Regular Articles

American Journal of Community Psychology

, Volume 36, Issue 3, pp 223-238

First online:

Decreasing Psychiatric Symptoms by Increasing Choice in Services for Adults with Histories of Homelessness

  • Ronni Michelle GreenwoodAffiliated withThe City University of New York Graduate CenterSocial and Behavioural Science, Tilburg UniversitySchool of Psychology, Cardiff University Email author 
  • , Nicole J. Schaefer-McDanielAffiliated withThe City University of New York Graduate Center
  • , Gary WinkelAffiliated withThe City University of New York Graduate Center
  • , Sam J. TsemberisAffiliated withPathways to Housing

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Despite the increase in consumer-driven interventions for homeless and mentally ill individuals, there is little evidence that these programs enhance psychological outcomes. This study followed 197 homeless and mentally ill adults who were randomized into one of two conditions: a consumer-driven “Housing First” program or “treatment as usual” requiring psychiatric treatment and sobriety before housing. Proportion of time homeless, perceived choice, mastery, and psychiatric symptoms were measured at six time points. Results indicate a direct relationship between Housing First and decreased homelessness and increased perceived choice; the effect of choice on psychiatric symptoms was partially mediated by mastery. The strong and inverse relationship between perceived choice and psychiatric symptoms supports expansion of programs that increase consumer choice, thereby enhancing mastery and decreasing psychiatric symptoms.


homelessness treatment services choice psychiatric disabilities