Evaluation of an integrated housing and recovery model for people with severe and persistent mental illnesses: the Doorway program

Abstract

Objective The Doorway program is a 3-year pilot integrated housing and recovery support program aimed at people with a severe and persistent mental illness who are 'at risk' or actually homeless. Participants source and choose properties through the open rental market, with appropriate rental subsidy and brokerage support. This arrangement is highly innovative, differing from widely favoured arrangements internationally involving congregate and scattered-site housing owned or managed by the support program. The aim of the present study was to determine the effects of the Doorway program on participants' health, housing, service utilisation and costs. Methods A pre-post study design was used with outcome measures consisting of a number of question inventories and their costs (where relevant). The principal inventories were the Behaviour and Symptom Identification Scale 32 (BASIS-32), a consumer-oriented, self-report measure of behavioural symptoms and distress, the Health of the Nation Outcome Scale (HoNOS), an interviewer-administered measurement tool designed to assess general health and social functioning of mentally ill people and the Outcomes Star (Homelessness) system which measures various aspects of the homelessness experience. Baseline measurements were performed routinely by staff at entry to the program and then at 6-monthly intervals across the evaluation period. Results For 55 of 59 participants, total mean BASIS-32 scores (including as well three of five subscale scores) improved significantly and with moderate effect size. Four of the 10 domain scores on the Outcome Star (Homelessness) inventory also improved significantly, with effect sizes ranging from small-medium (three domains) to large (one domain). Mean usage of bed-based mental health clinical services and general hospital admissions both significantly decreased (with overall net savings of A$3096 per participant per annum). Overall cost savings (including housing) to government ranged from A$1149 to A$19837 depending on the housing type comparator. Conclusion The Doorway program secured housing for this vulnerable group with additional benefits in client outcomes, including reduced use and cost of health services. These findings, if confirmed in larger studies, should have widespread applicability internationally. What is known about the topic? Beneficial effects of housing and recovery programs (Housing First) on people with severe and persistent mental illness and who are 'at risk', or actually homeless, are being demonstrated in Northern America. These effects include housing security, well being, health service utilisation and cost effects on government. However, these beneficial effects can only be regarded as settled for housing security. The highly innovative Doorway care model in which participants source and choose properties through the open rental market, with appropriate rental subsidy and brokerage support, has not been investigated previously. What does this paper add? This paper adds new data on the Doorway care models, it's ...

Homeless status documentation at a metropolitan hospital emergency department

“…Integrated housing and support programmes can also produce healthcare cost savings (e.g. mean12 month healthcare saving of AU$11 033 in one programme), potentially off‐setting expenditure.…”

Housing, homelessness and mental health: towards systems change

“…Doorway is a collaboration between hospitals, housing and mental health service providers and landlords. The program links consumers with private rental housing and psychosocial support while providing time limited rental subsidy, brokerage and tenancy support (Dunt et al 2017). The model is based on HF principles, but is highly innovative, as it diverges from the predominant model of providing housing via social housing providers, in favour of the private rental market.…”

“…Other community based health services may also be involved for specialised purposes. AMHSs, and specifically the case manager, exercise governance for these different program inputs into an individual participant's care (Dunt et al 2017).…”

“…The evaluation found that participant usage of bed-based clinical service and hospital admissions reduced significantly during the program, totalling annual cost savings to government ranging from $1,149 to $19,837 per individual. Outcomes for participants included modest improvements in the proportion of tenants in paid or unpaid employment, taking steps to find work, seeing an employment consultant, accessing education and vocational training opportunities and receiving qualifications for their vocational training (Dunt et al 2017).…”

“…Properties sourced through the open rental market, the provision of appropriate rental subsidy and brokerage support and collaboration between hospitals, housing and mental health service providers and landlords were identified as critical success factors by the evaluation (Dunt et al 2017).…”