Housing First for Severely Mentally Ill Homeless Methadone Patients

Abstract

The Housing First approach used by Pathways to Housing, Inc., was used to enhance residential independence and treatment retention of homeless, seriously mentally ill methadone patients. The Keeping Home project first secured scattered-site apartments and assertive community treatment services and then addressed patients' service needs. Three years post-implementation, methadone treatment retention for 31 Keeping Home patients versus 30 comparison participants (drawn from an administrative database) was 51.6% vs. 20% (p < .02); apartment/independent housing retention was 67.7% vs. 3% or 13% (both p's < .01). Although results firmly support Keeping Home, future research needs to address study's possible database limitations.

Housing First Improves Residential Stability in Homeless Adults With Concurrent Substance Dependence and Mental Disorders

“…47 One study using the Housing First approach to improve residential stability and treatment retention of mentally ill patients (n = 31) on methadone compared with usual care (n = 30) reported better housing retention (67.7% vs 13%; P < .02) and methadone treatment retention (51.6% vs 20%; P < .01) among the Housing First group. 48 Our results support the integration of housing and intensive support services for persons who are homeless and had substance dependence. Despite the expansion of clinical services in Boston, Massachusetts, there has been no reduction in the all-cause mortality rate among homeless adults since the early 1990s.…”

One-Year Outcomes of a Randomized Controlled Trial of Housing First With ACT in Five Canadian Cities

“…These findings suggest that a majority of individuals with severe mental illness who are homeless are able to move immediately into and manage their own housing if given the right supports. This Canadian study extends the results of previous research conducted in large American cities (12)(13)(14)(15)(16)(17)(18)(19). The finding that Housing First participants had greater improvements in observer-rated community functioning in the first year of receiving services compared with participants in treatment Housing First Treatment as usual as usual has not been reported in previous research.…”

“…Compared with recipients of standard care-often a continuum of residential settings-recipients of Housing First obtained housing earlier and remained stably housed longer, showed greater reductions in use of health and social services, and reported higher levels of quality of life (8,9,11). However, the evidence base for the effectiveness of Housing First remains limited, consisting of published research from two small trials conducted in New York City and five quasi-experimental studies conducted in other American cities (12)(13)(14)(15)(16)(17)(18)(19). As well, most of the studies have focused narrowly on housing outcomes.…”

The longitudinal association between homelessness, injection drug use, and injection-related risk behavior among persons with a history of injection drug use in Baltimore, MD

“…Persons with a history of drug use face challenges in acquiring and maintaining proper housing, as they may be more likely to be low-income, unemployed, and have an incarceration record that can render them ineligible for subsidized housing. Housing First interventions, which provide housing to individuals without drug treatment or engagement in other services as a prerequisite, have been shown to increase housing stability and drug treatment retention among persons with substance abuse and psychiatric disorders (Appel et al, 2012; Tsemberis et al, 2004). Housing First models have also been reported to lessen healthcare and societal costs (Larimer et al, 2009).…”