For people with mental disorder, access to subsidized housing may be used as “leverage” to obtain adherence to treatment. Interview data from 200 outpatients at each of five sites provided the first national description of the use of housing as leverage. Results indicated that housing is most likely to be used as leverage when it is “special” housing, available only to people with mental illness. Most frequently, respondents state that the requirement that they participate in treatment is imposed by their landlord, rather than by a clinician. The use of housing as leverage strongly increases respondents’ perceptions of coercion. Despite this, however, participants who experience housing as leverage are no less satisfied than other participants with the treatment that they receive, and are much more likely than other participants to believe that using housing as leverage is effective in helping people stay well.
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References
Allen J. P., Eckardt M. J., Wallen J. (1988). Screening for alcoholism: techniques and issues. Public Health Reports, 103:586–592
Allen M. (2003). Waking Rip Van Winkle: Why developments in the last 20 years should teach the mental health system not to use housing as a tool of coercion. Behavioral Sciences and the Law 21:503–521
Allen M. (1996). Separate and unequal: The struggle of tenants with mental illness to maintain housing. Clearinghouse Review 30:720–739
*American Psychiatric Association (1994). Diagnostic and statistical manual of mental disorders. American Psychiatric Association, Washington, DC
Bonnie, R., & Monahan, J. (2005). From coercion to contract: Reframing the debate on mandated community treatment for people with mental disorders. Law and Human Behavior, 29, 487–505.
Edgar E., O’Hara A., Smith B., Zovistoski A. (1999). Priced Out in 1998: The housing crisis for people with disabilities. Technical Assistance Collaborative, Boston, MA
Endicott J., Spitzer R. L., Fleiss J. L., Cohen J. (1976). The Global Assessment Scale: a procedure for measuring overall severity of psychiatric disturbances. Archives of General Psychiatry 33:766–771
Ganju V. (1999). The MHSIP Consumer Survey. Texas Department of MHMR, Austin, TX
Gardner W., Hoge S., Bennett N., Roth L., Lidz C., Monahan J., Mulvey E. (1993). Two scales for measuring patients’ perceptions for coercion during mental health hospital admission. Behavioral Sciences & the Law 20:307–321
George L. K., Blazer D. G., Hughes D. C., Fowler N. (1989). Social support and the outcome of major depression. British Journal of Psychiatry 154:478–485
Hogan T. P., Awad A. G. (1992). Subjective response to neuroleptics and outcome in schizophrenia: a re-examination comparing two measures. Psychological Medicine 22:347–52
Korman H., Engster D., Milstein B. (1996). Housing as a tool of coercion. In: Dennis D., Monahan J. (eds) Coercion and aggressive community treatment. Plenum Press, New York, pp. 95–113
Levy, C.J. (2002). For mentally ill, death and misery. New York Times. April 28:2002
*LogXact® (2002). Software for exact logistic regression. Cytel Software Corporation, Cambridge, MA
McEvoy J., Apperson L. J., Appelbaum P. S., Ortlip P., Brecosky J., Hammill K., Geller J. L., Roth L. (1989). Insight into schizophrenia: its relationship to acute psychopathology. Journal of Nervous and Mental Disease 177:43–47
Monahan J., Bonnie R., Appelbaum P., Hyde P., Steadman H., Swartz M. (2001). Mandated community treatment: Beyond outpatient commitment. Psychiatric Services 52:1198–1205
Monahan J., Redlich A., Swanson J., Robbins P., Appelbaum P., Petrila J., Steadman H., Swartz M., Angell B., McNiel D. (2005). Use of leverage to improve adherence to psychiatric treatment in the community. Psychiatric Services 56:37–44
Moerner M. G., Mannuzza S., Kane J. M. (1988). Anchoring the BPRS: an aid to improved reliability. Psychopharmacology Bulletin 24:112–117
Newman S. J. (2001). Housing attributes and serious mental illness: Implications for research and practice. Psychiatric Services 52:1309–1317
O’Hara, A. (2002). Technical Assistance Collaborative, Personal Communication
O’Hara A., Cooper E. (2003). Priced out in 2002. Technical Assistance Collaborative, Boston, Ma
Rao J., Scott A. (1992). A simple method for the analysis of clustered binary data. Biometrics 48:577–585
*StatXact® (2003). Statistical software for exact nonparametric inference. Cytel Software Corporation, Cambridge, MA
Swartz M., Swanson J., Monahan J. (2003). Endorsement of personal benefit of outpatient commitment among persons with severe mental illness. Psychology, Public Policy, and Law 9:70–93
Swartz, M. S., Swanson, J. W., Kim, M., & Petrila, J. (in press). Use of involuntary outpatient commitment or related civil court treatment orders in five United States communities. Psychiatric Services.
Teague G. B., Ganju V., Hornik J. A., Johnson J. R., McKinney J. (1997). The MHSIP Mental Health Report Card: consumer-oriented approach to monitoring the quality of mental health plans. Evaluation Review 21:330–341
Tsemberis S., Gulcur L., Nakae M. (2004). Housing First, consumer choice, and harm reduction for homeless individuals with a dual diagnosis. American Journal of Public Health 94:651–656
Zelen M. (1971). The analysis of several 2×2 contingency tables. Biometrika 58:129—137
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Robbins, P.C., Petrila, J., LeMelle, S. et al. The Use of Housing as Leverage to Increase Adherence to Psychiatric Treatment in the Community. Adm Policy Ment Health 33, 226–236 (2006). https://doi.org/10.1007/s10488-006-0037-3
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DOI: https://doi.org/10.1007/s10488-006-0037-3