities” with the two subthemes “The normative expectation of and within skill training” and “Managing skill working relationships,” The findings highlight how health care staff are placed in complex work situations by having to manage different and partly contradictory expectations based on the organization of the health and welfare system and supported housing, the organization and implementation of their daily work together with the residents, and their own professional values.
... Providing sheltered housing in the community for the long-term patients of the old asylums, one of the first steps in the process of deinstitutionalization, was to provide shelter for the long-term patients of the old psychiatric hospitals. Most long-stay patients can successfully leave psychiatric hospitals and live in community settings [5]. Ideally, round the clock, a residential continuum with different housing options should be available for long-term patients of old asylums. ...
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Community psychiatry focuses on the early detection, prevention, early treatment and rehabilitation of patients with emotional disorders and social deviance as they develop in the community rather than as encountered one-on-one, in private practice, or at larger centralized psychiatric facilities. Particular emphasis is placed on the social-interpersonal-environmental factors that contribute to mental illness. Nurses, being a part of health care team, play a very important role in community psychiatry and implementing the psychosocial rehabilitation. They are the direct care providers in implementing psychosocial rehabilitation at the grass root level.
... 61 Supported housing has been contrasted with traditional sequential residential rehabilitation programs, which begin with acute or long-term treatment and step down to levels of accommodation with reducing levels of support and a requirement that residents participate in mandatory treatment plans. 62 The largest study of supported housing was carried out in Canada using a model known as Housing First, which was applied to homeless individuals. 63 The model is characterised by a combination of access to good housing in noncongregate facilities, often through supplement to rent, and support by an ACT team or ICM team (see above). ...
Article
Objective: The objective of this review is to identify the features and components of a comprehensive system of services for people living with schizophrenia. A comprehensive system was conceived as one that served the full range of people with schizophrenia and was designed with consideration of the incidence and prevalence of schizophrenia. The system should provide access to the full range of evidence-based services, should be recovery oriented, and should provide patient-centred care. Method: A systematic search was conducted for published guidelines for schizophrenia and schizophrenia spectrum disorders. The guidelines were rated by at least 2 raters, and recommendations adopted were primarily drawn from the National Institute for Clinical Excellence (2014) Guideline on Psychosis and Schizophrenia in adults and the Scottish Intercollegiate Guidelines Network guidelines on management of schizophrenia. Results: The recommendations adapted for Canada cover the range of services required to provide comprehensive services. Conclusions: Comprehensive services for people with schizophrenia can be organized and delivered to improve the quality of life of people with schizophrenia and their carers. The services need to be organized in a system that provides access to those who need them.
... Provision of PSH is often designated as either a Treatment First (TF) or Housing First (HF) model. The TF model is recovery driven and guided by "treatment readiness," in which eligibility for housing requires the consumer's active participation in treatment and adherence to psychiatric and/or substance use treatment [8]. In contrast, the HF model uses a consumer-driven model, in which the consumer has immediate access to permanent housing regardless of adherence to treatment. ...
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Severe and persistent mental illnesses are frequently associated with homelessness and extensive use of public services. Cost savings after the provision of permanent supportive housing (PSH) have been examined in large metropolitan areas but not in medium-sized communities. Administrative and clinical data were collected to determine use of public services, such as use of emergency services, inpatient psychiatric and medical services, and correctional facilities, in the year preceding and the year subsequent to placement in PSH. Costs of the housing and the utilized services were also calculated. Ninety-one subjects were in housing first (HF) programs and 19 were in treatment first (TF) programs. Overall there was a net cost savings of over $1.2 million or $6134/consumer/year of PSH. Nearly all cost savings were in reduced service utilization which implies prevention of both medical and psychiatric morbidity. In HF the average per patient cost savings ($21,082.12) was not significantly greater than TF ($12,907.29; p = 0.33). Provision of PSH in a mid-sized city provides significant cost savings.
... We investigated if there was a relationship between length of CCU stay, discontinuation of involuntary treatment on, or before, discharge (CTO > VOL) and subsequent mental health or social outcomes. We hypothesised that improvements made in the residential treatment setting would be maintained on the transition to less restrictive settings (Corrigan & Mueser, 2016;Ridgway & Zipple, 1990). We also explored the predictors of CTO discontinuation during CCU care and investigated if there was an association between duration of CCU residence and legal status on discharge. ...
Article
To compare the post-discharge outcomes of people admitted to community-based residential mental health rehabilitation facilities subject to a Community Treatment Order (CTO) who do and do not have this order discontinued prior to discharge. People subject to a CTO who were admitted across five Community Care Units (CCUs) in Queensland, Australia between 2005 and 2014 (N = 311), were grouped based on involuntary treatment status at the time of their discharge. Individuals whose status changed to voluntary (n = 63; CTO > VOL) were compared with those whose treatment remained involuntary (n = 248; CTO-CTO) on demographic, clinical and treatment-related characteristics. Group-level and individualised changes were assessed between the year pre-admission and the year post-discharge. The primary outcome measure was change in mental health and social functioning (Health of the Nation Outcome Scale). Secondary outcomes included disability (Life Skills Profile-16), service use, accommodation instability, and involuntary treatment. Logistic regression was completed to examine predictors of CTO discontinuation during CCU care. Potential predictors covered service-, consumer-, and treatment-related characteristics. Compared to the CTO-CTO group, the CTO > VOL group had significantly longer episodes of CCU care, more frequent primary diagnoses of schizophrenia spectrum disorders, and were more likely to be female. Following discharge, CTO > VOL subjects had more frequent reliable and clinically significant improvement in HoNOS scores, as well as more frequently demonstrated reliable improvement in hospital bed use and accommodation instability than the CTO-CTO subjects. CTO discontinuation was predicted by longer duration of CCU care, being a female, and having a smaller number of psychiatry-related bed use prior admission. Our findings suggest that CCU care of sufficient duration may lessen the need for subsequent compulsory treatment in the community.
... Two main models of care have been investigated for homeless people with severe mental disorders (Fitzpatrick-Lewis et al., 2011;Hwang et al., 2005;Luchenski et al., 2018). Treatment first, also called treatment-as-usual (TAU) or standard treatment, is the first and most common model and consists of providing temporary congregate housing along with a requirement of detoxification, sobriety, and 'housing readiness' before giving access to independent housing (Ridgway and Zipple, 1990). The second model, Housing First (HF), combines unconditional access to permanent and independent housing and support from an assertive case management team (ACT) (Tsemberis, 2011). ...
... The new standard care was set-up in a so-called 'Residential Continuum' or 'Continuum of Care'. This aimed to provide housing in increasingly less restrictive and more autonomous settings over time (1). ...
Article
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Objective: To systematically explore the outcomes of Independent Housing and Support (IHS) for people with severe mental disorders when compared to other residential settings. Method: Systematic review of Randomised and Non-Randomised Controlled Trials of publications that analyse the outcomes of living in independent settings versus institutionalised accommodation. Risk of bias assessment was adapted from the Cochrane Collaboration's ACROBAT-Tool. The analysis was conducted separately for publications with homeless and non-homeless people. Results: Twenty-four publications from studies with homeless people and eight publications from studies with non-homeless people were included. Risk of bias was much lower in studies with the homeless. No RCT was found in the sample of publications with the non-homeless. Overall, results from Independent Housing and Support-settings are not inferior to results from institutionalised settings. Conclusion: The results indicate that Independent Housing and Support-settings provide at least similar outcomes than residential care. We propose that clients' preferences should determine the choice of housing setting.
... The Housing First model was originally created as an alternative to the more traditional "housing ready" model, which expected homeless individuals to deal with their mental health issues and chemical dependencies before being offered stable housing (Padgett, Henwood, & Tsemberis, 2016;Pleace & Bretherton, 2013). The traditional model for helping people with SMI and/or chemical dependency (CD) was communal residential treatment, followed by supported living, and then ultimately independent living (Carling, 1990;Pleace & Bretherton, 2013;Ridgway & Zipple, 1990). This has been referred to as linear residential treatment or the staircase model and has been widely criticized for being overly controlling, resulting in many people dropping out (Padgett et al., 2016). ...
Article
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The Housing First model has been shown to be a highly effective approach to achieving permanent housing for chronically homeless individuals with serious mental illness and chemical dependency. There are numerous components of the model that lend themselves toward achieving similar goals for homeless domestic violence (DV) survivors and their children. A leading cause of homelessness for women, many of whom are mothers, is DV. This article describes the commonalities between the Housing First model and the tenets of DV victim advocacy work and explores how Housing First can be adapted to effectively achieve safe and stable housing for DV survivors and their children. Preliminary evidence for the adapted model – termed Domestic Violence Housing First – is provided, and policy implications are discussed.
... Community-based mobile support services were first developed in the 1970's in Madison, Wisconsin as Programs for ACT (Stein and Test, 1980) to provide community-based treatment that supported individuals with severe mental illness to live in the community and reduce their use of psychiatric hospitalization. Researchers and advocates had identified "supported housing" -independent apartments integrated into the community-as the housing preference for persons with psychiatric disabilities (Carling, 1993;Howie the Harp, 1993;Ridgway and Zipple, 1990) because it provided normalized living in the community. The idea of community-based, independent living, with flexible supports was promoted as an ideal before PHF made it a reality. ...
Chapter
Almost 30 years ago, Beth Shinn argued that individual-level analyses and person-centered approaches favored by psychology are limited in understanding the causes and solutions to homelessness. At the same time, community psychology has contributed significantly to the research base and the development of interventions and policy on homelessness over the past four decades. To demonstrate this contribution, the article focuses on Housing First, a programmatic and policy response to chronic homelessness. Developed by Dr. Sam Tsemberis, a community-clinical psychologist, the approach combines the provision of rent supplements with intensive community support to assist individuals to move into regular housing in the community as rapidly as possible and without any pre-conditions. Randomized controlled trials conducted in the United States, Canada, and France have consistently demonstrated the effectiveness of Housing First in helping 80%–90% of individuals with longstanding histories of homelessness to successfully achieve stable housing. Future research is required on enriching and targeting the support provided in Housing First in order that it facilitate community integration and recovery among formerly homeless individuals. Community-clinical psychologists can play an important in the evolution and scaling up of Housing First. Homelessness represents one of the most significant social problems facing industrial developed countries like the United States and Canada. As presented in this article, there is a need for clinical psychology training to extend its focus on the development of community-clinical psychology competencies so that clinical psychology can contribute to ending homelessness.
... Within community mental health in the U.S., efforts to promote the social inclusion of persons with serious mental illnesses have relied primarily on individualistic models, such as the individual placement and support (IPS) model of supported employment [1,2], with similar efforts in the housing [3] and educational [4,5] domains. While these efforts have been highly successful in improving employment, educational, and housing status-allowing them to be considered ''evidence based practices'' [6][7][8] -little is known as to whether the same can be said for the broader outcome of social inclusion. ...
Article
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U.S. efforts to promote the social inclusion of persons with serious mental illnesses have relied primarily on individualistic models, exemplified by the individual placement and support (IPS) model of supported employment. As little attention has been paid to social outcomes other than employment, the study examined the objective and subjective outcomes of IPS in terms of social inclusion by critically reviewing the research literature. A little over half of IPS users are likely to obtain competitive jobs; work, on average, for less than 6 months; and earn less than $5000 per year over the first few years. IPS appears limited in promoting broader social inclusion, calling into question the wisdom of limiting service user choices solely to individualistic approaches to what may be considered more of a social challenge. A social model of “enclave communities” may improve social inclusion outcomes and establish a more solid foundation for employment programs, including IPS.
Article
This study investigated the effectiveness of the addition of rent assistance to existing housing and support services in the Waterloo region of Ontario for people experiencing chronic homelessness. A nonequivalent comparison group design was used to compare the outcomes between (a) participants selected to receive rent assistance plus support services (n = 26) and (b) participants receiving support services only (n = 25). Participants were interviewed at baseline and 6 months later. Participants in the rent assistance condition showed significantly greater improvements over time relative to the comparison group in housing stability and quality of life. They also demonstrated significantly better perceived housing quality, and there were trends of greater improvement in community functioning, social support, and food security. The findings demonstrate that rent assistance is associated with superior program outcomes for people experiencing chronic homelessness and is a necessary component of supported housing models, such as Housing First.
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This Report is the final report about the Housing First Europe social experimentation project funded by the European Commission
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One major source of confusion surrounding the use of the term recovery derives from a lack of clarity about the respective roles of health care practitioners and people with mental health problems. We offer two definitions of recovery in order to distinguish between the process of recovery and the provision of recovery-oriented care. Recovery refers to the ways in which a person manages a mental health condition trying to restore or develop a meaningful sense of belonging and a positive sense of identity apart from this condition. Recovery is a process of change through which individuals improve their health and wellness, conduct self-directed lives, and strive to reach their full potential. Recovery-oriented care is what mental health treatment and rehabilitation practitioners offer in support of the person's own long-term recovery efforts. The promotion of wellness through self-care and early intervention, both mental and physical, is an important component of it. Recovery-oriented care requires that people in recovery be involved in all aspects and phases of the care delivery process. In this article we clarify the terminology and provide a discussion of some of the ways in which recovery and recovery-oriented practice are commonly viewed from the perspectives of policy and practice. In contrast, we argue for a paradigm shift in which the role of the person "in recovery" remains at the center of all conceptualizations and debates while considering the role of culture in shaping how recovery is viewed and best promoted in different societies. We propose to promote this approach with cultural adaptations and to include this model in health schools and residency programs. Students and future professionals of health will thus have information about this model and will be able to decide on its integration in their daily practice.
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Recovery in co-occurring substance use and mental health problems is a personal and social process that involves quality of life and community inclusion. Recovery-oriented practices consequently need to address both personal and social issues, and collaborative approaches can be useful in developing recovery-oriented practices to promote recovery and citizenship. The aim of the present study was to examine the potential benefits of using a collaborative approach to recovery-oriented practice development for self-reported recovery and citizenship among residents at a supported housing site. Residents, staff, and researchers collaborated to develop principles for a recovery-oriented practice, which were then to be integrated into practice. A prospective comparative design was applied with residents at a supported housing site with an ongoing collaborative recovery-oriented practice development initiative (n = 7), and a reference group of residents at supported housing sites following practice as usual (n = 21). There was a significant increase in the recovery domain of willingness to ask for help after the recovery-oriented practice development among residents at the project site. The reported levels of the citizenship domains civil and legal rights and staff support among residents at the project site demonstrated stability, whereas the levels of these domains decreased among residents at the reference sites. The results suggest that facilitating collaborative approaches to developing recovery-oriented practices can help promote recovery and protect citizenship for residents in supported housing. The study had several meth-odological limitations; thus, further research on the promotion of recovery and citizenship in supported housing is needed.
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Supported living has been shown to improve functioning and social inclusion in people with severe and persistent mental health problems, reduce hospitalisation and provide secure accommodation in a population where housing needs are often unmet. Conversely, living in supported accommodation has been depicted by some as depersonalising, marginalising and an ordeal to survive. Discussions regarding housing and support often lack a thorough consideration of individual experiences, with a reliance on quantitative surveys. The question remains how to assure that supported accommodations actually are supportive of the residents' ongoing recovery process. The present study sought to shed light on the experiences of residents in an enhanced supported living service in the United Kingdom. Semi-structured interviews were conducted with nine residents of the service between July 2020 and February 2021. Transcripts were analysed using thematic analysis and indicated three superordinate themes of experiences considered valuable to residents: (1) support from care staff which was readily available; (2), a sense of community and daily activity offered by the residence and on-site activities; and (3) the experience of supported living as a stepping-stone in an ongoing recovery process. Findings indicate the power of comprehensive care with supportive staff, peer-relations, autonomy and fostering hope in empowering individuals in their ongoing recovery.
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There is mounting evidence that preventative services and Housing First, working with other homelessness services within an integrated home-lessness strategy, can greatly reduce the experience of lone adult homeless-ness. However, progress in reducing the socioeconomic inequalities and poor social integration associated with lone adult homelessness has been more mixed. Housing can be both secured and sustained, but absence of family and friendship ties, poor community inclusion, relatively poor health and economic exclusion can still continue after the physical experience of homelessness has ended. This paper draws on a two-year longitudinal evaluation of a multi-site programme that was designed to promote economic and social integration among homeless people in the UK. Tracking a cohort of people using the service over two years, it was found that people whose lives had been char-acterised by sustained social and economic integration prior to homelessness were most readily assisted by the programme. Successes were also achieved with homeless people who had little experience of formal paid work, and with people with higher needs for treatment and support, but results were more mixed. Work secured with the help of the programme could play an important role in facilitating and sustaining an exit from homelessness. However, some programme participants who were 'successful', in that they secured work and were no longer homeless, found themselves in a liminal state, in which their employment and housing were both poor quality and insecure. \ Keywords_ Homelessness and social integration, social cohesion, employment , education and training, labour market activation.
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Homelessness is considered a serious public health concern. Bidirectional relationship has been established between homelessness and mental illness by research studies and its association with compromised well-being, poor quality of life and low productivity. Recent legislative enactments in India have necessitated on the part of the state to address issues related to the rights of persons with mental illness including shelter and housing. Therefore, it becomes imperative to discuss opportunities and prospects in India towards rehabilitating homeless mentally ill in context of existing programs, policies and legislations.
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The World Health Organization (WHO) defines mental health as “a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community”. A person’s mental health is shaped by various social, economic, physical, and environmental factors, at different stages of life. Risk factors are heavily associated with social inequalities in the domains of employment, housing, and education. Theories of social determinants of health postulate the beneficial effects of factors exterior to medicine (regarding income, housing, education, and employment) on the health of individuals and populations. Recognition of the effect of social determinants on the health of vulnerable populations has been at the core of the intervention models and housing services developed by social service professionals in Québec. This article offers a review of housing services provided to psychiatric patients living in the community, over the last 50 years in Quebec. Different models of housing with social support which contribute to the autonomy, the security, and the empowerment of psychiatric patients are presented.
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Nussbaum’s Central Capabilities refer to the elements of a well-lived life, and many adults who experience homelessness are deprived of these capabilities. The study aim was to investigate whether service users experience different homeless services as affording or constraining capabilities. We conducted semi-structured interviews with homeless service users (n = 77) in Housing First (HF) and staircase services (SS) in eight European countries. We used thematic analysis to identify three themes: autonomy and dependency, the relational impact of living arrangements, and community interaction and stigma. While SS participants were able to address their bodily integrity and health, their higher-order capabilities were constrained by their homeless situations. HF participants described home as a base from which they could enact a wide range of capabilities indicative of a well-lived life. We conclude that housing-led service models with appropriate supports are key to affording service users’ capabilities. Practical and policy implications are discussed.
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The aim of this study was to examine the extent of and variation in person-centered care across programs within community mental health clinics. Service plans ( N = 160) from programs within eight clinics were assessed for person-centered care planning using an objective fidelity measure. Univariate statistics calculated overall fidelity to person-centered care planning and mixed-effect regression models examined person-centered care planning by program type. Overall, providers demonstrated low levels of competency in person-centered care planning. There were significant differences according to program type, with providers from assertive community treatment programs demonstrating the highest level of competency. Providers need more training and support to implement person-centered care consistently across community mental health programs. Those program types with associated fidelity measures that include person-centered care had a higher level of competence confirming the value of fidelity measurement in promoting quality services.
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Deinstitutionalization of the mentally ill has had an enormous impact on the mentally ill, the community, family members and taxpayers. This paper assesses the impact of deinstitutionalization on each of these groups. The approach is interdisciplinary in nature, using schools of thought found in the fields of political and economic thought in analyzing the effect of deinstitutionalization on each stakeholder group. Although assessments vary by stakeholder group, some overall observations can be made. Ironically, both libertarian and utilitarian arguments favor deinstitutionalization, although for different reasons. A deontological view, however, finds deinstitutionalization lacking.
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Homeless people typically experience multiple social exclusions that severely affect their well-being. Therefore, based on clients’ participation, this study aims to explore what homeless people facing multifaceted social exclusion perceive as their biggest challenges in daily life, thereby rethinking the current homelessness policies and practices in Taiwan. Using the photovoice method, six homeless people living in the vicinity of the Taipei Main Station participated in the three-stage project. They took photographs to illustrate the main life difficulties and satisfactions they faced and engaged in dialogues through the images presented in the photographs. Through the photovoice workshops, ‘poor sleep’ was identified as their major common predicament, and all participants responded with strong emotions about the dire need to sleep well. In the final stage, homeless participants proposed the ‘Sleep First’ solution based on their own perspectives, which supported the philosophy of the ‘Housing First’ approach to addressing homelessness.
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This article reassesses the policy concept of chronic homelessness in the light of women’s experiences of long-term homelessness. Chronic homelessness, associated with long-term homelessness and high levels of emergency and homelessness service use among men, has received increased focus in research, policy and services in recent years, and despite women’s comparative housing disadvantages, the overwhelming majority of people identified as experiencing chronic homelessness are male. This article draws on Carole Bacchi’s work on how policy problems are represented, and on the results of a small qualitative study with women experiencing long-term or chronic homelessness, to show how current representations of chronic homelessness obscure rather than reflect women’s experiences of long-term homelessness, marginalising their claims to housing and other assistance. The article concludes by suggesting opportunities to change this representation of the problem through research, evaluation, policy and program development that are informed by women’s experiences.
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The built environment directly and indirectly affects mental health, especially for people transitioning from long-term homelessness to permanent supportive housing (PSH) who often experience co-occurring behavioral health challenges. Despite a rapid increase in PSH availability, little research examines influences of architecture and design within this context. This integrative review synthesized limited research on PSH design in the U.S. and Canada to identify built environment characteristics associated with PSH residents’ mental health, highlight gaps in the literature, and prioritize future research directions. A systematic search for peer-reviewed articles was conducted using nine databases drawing from multiple disciplines including architecture, environmental psychology, interior design, psychology, psychiatry, medicine, and nursing. Seventeen articles met inclusion criteria. Study design, methodology, built environment properties, place attributes, and relevant findings were extracted and iteratively analyzed. Three domains relevant to architecture and design were identified related to home, ontological security, and trauma sensitivity; dwelling unit type, privacy, control, safety, housing quality and location, and access to amenities; and shared common space. Integrative review results emphasize the potential of architecture and design to contribute to improved built environment quality and mental health outcomes among PSH residents. Methodological limitations and directions for future research are also discussed.
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Purpose: This study aims to explore the independent housing experiences of people with mental illness who receive supported independent housing services provided by the public sector.Methods: Data were collected through face-to-face interviews using semi-structured interviews. Twelve participants, who had been living independently in the community for around 11 months, were included. A qualitative descriptive method and a content analysis method were applied.Results: Independent housing experiences of people with mental illness were classified into the following four domains: house effect, growth, challenges and limitations, relationships, and support. Eleven categories included the starting point of life, environmental & psychological comfort, inspire independence and confidence, recognition of goals and responsibilities, positive self-awareness, psychological difficulties, immaturity of daily coping, unstable self-protection, relationship improvement, and importance of support resources.Conclusion: For successful community integration of mentally disabled people, continuous legal institutional preparation for stable housing, government active interest, and flexible financial support are needed. In addition to housing support, a recovery-based independent housing case management model needs to be developed for successful maintenance of independent living. We also suggest a study on the effectiveness of independent housing to determine evidence for making a policy.
Article
Discusses the role of psychologists in promoting reasonable workplace accommodations for the mentally handicapped. Historical and current trends in employment-related psychological treatment are reviewed. The relevant provisions of the Americans with Disabilities Act are described, including areas of ambiguity. The specific difficulties of integrating the mentally disabled in mental-health and rehabilitation employment settings are considered. The responsibilities of psychologists to the disabled and to employers are assessed. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
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