Housing Choice, Outcomes, and Neighborhood Characteristics in Housing Programs for Individuals with a Serious Mental Illness: Analysis of a Phoenix Survey of Individuals with Serious Mental Illness
Mushkatel, Alvin, Guhathakurta, Subhrajit, Thompson, Jackie, Thomas, Kathy, Franczak, Michael, Public Administration Quarterly
While research has recently documented the importance of housing assistance to individuals with a serious mental illness (SMI), research is inconclusive as to the relative importance of different types of housing assistance for individuals with serious mental illnesses in relation to their well-being or integration into the community. More specifically, the relative importance of individual characteristics, including their socio-demographic factors, differently structured housing programs, and the environmental context (neighborhood level variables) to client success is not well researched. Yet, these factors are of critical importance in further understanding how various programs, including housing, can be designed and implemented to help individuals with serious mental illnesses integrate into the community (mainstreamed). For example, are there particular client socio-economic characteristics which interact either positively or negatively and allow for more successful housing program placements? Are there neighborhood characteristics, such as a concentration of residents receiving other types of assisted housing subsidies in a neighborhood, and are these concentrations associated with differential reintegration outcomes? Finally, is there an interactive effect among these three types of factors (individual, neighborhood context, and type of housing program), and if so, what, and under what conditions?
The 1970s brought about the deinstitutionalization era, which was a movement to discharge individuals with serious mental illnesses from state mental health facilities in order to reintegrate them into mainstream society. The shift in how individuals with a serious mental illness were treated is highlighted by the fact that in 1955 there were 559,000 individuals in state hospitals. Despite the fact that the nation's population increased by over 100 million from 1955 to 1998, there were only just over 57,000 individuals in state hospitals by the end of 1998 (Lamb and Bachrach 2001). The deinstitutionalization era also corresponded to the increased use of psychotropic medications to control the effects of severe mental illness and facilitated the discharge of this population from state hospitals. Torrey (1997) estimated that deinstitutionalization had resulted in 2.2 million severely mentally ill patients without supportive psychiatric services. The fact that individuals were more dependent on these psychotropic medications also increased their dependence on community-based supportive services.
Deinstitutionalization placed poorly understood demands on both community-based alternative care for those with a severe mental illness, as well as government-assisted housing services, therefore resulting in a lack of community-based support services to meet the needs of this population. Without the proper support, many of these individuals were out on the streets, and nationally, the homeless population began to increase. It is estimated that between one-third and one-half of the homeless were individuals with a serious mental illness (National Institute of Mental Health, 2000).
In order to more effectively utilize housing resources, the Department of Housing and Urban Development (HUD) adopted a strategy of providing housing programs that would cover the entire housing continuum of care. These programs would not only provide housing assistance to those of low and moderate income, but also to the nation's special populations, including the disabled and individuals with a serious mental illness (HUD, 1995 ) Additionally, the mental health community realized that they, too, would need to provide a continuum of mental health services in communities including case management, medication, and other services designed to provide preparation and support for those now living in the community (Fosburg, et al. 1997). In the 1980's the "continuum approach" came under criticism for not being able to meet the changing needs of individuals with a serious mental illness (Dickey, et. …