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From Principles to Practice: A Study of Implementation of Supported Housing for Psychiatric Consumers

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Abstract

In the post-deinstitutionalization era, supported housing has emerged as a housing and service approach considered most conducive to the goal of consumer empowerment and community integration. Although prior research found beneficial effects of supported housing, little empirical work has been done on identifying the gaps between the principles and practice of supported housing. Using multiple data sources on 27 supported independent living (SIL) programs for psychiatric consumers in a large metropolitan community, this paper examines the extent to which these programs are implemented in accordance with supported housing. Findings suggest consistency with as well as deviation from the supported housing approach in regard to consumer choice, typical and normalized housing, resource accessibility, consumer control and provision of individualized and flexible support. This study suggests methods for assessing housing programs for psychiatric consumers along these domains. Implications for the development of housing programs that promote consumer empowerment and community integration are discussed.

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Notes

  1. Twenty-eight percent of the 406 consumers refused to participate when contacted for the study and another 10% did not participate for reasons other than refusal. The reasons include inability to locate study participant, hospitalization and other institutionalization, psychiatric relapse and other illnesses, deaths, and potential participants’ scheduling for discharge from SIL.

  2. Of the 538 consumers in SIL programs at the time of the study, one had no address information and another was incarcerated.

  3. Block groups are census units comprising of several street blocks. A census tract is comprised of roughly 5 block groups. In Philadelphia, a block group has an average of 840 persons. In this study, we included 1785 block groups with 10 people or more.

  4. We did not include stable and affordable housing because SIL housing is considered permanent housing and residents pay no more than 30% of their income on rent.

  5. Race distribution is constructed as a three-category variable. The categories are, respectively, white, black, and others.

  6. Take a hypothetical example where there are three buildings, each with 16 mental health consumers. Building A has 64 rental units, building B has 32 rental units and building C has 16 rental units. According to the sliding scale captured in Fig. 2, building A is a highly normalized environment (25% of consumers in the building), building B a moderately normalized environment (50% of consumers) and building C a lowly normalized environment (100% consumers).

  7. To illustrate, a building with four mental health consumers is less likely to create an image problem than a building with 16 consumers, although consumers occupy 100% of the units in both buildings.

  8. SIL residents under the master-lease condition signed their rental contract with and paid monthly rent to their housing or service provider (either the 1260 HDC or residential support team).

  9. Seven of the 27 residential support teams had all their consumers living in properties that were owned by the agencies operating the SIL teams.

  10. SRO housing refers to a unit that contains no sanitary facilities or food preparation facilities, or contains one but not both types of facilities. In other words, a tenant in a SRO needs to share cooking facilities or bathroom with residents living in other SROs.

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Acknowledgments

A National Institute of Mental Health grant to the University of Pennsylvania School of Social Policy and Practice (R24 MH 63220) provided support for the research leading to this paper. The authors wish to express their gratitude to Robert Spencer, Raj Phatak, Danielle Masursky, Michele Wexler Kempinski, and Harriet Herman, from the Philadelphia Department of Behavioral Health, for their helpful comments on the paper.

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Authors and Affiliations

  1. School of Social Policy & Practice, University of Pennsylvania, 3701 Locust Walk, Philadelphia, PA, 19104-6214, USA

    Yin-Ling Irene Wong

  2. Drucker Brain Injury Center, MossRehab Hospital, 1200 W. Tabor Rd., Philadelphia, PA, 19140, USA

    Michael Filoromo

  3. Center for Mental Health Policy & Services Research, University of Pennsylvania, 3535 Market St., 3/F, Philadelphia, PA, 19104-2648, USA

    Julie Tennille

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  1. Yin-Ling Irene Wong
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  2. Michael Filoromo
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Correspondence to Yin-Ling Irene Wong.

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Wong, YL.I., Filoromo, M. & Tennille, J. From Principles to Practice: A Study of Implementation of Supported Housing for Psychiatric Consumers. Adm Policy Ment Health 34, 13–28 (2007). https://doi.org/10.1007/s10488-006-0058-y

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