Housing Stability Among Individuals with Behavioral Health Needs: A Conceptual Framework of Definition

Background and Purpose: Housing instability, such as homelessness, poor housing quality, and frequent relocation, is widely experienced among individuals with behavioral health needs. Despite the increasing efforts in improving housing stability, research has largely conceptualized housing stability in a narrow sense and heavily relied on objective measures, such as housing types and housing duration. While emerging research has started to recognize the importance of subjective housing stability, what constitutes it remains unclear, resulting in challenges operationalizing this important domain. In addition, current literature advancing the conceptualization of housing stability has rarely attended to individuals with behavioral health needs, a sub-group population that disproportionately represents people experiencing housing instability. These gaps lead to imprecise and inconsistent measurements of housing stability, making it difficult to comprehensively assess individuals’ housing needs, develop optimal housing interventions, and compare the effectiveness across different interventions. To fill these gaps, the present study constructed a conceptual framework of housing stability from the perspectives of individuals with serious mental illness and co-occurring substance use problems and their behavioral health service providers.

Methods: Following the principles of grounded theory, we collected and analyzed qualitative data from 24 individuals with serious mental illness and substance use problems through semi-structured interviews and 22 behavioral health service providers through three focus groups. We conducted data analysis through an iterative process of initial coding, focused coding, and theoretical coding. We used a variety of data analysis tools such as diagraming, memos, and episode profiling to assist data interpretation. We enhanced the study rigor by using multiple strategies, including triangulating different sources of data, having multiple coders, keeping an audit trail, and memoing our reflexive process.

Results: We developed a three-layered conceptual framework consisting of two overarching components: objective and subjective housing stability (layer 1). Objective housing stability includes two domains: permanency and supportive services; subjective housing stability includes two domains: the functional domain and the experiential domain (layer 2). The functional domain entails the physical and economic characteristics of housing, and it includes three categories: physical shelter, housing quality, and housing affordability. The experiential domain entails the positive interactions between the person and their living environment, and it includes three categories: autonomy and self-determination, supportiveness and connectedness, and safety (layer 3). We mapped the relationship among the components of subjective and objective housing stability.

Conclusions and Implications: Our proposed conceptual framework expands the current conceptualization of housing stability by providing a more comprehensive understanding of housing stability and delineating the various conceptual components and their relationships within the framework. It offers important implications to research, practice, and policy. By incorporating the subjective, experiential aspect of housing stability, the proposed conceptual framework informs the development of housing stability interventions that improve the individuals' living experience and overall wellbeing rather than merely “being housed”. It enables practitioners to consider the diverse housing needs when assessing and planning for housing and supportive services. It urges policy makers to establish guidelines and allocate resources to develop a person-centered and equitable housing infrastructure and service system.