Does Ending Homelessness Improve Social Relationships and Support?

Background and Purpose:  Ending homelessness through the provision of permanent supportive housing (PSH) can put individuals on a path toward improved health and well-being.  Change in behavioral health over time has received increasing attention among formerly chronically homeless persons who have transitioned to PSH.  Less attention has been paid to changes in social relationships and support among persons in PSH, although social integration is arguably a central aspect of health and well-being through access to and provision of supportive resources and capital.  We systematically investigated social relationships and support among chronically homeless persons accepted into PSH.  We were interested in determining the extent to which social relationships changed – for example, whether the availability of tangible, informational, and emotional support increased among residents in PSH – and whether these network changes were associated with substance use and mental health.

Methods:  One-on-one structured interviews were conducted with chronically homeless individuals upon acceptance into permanent supportive housing (PSH) in Los Angeles County and again three months after these individuals moved into their housing.  Study eligibility criteria were age 40 or older and history of chronic homelessness.  The study sample consisted of 102 persons who had completed both baseline and 3-month follow-up interviews.  Data describing ego-centric social networks and support, as well as participant demographics, substance use (NIDA-modified ASSIST and NIAA Task Force questions) and mental health (Modified Colorado Symptom Index – MCSI) were collected using computer-assisted personal interviewing.  Descriptive and univariable analyses were conducted using chi-squared or t-tests, as appropriate. 

Results:   Participants were predominately African American (60%) and male (70%).  Although the proportion of persons in respondents’ networks who provided emotional support (i.e. persons in whom one could confide) did not change over time, network members who provided tangible (i.e. food, money, or a place to stay) and informational support (i.e. advice) decreased overall by 3-month follow-up.  Participants with decreased availability of informational support had significantly higher rates of PTSD (63%) at 3-month follow-up compared to participants who experienced either no change or increases in informational support (37%).  A decrease over 3-months in the availability of persons who provided advice was associated with significantly higher mental distress scores at 3 months.  Additionally, over time, there were increases overall in proportions of hard drug users and binge drinkers in networks, and participants with these network changes themselves had higher rates of hard drug use (53%) and binge drinking (64%) at 3 months than participants with no change or decreases in proportions of network members who engaged in substance use.

Conclusions and Implications:  Results suggest that social relationships and support change over time among formerly chronically homeless persons in PSH, and that these changes are associated with health and well-being.  That there were decreases in availability of persons who provided tangible and informational support after move-in is contrary to expectation, given the significant transition and life change represented in securing PSH.  Formerly homeless persons may need additional support from case managers and therapists to facilitate mental health and pro-social (i.e. non-drug using), supportive networks.