Housing First Services for People Who Are Homeless With Co-Occurring Serious Mental Illness and Substance Abuse

Abstract

The literature on homeless adults with severe mental illness is generally silent on a critical issue surrounding service delivery—the contrast between housing first and treatment first program philosophies. This study draws on data from a longitudinal experiment contrasting a housing first program (which offers immediate permanent housing without requiring treatment compliance or abstinence) and treatment first (standard care) programs for 225 adults who were homeless with mental illness in New York City. After 48 months, results showed no significant group differences in alcohol and drug use. Treatment first participants were significantly more likely to use treatment services. These findings, in combination with previous reports of much higher rates of housing stability in the housing first group, show that “dual diagnosed” adults can remain stably housed without increasing their substance use. Thus, housing first programs favoring immediate housing and consumer choice deserve consideration as a viable alternative to standard care.

Daily Substance Use and Mental Health Symptoms among a Cohort of Homeless Adults in Vancouver, British Columbia

“…Missing values for any of these items were replaced by the mean value for that specific item PTSD post-traumatic stress disorder daily substance use in our study (29 %) is dramatically higher than other Housing First intervention studies of homeless, mentally ill persons. 2,7 In previous studies, drug use was characterized as high frequency when the participant reported using 4 days out of the past 6 months (G25 %) and heavy alcohol use consisted of consuming alcohol on 28 days out of the past 6 months 7 or 15 days in the previous month (16 %). 2 As with the high-frequency substance users in the Collaborative Initiative on Chronic Homelessness study, 2 DSUs in our sample also experienced long durations of homelessness over their lifetime and had more mental health symptoms compared to participants who were abstinent or used substances less than daily.…”

“…6 Recently, Housing First has been shown to be effective among homeless individuals with active substance use disorders. 2,7 However, while substance use per se was prevalent among participants in these studies, the implications of different severities and forms of substance use have not been well characterized in this context. For example, Padgett et al 7 defined heavy use of drugs as using 4 days out of the previous 6 months.…”

“…2,7 However, while substance use per se was prevalent among participants in these studies, the implications of different severities and forms of substance use have not been well characterized in this context. For example, Padgett et al 7 defined heavy use of drugs as using 4 days out of the previous 6 months. This definition does not capture the reality of substance use among people who are homeless and mentally ill in Vancouver, British Columbia, 8 which has the highest provincial lifetime reported use of illicit drugs in Canada (50.8 % of the general population).…”

There's no place like (a) home: Ontological security among persons with serious mental illness in the United States

“…The NYHS was a four-year trial in which homeless mentally ill adults received immediate housing through Pathways (the experimental condition) or 'usual care' ('treatment first') and were assessed for an array of outcomes (Tsemberis, Gulcur & Nakae, 2004). Quantitative findings from the NYHS revealed significantly greater housing stability among the experimental group members enrolled in Pathways (Padgett, Gulcur & Tsemberis, 2006;Tsemberis et al, 2004). …”

Efficacité de l’approche « logement d’abord » : une revue systématique

“…Dans deux des trois études qui ont comparé l'approche « logement d'abord » avec les interventions psychosociales traditionnelles, les personnes qui ont eu accès à un programme basé sur l'approche « logement d'abord » ont passé moins de temps en situation d'itinérance et plus de temps dans un logement que celles qui ont fait l'objet d'interventions psychosociales traditionnelles (tableau 8) (Montgomery et al, 2013 ;Padgett, Gulcur & Tsemberis, 2006). Ces résultats sont aussi rapportés dans les revues systématiques de Nelson et al (2007) et Rog (2004.…”