Housing is a key determinent of health for people living with severe mental illnesses (SMI). Because of the current lack of adequate supportive housing, people with psychotic illnesses are being discharged from hospital to homeless shelters or to the street and often need to be re-hospitalized. Affordable and supportive housing reduces hospitalizations, psychiatric symptoms and substance use while increasing freedom, privacy, dignity and safety. Supportive Housing for those with psychotic illnesses provides 24 hour onsite staffing, personal support, and health partner connections because they have complex support and medical needs and cannot live independently in the community. Well managed supportive housing is a necessary component of the treatment plan for those with SMI.

Support with medication is the cornerstone of well managed supportive houisng. To stay well, residents require a regimen which includes regular checkups for compliance, progress, stabiliztion, and side effects.

Each resident has unique needs which can be reflected in an individualized support plan that supports skill building and hygiene.

Appropriate oversight is imperative. Lack of oversight, may result in an environment that is not conducive to recovery for residents and may include drug dealing and prostitution. Monitored standards must be applied to ensure the quality and safety of the housing and for the level of the support offered. Whether the provider of Supportive Housing be a private citizen or corporation, a government organization, a charitable organization or a religious organization – they all need oversight as well as accountability for the expenditure of public funds required to maintain supportive housing. Government funded support programs like nursing homes, long term care, day nurseries all have set standards and government inspections but there are no standards or government inspections for supportive housing for those with severe mental illnesses.

Because those with severe mental illnesses have different challenges than those who have concurrent disorders (severe mental illness and an addiciton) , it is important to that they live in separate supportive housing programs.

Mental Health Recovery, Paid Work and Social Inclusion

Supportive housing can promote mental health recovery and social inclusion. More supportive housing in the community provides an underutilized work force to businesses that require workers to staff businesses such as Tim Horton’s, or No Frills. Research has demonstrated that there is a higher motivation among persons with SMI who work but it is considerably more difficult for them to even get a job. Once hired, people with SMI appreciate the opportunity to work and are more motivated to perform above what is expected. This higher level of motivation leads to better mental health recovery, friendlier dealings with customers, higher loyalty towards their employer, and a more consistent performance. It’s important to also offer a variety of opportunities to participate in supported volunteer work; many people with schizophrenia experience significant cognitive losses which makes paid, competitive work inappropriate. 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, which is common in this population, and promote increased self-esteem through establishing opportunities for new, productive experiences.

Position

Given the current homelessness crisis among those with SMI and concurrent disorders, public policy needs to be focussed on the development of supportive housing and standards for this type of housing. Currently, there are no official standards for supportive housing for those with severe mental illnesses or concurrent disorders.

Each resident must have an individualized support plan which reflects the resident’s unique needs.

Safety measures need to be in place.

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