Reprinted from "Housing and Homelessness" issue of Visions Journal, 2007, 4 (1), pp. 27-28
When a serious mental illness strikes, it can completely turn your life upside down. Not only do you have to deal with all the daily challenges of a mental illness, but you now have added financial pressures. You find your rent is so high it leaves you with too little money to feed yourself properly. You could even find yourself living in a dirty, rundown, bug-infested room in a Downtown Eastside hotel, because now it's all you can afford. Under these conditions, it's no surprise that your mental health doesn't improve. And it's no surprise that you are now at much higher risk for other health problems like diabetes, heart disease, asthma and high blood pressure.
It has been shown that there is a strong link between having access to safe, secure and affordable housing and better health.1 Therefore, having supported† housing should help improve overall health and, in particular, mental health.
Vancouver Coastal Health (VCH) - which serves Richmond, Vancouver, North Shore, Coast Garibaldi and Bella Bella/Bella Coola - strongly believes we can best support people with a mental illness by ensuring affordable housing and a broad range of support for those who need it. About 1,400 people in the VCH region live in mental health supported housing.
What is "supported housing"?
Supported housing is a place that you can afford, even if you are on income assistance.
Supported housing is not treatment, but it does help people to maintain their links to treatment and to get maximum benefit from it. Staff are there to help you keep your appointments with a mental health counsellor and a physician, and to help you take your medication. These supports are in addition to the help you would get from a mental health professional at a community team or a doctor's office.
Supported living staff also help you learn basic skills to manage a household, look for a job or go back to school.
People living in supported housing speak passionately about how it has changed their lives for the better. They speak about how having an affordable place to live and support staff to help manage day-to-day challenges gives them the energy to focus on getting well. They say this is the key to putting the pieces of their lives back together.
Our research findings
As a health organization, we wanted to find out if there were measurable changes in the use of hospital services. In particular, we wanted to see whether living in supported housing would mean fewer visits to the emergency room or to less time spent in hospital.
To find out, we looked at 263 people who had moved into mental health supported housing. We counted their visits to the emergency room and the number of days spent in hospital in the year before getting into supported housing and in the first year they spent in housing.
We found that emergency room visits went down by almost one-third and that days spent in hospital went down by over half in the first year spent in supported housing.
Somewhat to our surprise, we found that almost all the reductions in the hospital stays were related to psychiatric admissions as opposed to medical concerns. While almost everyone who moved in was already getting treated for their mental illness, getting into supported housing was a very significant stabilizing factor.2-3 It is obviously very positive for people with a mental illness to be in stable housing and not needing to be in hospital.
For the broader community, it means more hospital beds are available for others who are in need. In fact, this study found that one less hospital bed was used for every 60 people who moved into supported housing - an important finding at a time when empty hospital beds are scarce.2-3
The results of our study are similar to previous work done locally2-3 and are consistent with other studies done in the United States.4-6
Did you know?
Why it works
What appears to make the difference is the combination of mental health treatment and supported housing together. While mental health treatment is necessary for recovery from a mental illness, it is not enough on its own. Without the practical, day-to-day support offered by supported housing staff, it is not possible to intervene quickly enough to keep people out of hospital. Having someone visit regularly, however, can help reduce day-to-day stress or identify whether medication changes are needed. This tells us we should make supported housing available whenever possible.
About the authorLinda is the Director of Vancouver Housing Services for Vancouver Coastal Health.
Eberle, M. et al. (2001). Homelessness: Causes and effects. Volume 1. The relationship between the health, social services and criminal justice systems: A review of the literature. Prepared for BC Ministry of Social Development and Economic Security and BC Housing Management Commission.
Thomas, L. (2006). Outcome evaluation: Mental health supported housing. Unpublished study, Vancouver Coastal Health Authority.
Thomas, L. (2006). Outcome evaluation: Changes in hospital utilization by individuals one year post access to supported housing and non-supported affordable housing. Unpublished study, Vancouver Coastal Health Authority.
Proscio, T. (2000). Supportive housing and its impact on the public health crisis of homelessness. www.csh.org/html/supportiveimpact_final.pdf
Sherwood, K.E. (2001). The New York/New York Agreement cost study: The impact of supportive housing on services use for homeless mentally ill individuals. www.csh.org
Averyt, J.M. & Kamis-Gould, E. (2002). The effect of supportive housing on tenants, including utilization and costs of service. Corporation for Supportive Housing. www.csh.org. Unpublished paper, University of Pennsylvania, Center for Mental Health Policy and Services Research .
Canadian Institute for Health Information. (2006). Hospital mental health services in Canada, 2003–2004. Ottawa: Author. http://secure.cihi.ca/cihiweb/products/HMHDB_2003-2004_e.pdf.
Canadian Institute for Health Information. (2007). Improving the mental health of Canadians: Mental Health and homelessness. Ottawa: CIHI.