The Impact of Interventions on Housing Stability Among Individuals with Serious Mental Illnesses: A Systematic Review

Background and Purpose: Having a stable housing is not only a basic human right but is also associated with positive behavioral health outcomes such as reduced psychiatric distress, increased continuity of care, and better community integration. Yet, individuals with serious mental illness (SMI) often struggle with accessing and maintaining stable housing. A number of interventions have been developed that aimed to improve housing stability among individuals with SMI and have documented various level of intervention effects, which calls for systematic efforts to synthesize the current state of knowledge on this topic. Existing reviews examining effects of such interventions either did not follow any systematic protocols, or were limited to specific types of interventions. Moreover, previous reviews did not account for the variability of housing stability measures, decreasing the ability to examine multiple spheres of housing stability. This systematic review aims to address these gaps by systematically examining the effects of interventions on housing stability among individuals with SMI by various housing stability measures.

Methods: This study followed the Preferred Reporting Items for Systematic review and Meta-Analysis (PRISMA). The authors searched articles in English and published before October 2017 from five databases: CINAHL, PyscInfo, SocINDEX, PubMed, and Cochrane Central Register of Controlled Trials (CENTRAL). We used search terms related to housing stability (e.g. housing tenure, housing status) and SMI (e.g. severe mental illness, serious mental disorder). A forward and backward search was conducted to include additional articles. Articles were included if a study sampled adults aged 18 years or older with SMI, measured housing stability as an outcome, and employed either randomized controlled trials or quasi-experimental study design. Two reviewers independently performed screening, data extraction and risk bias assessment. The results are narratively summarized.

Results: A total of 15 studies were included in the final review, among which 24 housing stability outcome measures were examined, encompassing four broader categories: four out of 8 studies (50%) examining housing status reported significant intervention effects; six out of 8 (75%) studies examining the number of homeless or housed nights reported significant intervention effects; two out of 4 (50%) studies examining housing quality reported significant intervention effects; one out of 3 (33%) studies examining other housing stability measures reported significant intervention effects. Overall, eight studies evaluating three types of interventions reported significant intervention effects on at least one of the housing stability measures: Housing First (n=5), Critical Time Intervention (n=1), and supportive housing plus case management services (n=2). Interventions combining provisions of both clinical services and housing are more likely to find significant intervention effects than those only providing clinical services.

Conclusion and Implications: This study represents one of the few efforts to comprehensively synthesize current knowledge on interventions improving housing stability among individuals with SMI. Findings suggest that while clinical interventions can be effective in improving housing stability, the positive outcome of these interventions can be maximally achieved and sustained through combining the provision of stable and independent housing. Future research should increase the use of theory in designing and evaluating housing stability interventions.