The Role of Psychiatric Disability in Community Integration, Recovery, and Life Satisfaction: A Comparison of Housing First Consumers and Community Residents Living in the Same Neighborhoods

Background: There has been much recent focus on prioritizing community integration and expanding Housing First programs that promote normalized living arrangements for people with psychiatric disabilities. Little is known, however, about the true potential for community integration and recovery that is available to persons with psychiatric disabilities in the communities in which they tend to live: socially disadvantaged neighborhoods with potentially restricted opportunities and resources. By comparing persons with psychiatric disabilities to other residents living in the same areas, this study examines the degree to which psychiatric disability serves as a challenge or barrier to integration, recovery and life satisfaction over and above the challenges other residents encounter in these same neighborhoods.

Methods: The sample consisted of 2 groups of residents living in apartments in the Bronx in New York City: 60 participants were from a Housing First program and diagnosed with severe mental illness, and 60 participants were from the general population and not diagnosed with severe mental illness. Housing First participants were recruited from Pathways to Housing, a program that provides scatter-site housing and flexible, consumer-driven Assertive Community Treatment services. Community residents were recruited in-person through flyers that were distributed in the same neighborhoods in which the Housing First participants lived. All participants completed an interviewer-administered survey that included measures of perceptions of building and neighborhood quality, community integration (physical, social, and psychological), perceived choice in housing and daily living, life satisfaction, health, psychological distress, and aspects of recovery relevant to all populations (e.g., safety, hopefulness, sense of purpose, meaningful activities, adequate income, trusted others, etc.) Regression analyses were used to investigate group differences and participants were matched on individual characteristics such as age, gender, and race/ethnicity.

Results: Results indicate that for most outcomes, the Housing First group did not differ significantly from other community residents living in the same areas. Housing First participants closely resembled other community residents in how they perceived their neighborhoods, the degree to which they were able to integrate and participate in their communities, and their achievement of domains representative of recovery. Housing First participants rated their overall health as poorer compared to the community sample and had higher levels of psychological distress.

Implications: These finding suggests that Housing First programs that facilitate access to permanent housing, entitlements, and flexible support services can help formerly homeless persons with psychiatric disabilities lead lives similar to those of persons without psychiatric disabilities. The finding that Housing First participants rated their health as poorer indicates that health should be a priority for programs addressing their needs. As a whole, however, participants in this study faced many challenges including unemployment, low incomes, and life in socially disadvantaged areas, suggesting the need for broader social and economic changes to improve their lives.