Author:
Kerman Nick,Kidd Sean A.,Mutschler Christina,Sylvestre John,Henwood Benjamin F.,Oudshoorn Abe,Marshall Carrie Anne,Aubry Tim,Stergiopoulos Vicky
Abstract
AbstractPermanent supportive housing is an effective intervention for stably housing most people experiencing homelessness and mental illness who have complex support needs. However, high-risk behaviours and challenges are prevalent among this population and have the potential to seriously harm health and threaten housing tenures. Yet, the research on the relationship between high-risk issues and housing stability in permanent supportive housing has not been previously synthesized. This rapid review aimed to identify the housing-related outcomes of high-risk behaviours and challenges in permanent supportive housing settings, as well as the approaches used by agencies and residents to address them. A range of high-risk behaviours and challenges were examined, including risks to self (overdose, suicide/suicide attempts, non-suicidal self-injury, falls/fall-related injuries), and risks to multiple parties and/or building (fire-setting/arson, hoarding, apartment takeovers, physical/sexual violence, property damage, drug selling, sex trafficking). The search strategy included four components to identify relevant academic and grey literature: (1) searches of MEDLINE, APA PsycINFO, and CINAHL Plus; (2) hand searches of three journals with aims specific to housing and homelessness; (3) website browsing/searching of seven homelessness, supportive housing, and mental health agencies and networks; and (4) Advanced Google searches. A total of 32 articles were eligible and included in the review. Six studies examined the impacts of high-risk behaviours and challenges on housing tenancies, with overdose being identified as a notable cause of death. Twenty-six studies examined approaches and barriers to managing high-risk behaviours and challenges in PSH programs. These were categorized into eight types of approaches: (1) clinical, (2) relational/educational, (3) surveillant, (4) restrictive, (5) strategic, (6) design-based, (7) legal, and (8) self-defence. Consistent across all approaches was a lack of rigorous examination of their effectiveness. Further, some approaches that are legal, restrictive, surveillant, or strategic in nature may be used to promote safety, but may conflict with other program objectives, including housing stability, or resident empowerment and choice. Research priorities were identified to address the key evidence gaps and move toward best practices for preventing and managing high-risk behaviours and challenges in permanent supportive housing.
Funder
Employment Support and Development Canada
Publisher
Springer Science and Business Media LLC
Subject
Psychiatry and Mental health,Public Health, Environmental and Occupational Health,Medicine (miscellaneous)
Reference85 articles.
1. Aubry T, Bloch G, Brcic V, et al. Effectiveness of permanent supportive housing and income assistance interventions for homeless individuals in high-income countries: a systematic review. Lancet Public Health. 2020;5:e342–60.
2. Peng Y, Hahn RA, Finnie RKC, et al. Permanent supportive housing with housing first to reduce homelessness and promote health among homeless populations with disability: a community guide systematic review. J Public Health Manag Pract. 2020;26:404–11.
3. Pottie K, Kendall CE, Aubry T, et al. Clinical guideline for homeless and vulnerably housed people, and people with lived homelessness experience. CMAJ. 2020;192:e240–54.
4. Aubry T, Roebuck M, Loubiere S, et al. A tale of two countries: a comparison of multi-site randomised controlled trials of Pathways housing first conducted in Canada and France. Eur J Homeless. 2021;15:25–44.
5. Busch-Geertsema V. Housing first Europe – results of a European social experimentation project. Eur J Homeless. 2014;8:13–28.