Abstract

Executive Summary Objective: Individuals with severe and persistent mental illness (SPMI) identify housing as an important factor in achieving and maintaining their health. However, many live in substandard accommodations that are physically inadequate, crowded, noisy and located in undesirable neighbourhoods. In much of the research on housing for persons with SPMI, the central outcome of interest is remaining housed; however, it is worth investigating whether housing has other benefits. This paper is a systematic review of studies that investigated the relationship between housing-related independent variables and health-related dependent variables. Methods: Ten online databases were searched for studies published since 1980 that had study populations of adults with SPMI, analysed primary or secondary empirical data, and measured housing related independent variables and health related dependent variables. Clearly defined epidemiological criteria were used to assess the strength of evidence of the selected studies. Results: Twenty-nine studies met the suitability criteria, of which fourteen reported health care utilization outcomes; twelve examined mental status outcomes; and nine reported quality of life outcomes. Suggestions for Further Research: Although there is good evidence that housing interventions benefit the homeless population, more research is needed about housing solutions for individuals with SPMI who are housed, but in precarious or inappropriate housing situations. Study methodologies could be improved by emphasizing longitudinal designs that focus on participant retention and by implementing matched control groups or randomized interventions to strengthen internal validity. Service and Policy Implications: Ensuring that a person is adequately housed upon discharge from hospital should be a treatment priority. When housing eligibility is not dependent on psychiatric treatment compliance and sobriety, providing permanent housing minimizes harm and may free people to voluntarily seek treatment. Housing that offers an unlimited length of stay is recommended because SPMI is a chronic and fluctuating condition that requires stable surroundings to maintain health.