Housing First, consumer choice, and harm reduction for homeless individuals with a dual diagnosis

Abstract

Objectives: We examined the longitudinal effects of a Housing First program for homeless, mentally ill individuals' on those individuals' consumer choice, housing stability, substance use, treatment utilization, and psychiatric symptoms.

Methods: Two hundred twenty-five participants were randomly assigned to receive housing contingent on treatment and sobriety (control) or to receive immediate housing without treatment prerequisites (experimental). Interviews were conducted every 6 months for 24 months.

Results: The experimental group obtained housing earlier, remained stably housed, and reported higher perceived choice. Utilization of substance abuse treatment was significantly higher for the control group, but no differences were found in substance use or psychiatric symptoms.

Conclusions: Participants in the Housing First program were able to obtain and maintain independent housing without compromising psychiatric or substance abuse symptoms.

FIGURE 1—

Consumer choice in housing: baseline–24 months. Note. At baseline, participants were asked how much choice they would like to have. Subsequent time-points assess how much choice participants actually have.

FIGURE 2—

Proportion of time spent homeless: baseline–24 months.

FIGURE 3—

Proportion of time stably housed: baseline–24 months.

FIGURE 4—

Average number of substance abuse treatment services used: baseline–24 months.