From Residential Care to Supportive Housing for People With Psychiatric Disabilities: Past, Present, and Future

Abstract

For centuries, treatment and accommodation for people with significant mental health conditions in many countries, including the United States, have been viewed as necessarily inseparable elements, first in asylums and then, with deinstitutionalization, in community care models. The advent of psychiatric rehabilitation and later, recovery, helped to shift the paradigm of mental health services and the role of housing, to one focused on promoting the ability of individuals to achieve not only a life located in the community, but one that reflects a meaningful life as part of a community. In this context, supportive housing emerged as a model based on integrated, permanent, affordable housing, selected by the person, with flexible supports that are functionally separate, but available as needed and wanted. This model of housing has been predominant in American mental health services for over 20 years, and evidence now exists for its outcomes in terms of housing stability, symptom reduction, and psychosocial variables. Current challenges, both at the societal and the individual level, confront the sustainability of supportive housing, with some efforts being made by housing groups to address these challenges. This article reviews the evolution of supportive housing and its basic tenets, identifying the challenges and some efforts to address them. In addition, the article discusses the current social and economic climate, which appears to be shaping opposing trends, and makes a call to action, to mitigate the possible risks to the future of this value-based housing approach.

Selbstbestimmtes Wohnen mit Unterstützung – Entwicklung und Überprüfung der «Modelltreue- Skala Selbstbestimmtes Wohnen (MSSW)» für Menschen mit psychischen Beeinträchtigungen

“…Ein abermaliger Wandel stellte sich ab dem Beginn der 2010er-Jahre ein, als das selbstbestimmte Wohnen in der eigenen Wohnung mit einer stundenweisen professionellen Unterstützung immer populärer wurde. Damit verbunden war ein Richtungswechsel in den Zielen der Wohnunterstützung, die sich -ebenso wie andere Bereiche der psychiatrischen Versorgung -nunmehr die Recovery-und Inklusionsorientierung zu eigen machte [2]. Gestützt wurde dieser abermalige Wandel durch grosse Studien im Bereich der Menschen mit psychischen Erkrankungen in Obdachlosigkeit, die ergeben haben, dass viele Betroffene selbst nach Jahren des Lebens auf der Strasse in der Lage waren, in der eigenen Wohnung zurecht zu kommen und ein stabiles Leben zu führen [3,4].…”

“I will never forget him”. A qualitative exploration of staff descriptions of helpful relationships in supportive housing

“…In the last half‐century, most western countries have been through extensive mental healthcare system reforms in terms of deinstitutionalization (Fakhoury, Murray, Shepherd, & Priebe, 2002; Farkas & Coe, 2019; Roos, Bjerkeset, Sandenaa, Antonsen, & Steinsbekk, 2016) and a turn from a medically oriented psychiatry towards a recovery‐oriented mental health paradigm (Anthony, 1990; Russinova, Rogers, Cook, Ellison, & Lyass, 2013). The recovery–orientation implies focusing on the individual’s personal, unique process of changing one’s attitudes, values, feelings, goals, skills and roles (Anthony, 1990); a process of regaining control over one’s own life through one’s own efforts and with support from both one’s informal and professional networks (Leamy, Bird, Le Boutillier, Williams, & Slade, 2011; Topor et al, 2006).…”

“…Despite that the embedded goal of deinstitutionalization has been the promotion of the individuals’ ability to achieve a meaningful life as part of a community (Farkas & Coe, 2019), the situation in most western countries is that new institutions in the shape of co‐located staffed housing with institutional characteristics (e.g. household regulations) have become a common way of providing community mental health care for persons with extended and complex needs (Fakhoury & Priebe, 2007).…”

Quality of Community-based Care Services in Korea

“…Through community care, recipients in need of care are provided with the benefits of welfare and medical services that meet their needs while they live in the community, in their own houses, group homes, or the like. Community care is also a system through which self-realization and daily activities are enabled as part of the community (12)(13)(14)(15). Before the full community care project began, the government, through a pilot project initiated in 2010, began providing three major at-home care services for postpartum women and infants, house and health help, and elderly care in 2012.…”