Permanent Supportive Housing (PSH) 

September 2021 

Brief Description 

In 2020 there was a 15% increase in people experiencing 

chronic homelessness (officially defined as someone with a 

disability who has been continuously homeless for one year or 

more or has experienced at least four episodes of 

homelessness in the last three years where the combined 

length of time homeless on those occasions is at least 12 

months). Permanent supportive housing (PSH) is a 

multidisciplinary approach that cuts across the housing and 

health care systems to address the needs of people 

experiencing chronic homelessness. Eligibility is based on 

having a long-term disability, experiencing homelessness or 

unstable housing, or experiencing multiple barriers in 

maintaining housing stability. PSH is permanent housing with 

indefinite (non-time-limited) leasing or rental assistance and 

an array of voluntary supportive services. 

Is It a Good Fit for My Agency?

Community-based organizations that serve clients at risk of 

chronic homelessness may wish to consider a PSH program or 

partner with other organizations or providers to provide the 

housing or service components of PSH. 

Equitable Access to PSH

People who are African-American/Black, Hispanic/Latino, 

Native Hawaiian, and/or indigenous Alaska Native, Native 

Americans, and Pacific Islanders) remain disproportionately 

represented in the homeless population. Moreover, the 

experiences of individuals experiencing homelessness in rural 

areas may differ from those living in non-rural areas because 

of issues like the availability of housing, transportation, 

programs, and services. It is important that housing and 

services developed for and provided to diverse tenants, 

including those in rural areas, be equitable and culturally 

responsive. PSH supports equitable access to housing by 

maintaining that people or families experiencing homelessness 

do not need to be “housing ready” and are capable of 

maintaining a home when provided the opportunity and 

supportive services. 

How Does It Work? 

PSH typically follows the Housing First approach, meaning 

that people experiencing homelessness don’t need to progress 

through various service programs. Moreover, not all problems, 

including those related to behavioral health, need to be 

addressed before individuals can be housed—or as a condition 

of their retaining housing. 

Critical elements of PSH include: 

 Tenants having a lease or sublease and full tenancy rights. 

 Housing is not time-limited. 

 Preferences for housing are identified and choices are 

provided. 

 Housing is affordable and tenants don’t pay more than 

30% of their income towards rent and utilities. 

 Housing is integrated, and tenants interact with neighbors 

who do not have a disability. 

 Participation is voluntary, and tenants don’t get evicted 

for refusing services. 

 Tenants receive services based on their needs and choices. 

 Services promote recovery and help people choose, get, 

and keep housing. 

 Housing and services are provided separately. 

There are three main PSH models or housing types: 

 Single site model: Most units in the housing building(s) 

are dedicated to tenants in supportive housing. Supportive 

services are typically delivered within the housing 

building. 

 Scattered-site model: Most units/apartments are located 

throughout the community. Units are rented at market 

rates with money from funding sources such as housing 

vouchers. Supportive services within this model can be 

provided within the housing or off-site in the community. 

 Mixed or integrated housing model: A single property 

or building will have both supportive and affordable 

housing units and will include tenants who are not part of 

the PSH program. Supportive services within this model 

can be provided on-site within the housing property and 

off-site in the community. 

The services provided to PSH tenants include case 

management and care coordination, health and behavioral 

health services, and other services and supports to help tenants 

get and keep their housing (e.g., assistance with getting 

benefits and entitlements, independent living skills/education, 

peer support/recovery support, financial management 

skills/education, and referrals to community services and 

resources). 
 

 

 

 

 

 

Adopting and Financing PSH

Housing and Health Collaborations 

Some organizations may choose to establish a PSH program 

while others may choose to establish housing and health 

collaborations with the organizations that operate a PSH 

program. The Urban Institute developed a guide that covers 

crucial steps in collaborations, including formalizing 

commitments, selecting a target population, building a service 

package around that population, developing staff models, and 

coordinating between partners through regular communication 

and data sharing. 

Potential Funding Sources 

PSH requires three types of funds: capital, operating, and 

services. Funding is available from the government (federal, 

state, and local governments or authorities), private 

corporations and financial institutions, and philanthropy. It is 

important to consider what kind of funding aligns with the 

program model. 

The three types of funds are described below. 

 Capital funds to acquire, build, or rehabilitate units to 

be dedicated to PSH. Funding is available from the 

Low-Income Housing Tax Credit, the National Housing 

Trust Fund, Home Investments Partnership 

Program/Community Development Block Grant, Pay 

for Success/Social Impact Bond, US Department of 

Housing and Urban Development (HUD’s) Section 811 

Supportive Housing for Persons with Disabilities, 

Federal Home Loan Bank, Hospital and Health System 

Investment, and New Market Tax Credits. 

 Operating funds to cover operating costs such as 

property management, staffing, utilities, maintenance, 

insurance, and taxes. There are two types of rental 

assistance: tenant-based, which is attached to the tenant 

and moves with them if they move or relocate, and 

project-based, which is attached to the property or 

building, and the subsidy stays with the unit if the 

tenant moves. Some funding sources for operating 

funds are Federal Rental Assistance Vouchers such as 

from HUD, State Housing Vouchers, and Flexible 

Housing Pool. 

 Services funds to cover direct services like mental 

health counseling and case management, and costs 

associated with supporting the tenants including 

through life and job skills training. Funding sources for 

service funds include Medicaid, CoC programs, the 

Department of Health and Human Services, including 

SAMHSA, and state and local programs. The funding 

of the supportive services in PSH typically relies on the 

use of “braided” or “blended” funding. 

Benefits of the Program 

Housing has been identified as a fundamental human need that 

is essential for health and well-being. 

 PSH has been shown to help people who experience 

chronic homelessness maintain housing stability over a 

1-to-2-year period. 

 PSH has been shown to reduce perceived stress, 

depression, and other mental health problems. 

 Housing stability through PSH is the foundation for 

pursuing other health and social services goals, and 

reduces disruptions to employment, social networks, 

education, and the receipt of social service benefits. 

 PSH has also been found to result in fewer expenses for 

homeless shelters, jails and prisons, hospitals, 

ambulances, and emergency departments.1, 2 

How to Learn More 

More information is available at Substance Abuse and Mental 

Health Services Administration’s Permanent Supportive 

Housing Evidence-Based Practices KIT, the CSH 

(Corporation for Supportive Housing), the Technical 

Assistance Collaborative, and the United States Interagency 

Council on Homelessness (USICH). The Urban Institute also 

has resources for building teams for health and housing 

collaborations and implementing housing and health 

collaborations. 

1 See Home-Together-Federal-Strategic-Plan-to-Prevent-and-EndHomelessness.pdf (usich.gov) 2 See The Corporation for Supportive Housing - CSH