CLINICAL HANDBOOK OF SCHIZOPHRENIA

292 IV. PSYCHOSOCIAL TREATMENTThe research knowledge base also includes studies of housing and psychiatric disorders,housing and supports, case management approaches linked to housing subsidies, homelessnessassistance, and Housing First programs that serve people with psychiatric disabilitiesand active substance abuse.Several reviews have synthesized the supported housing research evidence base. Mostof the studies revealed positive outcomes associated with supported housing, betteroutcomes for supported housing compared to prior housing situation–homelessness–standard options, and better or equal outcomes compared to other residential programoptions. A few studies indicated somewhat more positive effects for comparison models,but these effects may have been related to a large differential in the resources attached tosupported housing rather than an enriched comparison condition; to crossover conditions;and to specific housing market factors, such as the association between racial disparitiesand the time it takes to exit homelessness/acquire housing. Studies generally showthat supported housing performs equally well or better than much more costly residentialoptions.A variety of outcome domains have been used to assess the effectiveness of supportedhousing programs. Outcome variables often include attainment of housing; increasedcommunity tenure; reduced homelessness; and reduction in the use of sociallysegregated settings, such as hospitals, shelters, and jails.• Reduced homelessness, housing attainment, and residential stability. Several supportedhousing studies indicate great reductions in homelessness of more than 50%, andup to 80 or 90% within 1 year. Supported housing greatly increases residential stability.Studies reveal that stable housing among formerly homeless individuals ranged fromabout 50% in 1 year to nearly 90% over a 5-year period. These findings are generallymuch higher than housing stability rates for comparison conditions. Some studies haveshown that residential stability for some people takes some time to achieve.• Reductions in recidivism to hospitalization. Supported housing reduces recidivismto psychiatric hospitalization. Reductions in magnitude of 50% of hospital bed day usewere found in several studies.• Reduced jail stays. Supported housing has been found to reduce or even eliminatejail days in “difficult to serve” study populations.• Symptom reduction. A few studies relate supported housing to reductions in psychiatricsymptoms.• Increased functioning. Some studies indicated increases in social functioning forpeople in supported housing over time, whereas others indicated no significant change infunctioning.• Increased life satisfaction. Increases in life satisfaction have been found in studiesof supported housing.• Improved subjective and objective quality of life. Some studies have demonstratedimproved quality of life with supported housing.• Sense of home. Over time, with the development of stability, privacy, sense ofidentity, physical comfort, domesticity, and support, people in supported housing programshave been found to develop a sense of home.Related Research on the Importance of Consumer Choiceand PreferencesResearch on consumer housing and support preferences was first undertaken in the mid-1980s. Studies undertaken in many areas across the country revealed the same basic