Mental health supported accommodation services: a systematic review of mental health and psychosocial outcomes

Abstract

BackgroundPost-deinstitutionalisation, mental health supported accommodation services have been implemented widely. The available research evidence is heterogeneous in nature and resistant to synthesis attempts, leaving researchers and policy makers with no clear summary what works and for whom. In this context, we undertook a comprehensive systematic review of quantitative studies in order to synthesise the current evidence on mental health and psychosocial outcomes for individuals residing in mental health supported accommodation services.MethodsUsing a combination of electronic database searches, hand searches, forward-backward snowballing and article recommendations from an expert panel, 115 papers were identified for review. Data extraction and quality assessments were conducted, and 33 articles were excluded due to low quality, leaving 82 papers in the final review. Variation in terminology and service characteristics made the comparison of service models unfeasible. As such, findings were presented according to the following sub-groups: ‘Homeless’, ‘Deinstitutionalisation’ and ‘General Severe Mental Illness (SMI)’.ResultsResults were mixed, reflecting the heterogeneity of the supported accommodation literature, in terms of research quality, experimental design, population, service types and outcomes assessed. There is some evidence that supported accommodation is effective across a range of psychosocial outcomes. The most robust evidence supports the effectiveness of the permanent supported accommodation model for homeless SMI in generating improvements in housing retention and stability, and appropriate use of clinical services over time, and for other forms of supported accommodation for deinstitutionalised populations in reducing hospitalisation rates and improving appropriate service use. The evidence base for general SMI populations is less developed, and requires further research.ConclusionsA lack of high-quality experimental studies, definitional inconsistency and poor reporting continue to stymie our ability to identify effective supported accommodation models and practices. The authors recommend improved reporting standards and the prioritisation of experimental studies that compare outcomes across different service models.Electronic supplementary materialThe online version of this article (10.1186/s12888-018-1725-8) contains supplementary material, which is available to authorized users.

Unmet needs of persons with a severe and persistent mental illness and their relationship to unmet accommodation needs

“…It seems the system has been unable to find a way to help this group of individuals with poor functioning and living skills and who are not capable of looking after themselves. HF services described earlier have shown to result in reduced rates of rehospitalisation as well as improved satisfaction, quality of life, social functioning and psychiatric symptomatology both internationally (McPherson et al, ; O'Malley & Croucher, ; Russolillo et al, ) and in Australia (Holmes et al, ). However, these services are not yet available in Gippsland.…”

“…Hence commenced the development of ‘mental health supported accommodation’ which has been defined as ‘any service that provided support, delivered predominately by non‐professionally qualified staff, to people with mental health problems living in community‐based accommodation, either alone or in shared settings’ (McPherson, Krotofil, & Killaspy, ). There has been an assumption that, with proper staged support, people with SPMI would progress from higher to lower levels of supported accommodation (O'Malley & Croucher, ).…”

“…For the majority of persons with SPMI, Housing First was beneficial and resulted in high levels of satisfaction, better quality of life and social functioning as well as psychiatric symptomatology (McPherson et al, ; O'Malley & Croucher, ). However, a smaller group of people with the most severe and enduring mental health problems who require long‐term, permanent accommodation with high levels of support tended to get left behind (Holmes et al, ; O'Malley & Croucher, ; Pleace, ).…”

What Works? Toward a New Classification System for Mental Health Supported Accommodation Services: The Simple Taxonomy for Supported Accommodation (STAX-SA)

“…Service descriptions from retained papers from two recent systematic reviews were used to assess the utility of the new taxonomy; a quantitative review of mental health and psychosocial outcomes associated with supported accommodation [7] and a qualitative review of service user experiences of supported accommodation [17]. The search strategies are described elsewhere, however, to summarize, an electronic search was conducted (January 2015, updated June 2017) using 10 databases; terms and concepts relating to ‘mental illness’, ‘supported accommodation’ and key outcomes, such as quality of life, housing retention and social functioning, were combined with MeSH terms, subject headings or thesaurus terms (depending on database).…”

“…Indeed, the majority of systematic reviews in this field have been unable to effectively compare service models (e.g., [7]) thus limiting the utility of the findings, leaving researchers and policy makers with little comparative evidence to inform system-level decisions. As stated by Fakhoury and colleagues [8], “ (The) diversity of models in relation to supported housing and inconsistent use of terminology…makes it difficult to compare outcomes or processes ” (p. 311).…”