Housing First and Severe Mental Disorders: The Challenge of Exiting Homelessness

• Author: James Lachaud,Rosane Nisenbaum,Vicky Stergiopoulos,Cilia Mejia-Lancheros,Stephen W. Hwang,Patricia O’Campo
• Published date: 01 January 2021
• Date: 01 January 2021
• DOI: http://doi.org/10.1177/0002716220987220
• Subject Matter: Evaluating Interventions

178 ANNALS, AAPSS, 693, January 2021

DOI: 10.1177/0002716220987220

Housing First

and Severe

Mental

Disorders: The

Challenge of

Exiting

Homelessness

By

JAMES LACHAUD,

CILIA MEJIA-LANCHEROS,

ROSANE NISENBAUM,

VICKY STERGIOPOULOS,

PATRICIA O’CAMPO,

and

STEPHEN W. HWANG

987220ANN THE ANNALS OF THE AMERICAN ACADEMYHOUSING FIRST AND SEVERE MENTAL DISORDERS

research-article2021

We examine the long-term housing trajectories of 543

program participants at the Toronto site of the At

Home/Chez-Soi project, a randomized controlled trial

of a Housing First (HF) intervention for adults with

mental disorders. The average follow-up period for our

study was 5.5 years. We find that the HF approach,

which includes housing subsidies and support services,

was strongly associated with rapid transitions to sus-

tained housing (70.4 percent of HF participants vs. 27.9

percent of treatment as usual participants). Mood dis-

orders with psychotic features and primary psychotic

disorders were negatively associated with the rapid and

sustained housing trajectory, and alcohol use disorders

were positively associated with a rapid then declining

housing trajectory. We argue that to understand the

long-term impacts of housing programs, research needs

to better explore comprehensive and personalized care

to support individuals with severe mental disorders.

Keywords: Housing First; psychosis; substance use;

exiting homelessness; housing trajectory

Most individuals who experience home-

lessness are rehoused within a few

months (Culhane etal. 2007; Lee, Tyler, and

Wright 2010), but those with severe mental

disorders experience greater difficulties in

successfully exiting homelessness (Brown

et al. 2017; Patterson et al. 2013). A study

conducted by Brown and colleagues (2017)

in King County, Washington (United States),

on the residential or housing pathways that

James Lachaud is a demographer with research inter-

ests in population and public health. He is currently a

postdoctoral research fellow at MAP Centre of Urban

Health Solutions, St. Michael’s Hospital in Toronto, and

holds a CIHR-IPPH/CMHC fellowship award in

research and knowledge translation on urban housing

and health.

Cilia Mejia-Lancheros is a public health and social

epidemiologist researcher. She is currently a postdoc-

toral research fellow at MAP Centre of Urban Health

Solutions, St. Michael’s Hospital in Toronto.

Correspondence: james.lachaud@unityhealth.to