Social Psychiatry and Psychiatric Epidemiology

, Volume 48, Issue 8, pp 1245–1259

Housing First improves subjective quality of life among homeless adults with mental illness: 12-month findings from a randomized controlled trial in Vancouver, British Columbia

  • Michelle Patterson
  • Akm Moniruzzaman
  • Anita Palepu
  • Denise Zabkiewicz
  • Charles J. Frankish
  • Michael Krausz
  • Julian M. Somers
Original Paper



This study used an experimental design to examine longitudinal changes in subjective quality of life (QoL) among homeless adults with mental illness after assignment to different types of supported housing or to treatment as usual (TAU, no housing or supports through the study). We hypothesized that subjective QoL would improve over time among participants assigned to supported housing as compared to TAU, regardless of the type of supported housing received or participants’ level of need.


Participants (n = 497) were stratified by level of need (“high” or “moderate”) and randomly assigned to Housing First (HF) in scattered-site apartments, HF in a congregate setting (high needs only), or TAU. Linear mixed-effects regression was used to model the association between study arm and self-reported QoL at baseline and at 6 and 12 months post-baseline by need level.


Based on the adjusted overall score on the QoL measure, participants randomized to HF reported significantly greater overall QoL as compared to TAU, regardless of need level or type of supported housing at both 6 and 12 months post-baseline. Scores on the safety and living situation subscales were significantly greater for both high and moderate need participants assigned to supported housing regardless of type at both 6 and 12 months post-baseline as compared to TAU.


Despite multiple health and social challenges faced by homeless individuals with mental illness, HF in both scattered-site and congregate models results in significantly greater perceived QoL as compared to individuals who do not receive HF even after a relatively short period of time.


Housing first Homelessness Mental illness Quality of life Randomized controlled trial 


  1. 1.
    Sussman S (1998) The first asylums in Canada: a response to neglectful community care and current trends. Can J Psychiatr 43:260–264Google Scholar
  2. 2.
    Lamb H, Bachrach L (2001) Some perspectives on deinstitutionalization. Psychiatr Serv 52:1039–1045PubMedCrossRefGoogle Scholar
  3. 3.
    Fulginiti D, Kriegel A, Brekke J (2012) Deinstitutionalization? Where have all the people gone? Curr Psychiatry Rep 14(3):259–269PubMedCrossRefGoogle Scholar
  4. 4.
    Forchuk C, Russell G, Kingston-MacClure S et al (2006) From psychiatric ward to streets and shelters. J Psychiatr Ment Health Nurs 13:301–308PubMedCrossRefGoogle Scholar
  5. 5.
    Frankish C, Hwang S, Quantz D (2005) Homelessness and health in Canada: research lessons and priorities. Can J Pub Health 96:S23–S29Google Scholar
  6. 6.
    Schutt RK (2011) Homelessnes, housing, and mental illness. Harvard University Press, CambridgeGoogle Scholar
  7. 7.
    Gilmer T, Stefancic A, Ettner S, Manning W, Tsemberis S (2010) Effect of full-service partnerships on homelessness, use and costs of mental health services, and quality of life among adults with serious mental illness. Arch Gen Psychiatry 67:645–652PubMedCrossRefGoogle Scholar
  8. 8.
    Ludwig J, Duncan G, Gennetian L, Katz L, Kessler R, Kling J, Sanbonmatsu L (2012) Neighbourhood effects on the long-term well-being of low-income adults. Science 337:1505–1510PubMedCrossRefGoogle Scholar
  9. 9.
    Tsemberis S, Eisenberg R (2000) Pathways to housing: supported housing for street dwelling homeless individuals with psychiatric disabilities. Psychiatr Serv 51:487–493PubMedCrossRefGoogle Scholar
  10. 10.
    Gulcur L, Stefancic A, Shinn M et al (2003) Housing, hospitalization, and cost outcomes for homeless individuals with psychiatric disabilities participating in continuum of care and housing first programmes. J Comm Appl Soc Psychiatry 13:171–186CrossRefGoogle Scholar
  11. 11.
    Yanos P, Felton B, Tsemberis S, Frye V (2007) Exploring the role of housing type, neighbourhood characteristics, and lifestyle factors in the community integration of formerly homeless persons diagnosed with mental illness. J Ment Health 16:703–717CrossRefGoogle Scholar
  12. 12.
    Field D (2011) Emotional refuge? Dynamics of place and belonging among formerly homeless individuals with mental illness. Emot Space Soc 4:258–267CrossRefGoogle Scholar
  13. 13.
    Siegel C, Samuels J, Tang D, Berg I, Jones K, Hoper K (2006) Tenant outcomes in supported housing and community residence in New York City. Psychiatr Serv 57(7):982–991PubMedCrossRefGoogle Scholar
  14. 14.
    Hubley A, Russel L, Palepu A, Hwang S (2012) Subjective quality of life among individuals who are homeless: a review of current knowledge. Soc Indic Res doi:10.1007/s11205-012-9998-7
  15. 15.
    Williams J (2000) Ready, set, stop: reflections on assessing quality of life and the WHOQOL-100 (US version). J Clin Epidemiol 53(1):13–17PubMedCrossRefGoogle Scholar
  16. 16.
    Lehman A (1988) A quality of life interview for the chronically mentally ill. Eval Progr Plan 11:51–62CrossRefGoogle Scholar
  17. 17.
    Lehman A, Postrado L, Rachuba L (1993) Convergent validity of quality of life assessments for persons with mental illnesses. Qual Life Res 2:327–333PubMedCrossRefGoogle Scholar
  18. 18.
    Uttaro T, Lehman A (1999) Graded response modeling of the quality of life interview. Eval Progr Plan 22(1):41–52CrossRefGoogle Scholar
  19. 19.
    Lehman A, Ward N, Linn L (1982) Chronic mental patients: the quality of life issue. Am J Psychiatry 139:1271–1276PubMedGoogle Scholar
  20. 20.
    Lehman A, Slaughter J, Myers C (1991) Quality of life in alternative residential settings. Psychiatr Q 62:35–49PubMedCrossRefGoogle Scholar
  21. 21.
    Brunt D, Hansson L (2004) The quality of life of persons with severe mental illness across housing settings. Nord J Psychiatry 58:293–298PubMedCrossRefGoogle Scholar
  22. 22.
    Oliver JP, Mohamad H (1992) The quality of life of the chronically mentally ill: a comparison of public, private and voluntary residential provisions. Br J Soc Work 22:39–404Google Scholar
  23. 23.
    Schutt R, Goldfinger S, Penk W (1997) Satisfaction with residence and with life: when homeless mentally ill person are housed. Eval Progr Plan 20:185–194CrossRefGoogle Scholar
  24. 24.
    Goering PN, Streiner DL, Adair C, Aubry T, Barker J, Distasio J et al (2011) The At Home/Chez Soi trial protocol: a pragmatic, multi-site, randomised controlled trial of a Housing First intervention for homeless individuals with mental illness in five Canadian cities. BMJ Open 1(2):e000323PubMedCrossRefGoogle Scholar
  25. 25.
    Zabkiewicz D, Patterson M, Frankish CJ, Somers J (2012) The Vancouver At Home Study: overview and methods of a Housing First trial among individuals who are homeless and living with mental illness. J Clin Trials. doi:10.4172/2167-0870.1000123 Google Scholar
  26. 26.
    Sheehan DV, Lecrubier Y, Sheehan KH, Amorim P, Janavs J, Weiller E et al (1998) The mini-international neuropsychiatric interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry 59(Suppl 20):22–33PubMedGoogle Scholar
  27. 27.
    Barker S, Barron N, McFarland B et al (1994) Multnomah community ability scale. Network Behavioral Health and Multnomah County, OregonGoogle Scholar
  28. 28.
    Stefancic A, Tsemberis S (2007) Housing First for long-term shelter dwellers with psychiatric disabilities in a suburban county: a 4-year study of housing access and retention. J Prim Prev 28:265–279PubMedCrossRefGoogle Scholar
  29. 29.
    Marsden J, Gossop M, Stewart D, Best D, Farrell M, Strang J (1998) The Maudsley addiction profile (MAP): a brief instrument for treatment outcome research. Development and user manual. National Addiction Centre/Institute of Psychiatry, London. Accessed 25 April 2012
  30. 30.
    van Buuren S (2007) Multiple imputation of discrete and continuous data by fully conditional specification. Stat Methods Med Res 16(3):219–24230PubMedCrossRefGoogle Scholar
  31. 31.
    Norman G, Sloan J, Wyrwich K (2003) Interpretation of changes in health-related quality of life. Med Care 41(5):582–592PubMedGoogle Scholar
  32. 32.
    Revicki D, Cella D, Hays R et al (2006) Responsiveness and minimal important differences for patient reported outcomes. Health Qual Life Outcomes 4:70PubMedCrossRefGoogle Scholar
  33. 33.
    Cohen J (1988) Statistical power analysis for the behavioural sciences, 2nd edn. Lawrence Erlbaum, HillsdaleGoogle Scholar
  34. 34.
    StataCorp (2011) Stata statistical software: release 12. StataCorp LP, College StationGoogle Scholar
  35. 35.
    Campbell DT (1969) Reforms as experiments. Am Psychol 24:409–429CrossRefGoogle Scholar
  36. 36.
    Susser E, Valencia E, Conover S, Felix A, Tsai W, Wyatt R (1997) Preventing recurrent homelessness among mentally ill men: a “critical time” intervention after discharge from a shelter. Am J Pub Health 87(2):256–262CrossRefGoogle Scholar
  37. 37.
    LaGory M, Fitzpatrick K, Ritchey F (2001) Life chances and choices: assessing quality of life among the homeless. Soc Q 42(4):633–651CrossRefGoogle Scholar
  38. 38.
    Michalos AC (1985) Multiple Discrepancies Theory (MDT). Soc Indic Res 16:347–413CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Michelle Patterson
    • 1
  • Akm Moniruzzaman
    • 1
  • Anita Palepu
    • 2
  • Denise Zabkiewicz
    • 1
  • Charles J. Frankish
    • 3
  • Michael Krausz
    • 4
  • Julian M. Somers
    • 1
  1. 1.Faculty of Health SciencesSimon Fraser UniversityBurnabyCanada
  2. 2.Division of General Internal Medicine, Centre for Health Evaluation and Outcome StudiesUniversity of British ColumbiaVancouverCanada
  3. 3.School of Population and Public HealthUniversity of British ColumbiaVancouverCanada
  4. 4.Department of Psychiatry, Centre for Health Evaluation and Outcome StudiesUniversity of British ColumbiaVancouverCanada

Personalised recommendations