Biomedical subjects
Publications and source records attributed to P J Carling.
Supported housing, preferred by consumers and demonstrated as effective for individuals with psychiatric disabilities, has taken four approaches: residential services, intensive case management, hybrid, and homeless outreach. Evaluating the choices for local settings requires confronting issues of flexibility and responsibility.
OBJECTIVE: An approach referred to as "supported housing," based on principles of consumer choice, integrated community housing, and flexible services, is replacing residential treatment facilities for persons with psychiatric disabilities. To improve understanding of the new approach, its evolution, and issues involved in its implementation, this paper reviews studies of the effectiveness of traditional housing programs and early reports of the development of supported housing programs. METHODS: A data base of more than 4,000 journal articles and book chapters published over the past 15 years was searched; both research studies and policy analyses were included. RESULTS AND CONCLUSIONS: Because of national and state policy shifts toward supported housing and growing evidence that both consumers and their families favor this new approach, supported housing models appear to be increasingly replicated throughout the U.S. Innovative financing strategies, such as forming coalitions to develop housing or creating capital funds, have been implemented. Results from studies of established programs indicate that support services for consumers should include working with individuals to formulate their housing and support goals; financial assistance in acquiring long-term stable housing; help in searching for an apartment and moving; assistance in managing money and participating in leisure activities; assistance with medication; ongoing monitoring of needs; crisis support; and peer support. Future research should focus on promoting consumers' choices and organizing flexible services to help them succeed in the community.
This article summarizes current thinking in the field about the types of housing environments which are most relevant both to the overall goal of community integration, and to the variety of specific support needs of individuals with psychiatric disabilities. Within the context of a "supported housing" approach, which focuses on maximizing consumers choices and preferences, using integrated regular housing stock, and making a full array of community supports available, the authors propose a number of specific criteria which can be useful to community mental health organizations in planning for, or selecting housing.
About 1,500 agencies responded to a nationwide survey of community residential programs affiliated with state departments of mental health that was conducted in 1986-87. The agencies served more than 59,000 individuals who had psychiatric disabilities in more than 16,000 residential settings. The results reveal rapid growth in the number of programs since 1980 and the availability of a broad range of residential programs. Group homes and supervised apartments were the most common types of residential programs identified in the survey. The most commonly offered services were social and recreational activities, medication supervision, and on-site crisis intervention. Programs also offered such services as client advocacy and case management. Most program staff did not have professional training in a mental health field.
Providing housing and supports for people with psychiatric disabilities, particularly those who are homeless, is a major public policy challenge. This article summarizes the ways in which the concept of these needs is rapidly shifting in the mental health field. The article is based on research on the effectiveness of non-facility-based community support and rehabilitation approaches, the findings of other disability fields, and the emergence of mental health consumers' own preferences for expanded choices, normal housing, and more responsive services, including consumer-operated services. These new sources of knowledge are facilitating a paradigm shift in which people with psychiatric disabilities are no longer seen as hopeless, or merely as service recipients, but rather as citizens with a capacity for full community participation and integration.
Recently, the Schizophrenia Bulletin published an article on the concept of "asylum" for the mentally ill (Wasow 1986). This concept of asylum, while based on a desire to protect people with psychiatric disabilities is too vague to be useful and is politically dangerous. As a response to currently inadequate community service systems, it fails to take into account the empirical evidence of effectiveness of community support and rehabilitation programs and ignores the larger social responsibility to provide stable housing, employment, and other necessities to these individuals. Finally, it conflicts with the desires of psychiatrically disabled persons themselves. There is a need for aggressive development of community support and rehabilitation services, greater attention to the stated desires of mental health consumers, and continuing research into program effectiveness.
A comprehensive study of both the feasibility and the desirability of operating a state mental health system without a state hospital, except for a small forensic facility, was carried out in Vermont. Feasibility was examined in terms of client needs, service system capabilities, financing, human resource requirements, legal and rights protection issues, and political considerations. The study team concluded that developing comprehensive regional community support and rehabilitation services to replace the state hospital for all public mental health clients except forensic patients was both feasible and desirable since it would result in better services at a roughly equivalent cost to the state. The team also developed recommendations for optimizing the success of regionalization.
Through a critical review of Shadish and Bootzin's (1981) work in "Nursing Homes and Chronic Mental Patients," the author defines the larger context in which this national problem occurs, presents important distinctions among various subgroups of nursing home residents, and summarizes some of the most glaring historical inadequacies of using institutions as the core of a mental health system. Through this approach, the presentation raises serious questions about Shadish and Bootzin's proposal to use nursing homes as a foundation on which to reconstruct an improved community services system for chronically mentally ill persons.
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