Assessing the Evidence Base Series Permanent Supportive Housing : Assessing the Evidence

Objectives: Permanent supportive housing provides safe, stable housing for people with mental and substance use disorders who are homeless or disabled. This article describes permanent supportive housing and reviews research. Methods: Authors reviewed individual studies and literature reviews from 1995 through 2012. Databases surveyed were PubMed, PsycINFO, Applied Social Sciences Index and Abstracts, Sociological Abstracts, Social Services Abstracts, Published International Literature on Traumatic Stress, the Educational Resources Information Center, and the Cumulative Index to Nursing and Allied Health Literature. The authors chose from three levels of evidence (high, moderate, and low) on the basis of benchmarks for the number of studies and quality of their methodology. They also described the evidence of service effectiveness. Results: The level of evidence for permanent supportive housing was graded as moderate. Substantial literature, including seven randomized controlled trials, demonstrated that components of the model reduced homelessness, increased housing tenure, and decreased emergency room visits and hospitalization. Consumers consistently rated this model more positively than other housing models. Methodological flaws limited the ability to draw firm conclusions. Results were stronger for studies that compared permanent supportive housing with treatment as usual or no housing rather than with other models. Conclusions: The moderate level of evidence indicates that permanent supportive housing is promising, but research is needed to clarify the model and determine the most effective elements for various subpopulations. Policy makers should consider including permanent supportive housing as a covered service for individuals with mental and substance use disorders. An evaluation component is needed to continue building its evidence base. (Psychiatric Services 65:287–294, 2014; doi: 10.1176/appi.ps.201300261) Recovery can be difficult for individuals with mental or substance use disorders who are homeless. Research shows that individuals who are homeless have worse health status than those who are at risk of homelessness (1). Compared with those who are housed, individuals who are homeless have worse outcomes in areas such as living situation, family and social relations, employment, daily activities, and legal and safety problems (2). An understanding of the impact of housing on health provides the foundation for including housing programs as a part of the treatment and recovery process for individuals with mental or substance use disorders. This article reports the results of a literature review that was undertaken as part of the Assessing the Evidence Base (AEB) Series (see box on next page). The objectives of this review were to describe the components of permanent supportive housing programs, rate the level of research evidence of existing studies (that is, methodological quality), and describe its effectiveness compared with other housing models and treatment as usual. The review also examined differences in the effectiveness of permanent supportive housing programs for various subgroups of the population.