Effects of Housing First approaches on health and well-being of adults who are homeless or at risk of homelessness: systematic review and meta-analysis of randomised controlled trials

Abstract

BackgroundHomelessness is associated with poor health. A policy approach aiming to end homelessness across Europe and North America, the ‘Housing First’ (HF) model, provides rapid housing, not conditional on abstinence from substance use. We aimed to systematically review the evidence from randomised controlled trials for the effects of HF on health and well-being.MethodsWe searched seven databases for randomised controlled trials of interventions providing rapid access to non-abstinence-contingent, permanent housing. We extracted data on the following outcomes: mental health; self-reported health and quality of life; substance use; non-routine use of healthcare services; housing stability. We assessed risk of bias and calculated standardised effect sizes.ResultsWe included four studies, all with ‘high’ risk of bias. The impact of HF on most short-term health outcomes was imprecisely estimated, with varying effect directions. No clear difference in substance use was seen. Intervention groups experienced fewer emergency department visits (incidence rate ratio (IRR)=0.63; 95% CI 0.48 to 0.82), fewer hospitalisations (IRR=0.76; 95% CI 0.70 to 0.83) and less time spent hospitalised (standardised mean difference (SMD)=−0.14; 95% CI −0.41 to 0.14) than control groups. In all studies intervention participants spent more days housed (SMD=1.24; 95% CI 0.86 to 1.62) and were more likely to be housed at 18–24 months (risk ratio=2.46; 95% CI 1.58 to 3.84).ConclusionHF approaches successfully improve housing stability and may improve some aspects of health. Implementation of HF would likely reduce homelessness and non-routine health service use without an increase in problematic substance use. Impacts on long-term health outcomes require further investigation.Trial registration numberCRD42017064457

Post-hospital medical respite care for homeless people in Denmark: A randomized controlled trial and cost-utility analysis.

“…These important differences give rise to further considerations about which services should be provided at a post-hospital medical respite care center and when the marginal effect of one additional day approaches zero. In comparison with other interventions such as housing first we see similar results regarding hospital use (22), which underline the importance of temporary or stable housing as our study reports that 23 % of the intervention group obtained temporary housing in continuation of the medical respite care stay.…”

“…This study is one of a few randomized controlled studies performed in acutely admitted homeless patients, a socially stigmatized group (22). The perspective of the economic evaluation is societal.…”

Trajectories and mental health-related predictors of perceived discrimination and stigma among homeless adults with mental illness

“…Our study also highlighted that receiving the HF intervention (rent supplements with assertive community treatment or intensive case management) did not influence the probability of membership in discrimination or stigma group trajectories. While the HF model has a positive impact on housing stability [49], these findings suggest the potential impact of HF on nonhousing outcomes such as stigma and discrimination is limited. Therefore, multidimensional support services and efforts are needed [50] to address the structural socioeconomic barriers and mechanisms that contribute to stigma and of people experiencing or at risk of homelessness, with and without mental illness.…”

Prevalence of mental disorders among people who are homeless: an umbrella review

“…Fifth, health services research should be conducted to examine how health systems and existing modalities of mental health care are equipped to address the burden of mental disorders among homeless people. This may require policy analyses and evaluations of mental health as well as social care programs to assess the effectiveness of the existing approaches, identify the gaps through rigorous research, and address the same through evidence-based multipronged pharmacological and non-pharmacological interventions (Baxter, Tweed, Katikireddi, & Thomson, 2019;Fitzpatrick-Lewis et al, 2011).…”