Supportive housing is a combination of housing and services intended as a cost-effective way to help people live more stable, productive lives, and is an active "community services and funding" stream across the United States. It was developed by different professional academics and US governmental departments that supported housing.Racino, Julie A. (2014). Public Administration and Disability: Community Services Administration in the US. NY, NY and London, UK: CRC Press, Francis and Taylor. Supportive housing is widely believed to work well for those who face the most complex challenges—individuals and families confronted with homelessness and who also have very low incomes or serious, persistent issues that may include substance use disorders (including alcoholism), mental health, HIV/AIDS, chronic illness, diverse disabilities (e.g., intellectual disabilities, mobility or sensory impairments) or other serious challenges to stable housing."Public Housing Authorities: helping to end homelessness through permanent supportive housing, Journal of Housing & Community Development March/April 2008 p18.
Supportive housing in rehabilitation Supportive housing can be coupled with such social services as job training, life skills training, alcohol and substance use disorder treatment, community support services (e.g., child care, educational programs, coffee klatches), and case management to populations in need of assistance.Cohen, M.D. & Somers, S. (1990, April). Supported housing: Insights from the Robert Wood Johnson program on chronic mental illness. "Psychosocial Rehabilitation Journal", 13(4): 43-51. Supportive housing is intended to be a pragmatic solution that helps people have better lives while reducing, to the extent feasible, the overall cost of care. As community housing, supportive housing can be developed as mixed income, scattered site housing not only through the traditional route of low income and building complexes."Journal of Housing & Community Development", March/April 2008 p18-21
Supportive housing has been widely researched in the field of psychiatric disabilities and psychiatric rehabilitation,Carling, P.J. (1995). Improving access to, preserving, and developing housing. In: P. J. Carling, Return to Community: Building Support Systems for People with Psychiatric Disabilities. (pp. 206-226). NY, NY and London: The Guilford Press.Rogers, E.S., Farkas, M., Anthony, W., Kash, M., Harding, O., Olschewski, A. (nd, @2009). "Systematic Review of Supported Housing Literature 1993-2008." Boston, MA: Boston University Center for Psychiatric Rehabilitation> based in part on housing and support principles from studies of leading community integration organizations nationally.Racino, J. (1991). Organizations in community living: Supporting people with disabilities. "Journal of Mental Health Administration", 18(1), 51-59. In addition, supportive housing has been tied to national initiatives in supportive living (usually developmental and intellectual disabilities)Taylor, S. (1987). "A Policy Analysis of the Supported Housing Demonstration in Pittsburgh, PA." Syracuse, NY: Center on Human Policy, Community Integration Project, Syracuse University. to cross-disability transferShoultz, B. (1988). My home not theirs: Promising approaches in mental health and developmental disabilities. In: Friedman, S.J. & Terkelson, K.G., "Issues in Community Mental Health: Housing". Canton, MA: PRODIST. and to national and international efforts on developing homes of one's own.Fitton, P. & Willson, J. (1995). A home of their own: Achieving supported housing. In: T. Philpot & L. Ward (Eds.), "Values and Visions: Changing Ideas in Services for People with Learning Difficulties." Oxford: Butterworth-Heinemann, Ltd. Supported housing in the field of mental health is considered to be a critical component of a community support system which may involve supported education,Housel, D. & Hickey, J. S. (1993, July). Supported education in a community college for students with psychiatric disabilities: The Houston College Model. "Psychiatric Rehabilitation Journal", 17(3):41-50. supported or transitional employment,Collignon, F.C., Noble, J. H., & Toms-Barker, L. (1987, October). Early lessons from the Marion County demonstration in integrating vocational and mental health services. "Psychosocial Rehabilitation Journal", XI(2): 76-86 case management services,Stroul, B. (1989, January). Community support systems for persons with long-term mental illness: A conceptual framework. "Psychosocial Rehabilitation Journal", 12(3): 9-26. clubhouses,Propst, R. (1992, October). Standards for clubhouses: Why and how they were developed. Special Issue: Clubhouse Model. "Psychosocial Rehabilitation Journal", 16(2): 25-30. supported recreationPyke, J. & Atcheson, V. (1993, October). Social recreation services: Issues from a case management perspective. "Psychosocial Rehabilitation", 17(2): 121-130. and involvement of family and friends often translated into psycho-educational programs.Ryglewicz, H. (1991, October). Psychoeducation for clients and families: A way in, out, and through in working with people with dual disorders. "Psychosocial Rehabilitation Journal", 15(2): 79-91.
From 2002 to 2007, an estimated 65,000 to 72,000 units of supportive housing were created in the United States. This represents about half the supply of supported housing units. Of the new units added, about half were targeted towards chronically homeless individuals, and one-fifth were for homeless families.Chronic Homelessness Briefing Paper, United States Interagency Council on Homelessness According to the United States Department of Housing and Urban Development (HUD), the number of Permanent Supportive Housing beds in the US increased from 188,636 to 353,800 between 2007 and 2017. Although of the shelter population, the majority remain as single, adult males of minority groups (approximately 65%), 38% were between 31 and 50 years old, and 38% had a disability; the rest were homeless families with a high concentration (likely due to high housing costs) in the states of California, New York and Florida.US Department of Housing and Urban Development. (2009). "The 2009 Annual Homeless Assessment Report to Congress." Washington, DC: Author.
Populations served Sponsors of supportive housing projects generally aim to serve a specific population; the characteristics of those served and the housing program range widely: However, supporters of regular housing and support services in the community suggest choice based on other personal, social, and situational factors than specific population basis (e.g., choice of roommates or housemates, neighborhoods they live in).Racino, J., Walker, P., O'Connor, S., & Taylor, S. (1993). "Housing, Support and Community: Choices and Strategies for Adults with Disabilities". Baltimore, MD: Paul H. Brookes.
Today, important new populations for supported housing in regular neighborhoods include working families, especially those with high proportional housing costs, older adults who need intensive (enriched) services to avoid nursing home placements, and people who need places to live due to the closure of the old style, institutional psychiatric care. Increasingly, supportive housing may be required as unemployment increases, for newly emerging groups such as newly legalized gay and lesbian partners, multi-generational immigrant groups in the new multicultural world, and for those adolescents aging out of their parents' homes to new community options. One of the 2000s textbooks on Supported/supportive Housing is a report on state projects in the US for older adults which includes use of the home and community-based (HCBS) waiver, efforts to reform more than 43 congregate residential categories in states, use of housing subsidies for low income persons, assisted living options, "comprehensive case/care management", and technical area such as "at-risk" housing and non-profit development.Pynoos, J., Hollander-Feldman, P.,& Ahrens, J. (2004). "Linking Housing and Services for Older Adults: Obstacles, Options and Opportunities." Binghamton, NY and London: The Haworth Press.
Benefits of supportive housing for specific populations groups Supportive housing proposes to be a comprehensive solution to a problem rather than a band-aid fix (such as a shelter). While many of those who stay in the shelter system remain in or return to the system for extended periods of time, a much higher percentage of those who are placed in supportive housing remain housed on a more permanent basis.Chronic Homelessness Brief , National Alliance to End Homelessness This idea is also referred to as the Housing First model, an approach to combating chronic homelessness by providing homes upfront and offering help for illnesses and addictions. The concept turns the traditional model, which typically requires sobriety (or prerequisites that can be used for enhanced services before a person can get housing), upside down.
Research has shown that coupling permanent housing with supportive services is highly effective at maintaining housing stability, as well as helps improve health outcomes and decreases the use of publicly funded institutions. A review of the impact of these services found that they can improve health outcomes among chronically homeless individuals, including positive changes in self-reported mental health status, substance use, and overall well-being. In the Collaborative Initiative to Help End Chronic Homelessness (CICH), participants who had been homeless for an average of eight years were immediately placed into permanent housing. The CICH evaluation reported that 95% of those individuals were in independent housing after 12 months.Elliott, Janice and Wilkins, Carol."Chronic Homelessness," United States Interagency Council on Homelessness Briefing Paper A study of homeless people in New York City with serious mental illness found that providing supportive housing to the individuals directly resulted in a 60% decrease in emergency shelter use for clients, as well as decreases in the use of public medical and mental health services and city jails and state prisons. Another study in Seattle in 2009 found that moving "people with chronic alcoholism" into supportive housing resulted in a 33% decline in alcohol use for clients.
There is significant support for the contention that supportive housing also costs less than other systems where its tenant base may reside, such as jails, hospitals, mental health facilities, and even shelters. Research on the overall costs to the taxpayer of supportive housing has consistently found the costs to the taxpayer to be about the same or lower than the alternative of a chronically homeless person sleeping in a shelter. The CICH evaluation showed that average costs for healthcare and treatment were reduced by about half, which the largest decline associated with inpatient hospital care."Supportive Housing is Cost-Effective ," National Alliance to End Homelessness The use of supportive housing has been shown to be cost-effective, resulting in reductions in the use of shelter, ambulance, police/jail, health care, emergency room, behavior health, and other service costs. For example, one 2016 report identified studies documenting that these services can reduce health care costs, emergency department visits, and length of stays in psychiatric hospitals. The Denver Housing First Collaborative documented that the annual cost of supportive housing for a chronically homeless individual was $13,400. However, the per-person reduction in public services recorded by the Denver Housing First Collaborative came to $15,773 per person per year, more than compensating for the annual supportive housing costs.Parvensky, John, and Perlman, Jennifer. "Denver First Housing Collaborative: Cost Benefit Analysis and Program Outcomes report "