Independent Housing and Support for People With Severe Mental Illness
Condition: Severe Mental Disorder
MeSH terms: Mental Disorders
Study type: Interventional

Summary: 
      Background: Adequate and stable housing conditions are fundamental for the psychiatric
      rehabilitation of individuals with severe mental illness (SMI). A common approach in
      psychiatric rehabilitation relies on a continuum of residential services that aims at
      enabling the person with SMI to live eventually independently. Current state of research,
      however, shows clearly that most persons in question remain in residential care settings or
      other treatment as usual conditions (RCS/TAU). The Independent Housing and Support (IHS)
      scheme is a new model that aims at direct placement in an independent accommodation in the
      community. Support is provided according to individual needs in a permanent housing situation
      without time limit. Up to now, randomized controlled trials (RCTs) to evaluate the
      effectiveness of IHS have only been conducted with homeless populations in North America. The
      purpose of the present study is to evaluate IHS compared to traditional RCS/TAU for
      non-homeless persons with severe mental illness. With this study, the investigators aim at
      demonstrating that IHS is not inferior to RCS/TAU. The rationale for utilizing a
      non-inferiority approach is based on the current state of research and on research that has
      shown strong preferences for IHS against RCS/TAU by people with SMI.

      Methods: As the preference issue makes RCTs in housing research difficult the investigators
      will use a specific time window in Zurich that allows conducting a RCT due to a scarcity of
      IHS settings and will combine the RCT with a comparative observational study in Berne where
      IHS is already well-established. At the Zurich site, a RCT compares the effects of living
      with IHS against living in residential care. At the Berne site, an observational study design
      (OSD) will be applied in connection with the same types of housing as in Zurich. Propensity
      scoring will be utilized to minimize the risk of bias in the OSD. A number of N=56 eligible
      subjects in Zurich and N=112 subjects (due to specific requirements for propensity scoring)
      in Berne complying with the inclusion criteria will be recruited and allocated to
      intervention and control groups according to the site-specific study designs. Recruitment
      period will last 21 months.
    


Intervention name(s): Independent Housing and Support (IHS); Residential Care Settings and other Treatment as Usual (RCS/TAU)
Intervention type(s): Behavioral; Behavioral
Intervention description(s): Direct placement of people with SMI in an independent accommodation in the community, usually in a flat rented by the service user. Support is provided by a coach according to individual needs in a permanent housing situation without time limit.; Placement in a common residential home or supportive housing setting with the aim to gain psycho-social stability before being able to maintain independent housing.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: As the preference issue makes RCTs in housing research difficult the investigators will use a specific time window in Zurich that allows conducting an RCT due to a scarcity of IHS settings and will combine the RCT with a comparative observational study in Berne where IHS is already well-established.
The investigators intend to directly compare the outcomes of a randomized controlled trial (RCT) with a study in an observational study design (OSD). Here, the investigators utilize the hypothesis that the OSD will provide similar results as the RCT.
Masking: None (Open Label)
Primary purpose: Supportive Care
Keywords: Psychiatric Rehabilitation; Supported Housing; Residential Care