As a psychiatry resident, I worked at a community service agency in Los Angeles, treating chronically homeless patients with serious mental illness and substance use disorders (SUD) as they transitioned into permanent, community-based housing with supportive services (“supported housing”). Naively, I expected to see decreased mental health symptoms when these patients became housed. Instead, I was struck by their range of mental health outcomes and variable levels of success using supported housing to exit homelessness.
Today, as a psychiatrist who treats and studies adults who are experiencing homelessness, my patients continue to inspire important and unanswered questions: What factors predict if a homeless person will be able to engage in supported housing to attain and retain an apartment? What supportive services facilitate permanent exits from homelessness?
At a national level, the Department of Housing and Urban Development (HUD) recognizes housing status as a critical determinant of physical and mental health.1 After developing federal housing projects that unintentionally evolved into concentrated islands of poverty, HUD embraced the notion of “mobility” for homeless individuals or persons at risk for becoming homeless, offering Housing Choice (Section 8) vouchers to mobilize persons with socioeconomic disadvantage into “mainstream” communities.
For low-income persons, Housing Choice vouchers subsidize rental costs in apartments available to the public at large. Voucher recipients pay a portion of their income towards rent and the remainder of costs are subsidized by local Public Housing Authorities (not-for-profit entities that work with local governments and agencies to develop housing strategies for communities).2
Dr Gabrielian is Psychiatrist and Health Services Researcher, VA Greater Los Angeles; Assistant Professor, Department of Psychiatry and Biobehavioral Sciences, UCLA David Geffen School of Medicine; and Affiliated Researcher, National Center on Homelessness Among Veterans, Los Angeles, CA.
Dr Gabrielian reports no conflicts of interest concerning the subject matter of this article.
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