Supportive Housing for People with Severe Mental Illness
Background
Housing is a key determinant of health for people living with severe mental illnesses (SMIs). However, the current lack of adequate supportive housing means people with psychotic illnesses are being discharged from hospital to homeless shelters or to the street and often re-hospitalized. People with SMIs have complex medical and support needs and often cannot live independently. Affordable and supportive housing reduces hospitalizations, psychiatric symptoms and substance abuse while increasing freedom, privacy, dignity and safety. Supportive Housing should provide 24 hour onsite staffing, health partner connections and personal support plans. The latter provide a regimen that includes skill building, hygiene, regular checkups for medication compliance, progress reports, stabilization, and monitoring of medication side effects.
People with SMIs have different challenges than those with concurrent disorders (i.e. a severe mental illness and an addiction). Each group needs separate supportive housing programs.
Supportive housing must be subject to oversight to ensure accountability for the expenditure of public funds and to maintain a safe environment for residents. Past experience has shown lack of oversight can lead to the creation of a harmful environment characterized by criminal activities such as drug dealing. Oversight must be backed up by the development of service standards that are monitored for compliance.
Government funded support programs like nursing homes, long-term care, and day nurseries all have set standards and government inspections but there are no standards or government inspections for supportive housing for those with SMIs. This must change.
Mental Health Recovery, Paid Work and Social Inclusion
Supportive housing coupled with appropriate treatment and skill development programs can promote mental health recovery and social inclusion for residents and provide an underutilized work force for local businesses.
Research demonstrates that many people with an SMI, if given the opportunity, are highly motivated workers. This higher level of motivation benefits both employee and employer. Paid work promotes mental health recovery for the latter while the employer gets a worker who is loyal and performs above the norm. Unfortunately, societal barriers still make it more difficult for people with SMIs to obtain paid work positions.
Not all people with SMIs are suited for paid work. People with schizophrenia experience significant cognitive losses that can make paid work inappropriate. It is, therefore, important to provide these people with opportunities for volunteer work. Supported volunteer work allows people a chance to interact with others in a stimulating and supportive environment that can help them develop a range of new social and cognitive skills. It can decrease isolation, common in this population, and promote increased self-esteem through new, productive experiences.
Position
Given the current homelessness crisis among those with SMIs and concurrent disorders, public policy must focus on the development of supportive housing together with oversight mechanisms and standards to ensure both accountability and safety.
Residents in supportive housing must have individual support plans that reflect their unique needs.
People with severe mental illnesses must be housed separately to those with concurrent disorders that involve addiction
Families of those with severe mental illnesses and concurrent disorders need to be consulted in the planning of supportive housing.
Supporting Research
Best Practices for Supportive Housing for the Mentally Ill By Dr David Laing Dawson https://dawsonross.wordpress.com/2024/11/18/best-practices-for-supportive-housing-for-the-mentally-ill/
Housing and Mental Health Centre for Addiction and Mental Health (CAMH) https://www.camh.ca/-/media/files/pdfs---public-policy-submissions/infographic_housing_mental_health-pdf.pdf
Turning the Key the Mental Health Commission of Canada https://www.mentalhealthcommission.ca/wp-content/uploads/drupal/PrimaryCare_Turning_the_Key_Summary_ENG_0_1.pdf
Work and employment for people with psychiatric disabilities Published online by Cambridge University Press: 02 January 2018 https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/work-and-employment-for-people-with-psychiatric-disabilities/DA5EC960B970AFB752D785EE3E024A19
Home Safe but not at Indwell By Marvin Ross, Karin Allen with notes from Dr. David Laing Dawson https://drive.google.com/file/d/13ERArBT24-mIUiYtGheu6BZjQItX9t4j/view