Neighborhood Factors in a Residential Continuum: Patterns and Outcomes

Background: In the field of mental health, residential continuum model housing refers to a residential service system that contains various settings differing in levels of care or supervision and levels of restrictiveness, with mental health consumers matched to housing settings based on their level of functioning and disabilities. Residential continua often combine facility-based programs that focus on rehabilitation/treatment with independent apartment-type housing resources targeting individuals who are “housing-ready” (Leff et al., 2009). Places of residence are associated with a set of intrinsic characteristics, impacting the quality of life of mental health residents (Dorvil et al., 2005). However, while the socio-spatial dimension is considered pivotal to the housing experience of people with psychiatric disabilities, little research has been conducted to examine the neighborhood characteristics of programs that comprise a residential continuum and the extent to which neighborhood characteristics are associated with outcomes.

Methods: This study involves analyses using multiple data sources available from a residential continuum in a large, urban community. Administrative databases provided residential addresses of 1,932 mental health residents living in 297 locations. The 2000 U.S. Census and city's police department database provided information on neighborhood characteristics. Geographic information system (GIS) methodology generated maps displaying the distribution of housing locations in relation to social distress, residential instability among community residents, crime, and race/ethnic diversity. Statistical analyses compared neighborhood characteristics of residents in facility-based programs with those in apartment-type housing.

A probability sample of 237 residents, selected from all residents in apartment-type housing, were interviewed as part of an NIMH-funded protocol on community integration. Cox proportional hazards models, adjusted for intra-block group correlation of outcomes, were used to estimate the effects of person-level and neighborhood-level characteristics on the probability of positive exit (to an arrangement with more autonomy) and negative exit (to an arrangement with more supervision or to homelessness) from apartment-type housing.

Results: Findings indicated that residents in apartment-type housing were located in neighborhoods with lower levels of social distress, lower levels of crimes, but slightly higher levels of residential instability, when compared to residents in facility-based residential programs. No difference was found between the two groups with regard to the racial/ethnic diversity of the neighborhoods they lived. Cox regression results indicated that a higher level of social distress in the neighborhood decreased the probability of a positive exit among apartment-type residents.

Implications: This study illustrates the utility of neighborhood analysis to inform policymakers and service providers about the socio-spatial distribution of people with psychiatric disabilities and the effects of neighborhood characteristics on outcomes. The location of apartment-type housing residents in neighborhoods with more favorable features may be attributable to different funding levels, varying funding configurations (i.e., resources devoted to housing and support services), and different intensity of community resistance associated with the type and clustering of mental health housing in a neighborhood. Future research needs to examine the effects of neighborhood characteristics on other outcomes besides residential stability, such as participation in community activities, for residents in both facility-based programs and independent housing.