More Than Just Finding Housing: Exploration of the Impact of Services for Homeless Individuals Suffering from Mental Illness or Co-Occurring Mental Illness and Substance Use Disorder

Background and Purpose

Homelessness has long been a social justice concern, particularly in the realm of racial, social, and economic inequality. Extensive national efforts to support individuals experiencing homelessness have been in place for decades, by providing housing-related services such as affordable housing and emergency shelters, as well as non-housing related wraparound services such as mental health and substance use treatment, case management, and employment services. This study proposes to examine the efficacy of the Healthy Communities Collaborative (HCC), a program administered by the Texas Health and Human Services Commission (HHSC) to serve homeless individuals that suffer from mental illness or co-occurring mental illness and substance use disorder in Austin, Dallas, Fort Worth, and San Antonio. This study explores the benefit of the HCC program and the impact of finding independent housing.

Methods

This study used data from the Adult Needs and Strengths Assessment (ANSA) for HCC clients who were homeless at baseline and at 6-month follow up (n=1049) and clients who were homeless at baseline but obtained housing at 6-month follow up (n=516). Profile Analysis aimed to identify the patterns of the mean scores on 6 of 8 ANSA domains (Risk Behaviors, Behavioral Health Needs, Life Domain Functioning, Strengths, Psychiatric History, and Psychiatric Crisis History) regarding housing status at 6-month follow up.

 

Results

Results revealed a parallelism effect, indicating significant differences between the housed and non-housed group in their overall shape of profiles of the ANSA domains (F (5, 1559) =14.41, p<.001; Wilks’ Lambda=.956, partial η2=.044). Parameter testing showed that housed clients had lower Risk Behaviors (p<.01), lower Life Domain Functioning needs (p<.001), and greater Strengths (p<.05) than non-housed clients. Parameter testing of Life Domain Functioning measures indicated that, housed clients had greater residential stability and reported better sleep compared to non-housed clients. Further, among Strengths measures, housed clients had stronger family strengths (i.e., stronger relationship among family members), better social connectedness (i.e., greater interpersonal skills), greater talents/interest (i.e., broadly any talent, creative or artistic skills), lower educational attainment, and had better natural support (i.e., support from non-family members) in comparison to non-housed clients. Though not significantly different, clients who remained homeless at 6-month follow up had greater Risk Behaviors, greater Life Domain Functioning needs, lower Strengths, and greater psychiatric Crisis History, compared to housed clients at 6-month follow up.

Conclusions and Implications

Study findings suggest that though the housed and non-housed groups are different in their overall ANSA domain profiles, housing status may have limited impact on an individual’s overall functioning than initially hypothesized. While housed individuals reported lower levels of risk behaviors, life domain functioning needs, and higher strengths, no differences in profiles were noted in behavioral health needs, psychiatric history, and psychiatric crisis history. Indicating that, though obtaining independent housing is important, individuals without housing in the HCC program appear to still benefit from non-housing related services provided by HCC. Further analysis is needed to assess the efficacy of the HCC program, specifically assessing the impact of non-housing related services to inform program partners, policy makers, and community agencies.