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The features of supported accommodation and housing that promote successful community living
Evidence review P
NICE Guideline, No. 181
National Guideline Alliance (UK).
The features of supported accommodation and housing that promote successful community living
Review question: What features of supported accommodation and housing promote successful community living in people with complex psychosis and related severe mental health conditions?
This was a mixed methods review that amalgamated findings from a qualitative search and a quantitative search.
Introduction
Moving from hospital with high levels of support and back into the community is an important step in the rehabilitation and recovery pathway. But for people with chronic serious mental health conditions there are many obstacles to successful community living. Meeting the demands of daily living, and keeping a roof over one’s head, with less support, is demanding and stressful. Residents may lack supportive social networks, or the social skills to gain them. They may subsequently be at greater risk of isolation, exploitation, and substance misuse. These increased stressors exacerbate psychiatric symptoms. The present review seeks to identify the factors that make successful community living more likely.
The title of the guideline changed to “Rehabilitation for adults with complex psychosis” during development. The previous title of the guideline has been retained in the evidence reviews for consistency with the wording used in the review protocols.
Summary of the quantitative search protocol
Please see Table 1 for a summary of the Population, Intervention, Comparison and Outcomes (PICO) characteristics of the quantitative component of this review.
Table 1
Summary of the quantitative protocol (PICO table).
For further details, see the review protocols in appendix A.
Summary of the qualitative protocol
Please see Table 2 for a summary of the Population, Interest and Context (PICo) characteristics of the qualitative component of this review.
Table 2
Summary of the qualitative protocol (PICo table).
For further details see the review protocols in appendix A.
Clinical evidence
Included quantitative studies
Five studies including 4 RCTs (Aubry 2016; Goldfinger 1999; Somers 2017; Tsemberis 2003) and 1 cohort study (Killaspy 2019) examining supported accommodation and housing were included in the review.
The included studies are summarised in Table 3. See also literature search strategy in appendix B and clinical evidence study selection in appendix C.
Included qualitative studies
A total of 16 qualitative studies were included examining the features of supported accommodation and housing that promote successful community living.
The included studies were published between 2002 and 2018. One of the studies identified was from the UK, 4 were from the Australia, 4 were from the USA, 2 were from Sweden and 2 were from Canada. There was also 1 study each from New Zealand, Denmark and Germany.
The included studies are summarised in Table 4. See also the literature search strategy in appendix B and study selection flow chart in appendix C.
Summary of studies included in the evidence review
See the full evidence tables in appendix D and the forest plots in appendix E.
Table 3See the full evidence tables in appendix D and the forest plots in appendix E.
Table 3
Summary of included qualitative studies.
See the full evidence tables in appendix D and the theme map in Appendix E.
Excluded studies
Studies not included in this review with reasons for their exclusions are provided in appendix K.
Quality assessment of clinical outcomes included in the evidence review
See the clinical evidence profiles in appendix F and quotes extracted from the qualitative studies in appendix M.
Economic evidence
Included studies
A systematic review of the economic literature was conducted but no economic studies were identified which were applicable to this review question.
Excluded studies
Studies not included in this review with reasons for their exclusions are provided in appendix K.
Summary of studies included in the economic evidence review
No economic studies were identified which were applicable to this review question.
Economic model
No economic modelling was undertaken for this review because the committee agreed that other topics were higher priorities for economic evaluation.
Evidence statements
Quantitative evidence statements
Comparison 1. Housing First versus Treatment as usual
Reduction in support need
No evidence was identified which was applicable to this review question.
Satisfaction with care
No evidence was identified which was applicable to this review question.
Quality of life: QoLI 20 (Change from baseline at 21/24 months)
Moderate quality evidence from 1 RCT (N=780) showed that there was no clinically important difference in the quality of life, assessed using the change in Quality of life inventory (QoLI) 20 between those receiving Housing First intervention and Treatment as usual (TAU) at 21/24 months follow-up.
Secure permanent tenancy: Number of people in stable housing at 21-24 months
High quality evidence from 1 RCT (N=780) showed that those receiving Housing First intervention spent a greater number of days in stable housing compared to those receiving Treatment as usual(TAU) at 21/24 months follow-up.
Comparison 2. Group housing versus independent apartments
Reduction in support need
No evidence was identified which was applicable to this review question.
Satisfaction with care
No evidence was identified which was applicable to this review question.
Quality of life
No evidence was identified which was applicable to this review question.
Secure permanent tenancy: Housed at 18 months follow-up
Low quality evidence from 1 RCT (N=110) showed that there was no clinically important difference in the proportion of people housed between those residing in group homes compared to independent apartments at 18 months follow-up.
Comparison 3. Congregate Housing First versus Treatment as usual
Reduction in support need: Recovery (Change from baseline RAS 22 score at 24 months)
Moderate quality evidence from 1 RCT(N=207) showed that recovery, assessed using change in RAS (recovery assessment scale)-22 score was higher in those receiving Congregate Housing First intervention compared to Treatment as usual(TAU) at 24 months follow-up.
Satisfaction with care
No evidence was identified which was applicable to this review question.
Quality of life: QOLI 20(Change from baseline score at 24 months)
Moderate quality evidence from 1 RCT (N=207) showed that there was no clinically important difference in the quality of life, assessed as change in the Quality of life inventory (QoLI) 20 between those receiving Congregate Housing First intervention and Treatment as usual(TAU) at 24 months follow-up.
Secure permanent tenancy- Number of days in stable residence (follow up 24 months)
High quality evidence from 1 RCT (N=207) showed that those receiving Congregate Housing First intervention spent higher number of days in stable residence compared to those receiving Treatment as usual(TAU) at 24 months follow-up.
Comparison 4. Scattered Housing First versus Treatment as usual
Reduction in support need: Recovery (Change from baseline RAS 22 score at 24 months)
Low quality evidence from 1 RCT(N=190) showed that there was no clinically important difference in recovery, assessed using change in RAS (recovery assessment scale)-22 score between those receiving Scattered Housing First intervention compared to Treatment as usual (TAU) at 24 months follow-up.
Satisfaction with care
No evidence was identified which was applicable to this review question.
Quality of life
Moderate quality evidence from 1 RCT (N=190) showed that there was no clinically important difference in the quality of life, assessed as the change in Quality of life inventory (QoLI) 20 between those receiving Scattered Housing First intervention and Treatment as usual (TAU) at 24 months follow-up.
Secure permanent tenancy- Number of days in stable residence (follow up 24 months)
High quality evidence from 1 RCT (N=207) showed that those receiving Scattered Housing First intervention spent higher number of days in stable residence compared to those receiving Treatment as usual(TAU) at 24 months follow-up.
Secure permanent tenancy
No evidence was identified which was applicable to this review question.
Comparison 5. Pathways to housing versus Treatment as usual
Reduction in support need
No evidence was identified which was applicable to this review question.
Satisfaction with care
No evidence was identified which was applicable to this review question.
Quality of life
No evidence was identified which was applicable to this review question.
Secure permanent tenancy- Proportion of time in stable housing (at 6 months follow up)
Moderate quality evidence from 1 RCT (N=297) showed that people receiving pathway to housing services spent higher proportion of time in stable housing compared to those receiving treatment as usual at 6 months follow-up.
Secure permanent tenancy- Number of participants in stable housing at 6 months follow-up
Moderate quality evidence from 1 RCT (N=297) showed that more number of people receiving pathway to housing services were housed in stable housing compared to those receiving treatment as usual at 6 months follow-up.
Comparison 6. Supported housing versus residential care
Reduction in support need
Very low quality evidence from 1 cohort study (N=390) showed that people receiving supported housing services had higher rates of reduction in support compared to those receiving residential care.
Satisfaction with care
No evidence was identified which was applicable to this review question.
Quality of life
No evidence was identified which was applicable to this review question.
Secure permanent tenancy
No evidence was identified which was applicable to this review question.
Comparison 7. Floating outreach versus supported housing
Reduction in support need
Very low quality evidence from 1 cohort study (N=440) showed that people receiving floating outreach services had higher rates of reduction in support compared to those residing in supported housing.
Satisfaction with care
No evidence was identified which was applicable to this review question.
Quality of life
No evidence was identified which was applicable to this review question.
Secure permanent tenancy
No evidence was identified which was applicable to this review question.
Comparison 8. Floating outreach versus residential care
Reduction in support need
Very low quality evidence from 1 cohort study (N=342) showed that people receiving floating outreach services had higher rates of reduction in support compared to those receiving residential care.
Satisfaction with care
No evidence was identified which was applicable to this review question.
Quality of life
No evidence was identified which was applicable to this review question.
Secure permanent tenancy
No evidence was identified which was applicable to this review question.
Qualitative evidence statements
Topic I. Meeting basic needs
Theme 1. A place to stay
- 1.1.
Having shelter and a stable place to eat and sleep are fundamental needs. Residents stated that assistance keeping a home, and financial and practical help were considered crucial when coping with the effects of severe mental health problems - even though residents sometimes resented needing this support. This was based on low quality evidence from 2 Australian studies and 1 Swedish study.
Theme 2. A safe environment
- 2.1.
To succeed in the community residents reported that they need to feel safe from things like abuse, violence and drug dealing/taking in their living environment. Some residents had come from unsafe previous environments or abusive relationships and so need somewhere better to turn. This was based on moderate quality evidence from 2 US studies and 1 Australian study.
- 2.2.
Some female residents had abusive experiences with men in previous care or community environments. They felt more able to live in the community when they had accommodation with some separation from men. This was based on low quality evidence from 1 Australian study and 1 Danish study.
Theme 3. Financially sustainable
- 3.1.
Financial difficulties are common for people living with severe mental illness. This is often a barrier to living where they want. Financial difficulties cause problems with paying for bills and essentials or affording to remain in a place. This threatens them with instability and is also a major stressor that can exacerbate mental health difficulties. This was based on low quality evidence from 1 Australian study and 1 US study.
Theme 4. Mental health support available
- 4.1.
Living in the community does not mean being beyond the need for psychiatric care. Residents report that services need to be sufficient to meet their mental health needs but often are not. This was based on very low quality evidence from 1 Swedish study.
- 4.2.
Psychotic delusions may occur related to accommodation or the surroundings. Particular environments may not be palatable to the resident. Adjustments such as moving to a new room or flat may be needed for the resident to feel comfortable. This was based on very low quality evidence from 1 Australian study.
Theme 5. Substance use problems
- 5.1.
‘Treatment first’ approaches were considered a barrier to recovery and stability. Residents with substance use problems felt the decision to change their substance use behaviour had to come from within themselves. The coercion of the ‘Treatment first’ approach did not motivate them, and instead made their life more unstable and kept them in unhealthy situations. Residents considered the ‘Housing First’ more helpful. However a Housing First support approach should be careful not to seem ‘uncaring’ in its approach to substance misuse. This was based on low quality evidence from 3 US studies.
Theme 6. Coercion
- 6.1.
While many people with severe mental health problems may aspire to return to the community from hospitalisation, some residents may not have chosen to. When asked, some residents reported that they had ended up living in the community only because it was where they had been sent from hospital, sometimes even after been being coerced or warned that they had to move on. This was based on very low quality evidence from 1 Australian study.
Topic II. A place to belong
Theme 7. Local area
- 7.1.
Residents wanted to be able to settle in one place. Frequent relocation was unsettling. Being able to familiarise themselves with an area, get to know their neighbours and fellow residents, and develop a general sense of belonging allowed them to thrive more. This was based on moderate quality evidence from 3 Australian studies.
- 7.2.
Living in a bad neighbourhood added to the stress that resident experienced. Being in a pleasant area, especially with features such as parks and cafes and transportation, was considered highly beneficial. This was based on low quality evidence from 1 US study and 1 Canadian study.
- 7.3.
Residents valued being in an area that was already familiar to them and in proximity to their existing networks. Being away from home was distressing. Ideally this meant not only being in a familiar city or region but in a familiar neighbourhood. This was based on low quality evidence from 1 US study and 1 Canadian study.
Theme 8. A sanctuary
- 8.1.
Residents valued having a place of their own to retreat to and find peace. Most often this was a private room or personal space, although some residents also appreciated a space like a garden to escape to. It allowed them to remove themselves from difficult social situations or retreat during overwhelming symptom flare-ups. They valued being able to personalize and make the place feel like their own. This was based on high quality evidence from 2 Australian studies, 2 Swedish studies and 1 Canadian study.
Theme 9. Facilities
- 9.1.
Residents appreciate accommodation with facilities available to support their activities of daily living and enable them to live more independently. Facilities described included laundry and cooking, telephones and internet, and living/dining space to host friends. Residents will often be at different stages regarding how able they are to utilise these facilities – it is important that residents are not out of their depth. Support will often be necessary. This was based on moderate quality evidence from 2 Canadian studies and 1 US study.
Theme 10. Avoiding loneliness
- 10.1.
Loneliness and isolation was suffered by many residents and was reported to be very bad for mental health symptoms. This was based on high quality evidence from 1 Australian study, 1 Swedish study, 1 Danish study and 1 New Zealand study.
- 10.2.
If living in their own home then family and neighbours were a good source of support and checking in, making community living more sustainable. This was based on low quality evidence 1 US study.
- 10.3.
Staff and professionals that work or visit the residence could also become like family, and were considered valuable support and company. This was based on moderate quality evidence from 1 British study, 1 Swedish study, and 1 Danish study.
Theme 11. Accepted in the community
- 11.1.
Family, neighbours and friends often struggle to understand symptoms of severe mental health problems. Residents reported that tensions could arise when living alongside others who don’t understand their symptoms. This was based on low quality evidence from 1 Australian study and 1 German study.
- 11.2.
Residents reported that being in a community with others that experienced mental health problems could be beneficial, as they felt part of a community and less likely to be rejected. This was based on high quality evidence from 2 Swedish studies, 1 Australian study and 1 Danish study.
- 11.3.
Negative social situations can be detrimental to the living environment and the resident’s emotional wellbeing generally. Living with residents with mental health problems and additionally dealing with their symptoms could be strenuous. In such cases residents reported being alone was often preferable to being in a challenging social environment. This was based on high quality evidence from 2 Canadian studies, 2 Swedish studies and 1 Canadian study.
- 11.4.
Sometimes residents living in a community with other people with severe mental health reported feeling segregated from the rest of society. They felt it set them apart as not ‘ordinary people’. This was based on very low quality evidence from 1 Swedish study.
Topic III. Reaching potential
Theme 12. Develop skills
- 12.1.
Residents wanted to develop or regain life skills and social skills that would allow them to cope better and develop/regain greater self-sufficiency. This was based on moderate quality evidence from 1 Australian study, 1 Swedish study and 1 Danish study.
- 12.2.
Once the residents felt confident in their home sphere, many wanted to develop more advanced skills for reintegration into society and meeting aspirations like an occupation or a romantic relationship. This was based on moderate quality evidence from 1 Australian study, 1 Swedish study and 1 US study.
Theme 13. Encouragement
- 13.1.
Having a nurturing environment with encouraging professionals, friends, relatives etc. around helped them to grow and become more independent. This feedback could be useful for developing activities of daily living but also social skills. Challenges, support and goals needed to be appropriate to their current level of coping. This was based on low quality evidence from 1 Swedish study and 1 US study.
- 13.2.
Residents with previous experience of failures and setbacks reported greater self-doubt and felt they might need extra support and encouragement to develop and learn to thrive. This was based on low quality evidence from 1 Australian study and 1 Swedish study.
Theme 14. Deep connections
- 14.1.
Residents considered their lives were enriched when they were able to form deep connections with people in their social circles (staff, other residents etc). Security, structure and a place to belong gave them the space to develop these types of relationships. This was based on low quality evidence from 2 Swedish studies and 1 Danish study.
Economic evidence statements
No economic evidence was identified which was applicable to this review question.
The committee’s discussion of the evidence
Interpreting the evidence
The outcomes that matter most
This review searched separately for qualitative and quantitative evidence about what promotes or inhibits successful community living for people with complex psychosis and related severe mental health conditions. The intention was that where applicable the evidence would then be synthesized.
For the quantitative review section reduction in the amount of support needed was a critical outcome because stable accommodation potentially enables people to progress through the rehabilitation pathway with greater autonomy and independence. Satisfaction with care and quality of life were important outcomes because someone’s living conditions have an important influence on both of these. Achieving a secure permanent tenancy was an important outcome because it is a direct measure of the effectiveness of accommodation intervention in providing a stable home.
For the qualitative section the most important outcomes were chosen from amongst the emergent themes. The emergent themes fell under three topics – meeting basic needs, having a place to belong, and reaching potential. The committee thought that the most important outcomes were those related to meeting basic needs – especially having mental health support available, safety and suitability (including protected characteristics and reasonable adjustments), and user’s choice of place/inclusion in decisions.
The quality of the evidence
Evidence was identified for all of the quantitative outcomes except for satisfaction with care. The quantitative evidence statements were assessed using GRADE methodology and were classified as ranging from low to high quality. Moderate to high quality RCT evidence suggested some types of supported accommodation are more beneficial than treatment as usual for stability and recovery outcomes. There was also very low quality evidence from observational study data suggesting that some types of supportive accommodation are better than others at reducing support need. The committee agreed the quantitative findings were more relevant to recommendations they were developing about ‘components of an effective pathway’ (see Evidence Report F) and so were used to inform/strengthen recommendations in that area instead of this section.
The qualitative evidence statements were assessed using GRADE CERQual methodology, and ranged in quality from very low to high. Where the ratings were downgraded this was most often due to adequacy of the data, as almost half of the evidence statements had only had one or two studies supporting them. For about a third of the evidence statements there was some downgrading due to methodological limitations in the studies (individually assessed using the CASP quality ratings) which limited how much confidence could be had in their findings. Finally, several of the evidence statements were downgraded for applicability – where the findings were not UK based or had only been identified in studies from one or two countries only and so may not be generalizable. When it came to discussing the evidence and making recommendations the committee considered all the evidence statements, including all of those of lower quality, as they agreed most of these statements still had a high face validity according to their experience.
The committee discussed the quantitative evidence on Housing First interventions – interventions that aim to find a person secure accommodation to give them a stable environment before starting treatment. In the two included studies, the Housing First interventions included offering housing plus assertive community treatment to homeless people. The committee’s view was that the assertive community treatment component was similar to floating outreach. The committee recommended offering both supported housing and floating outreach as components of the rehabilitation pathway, as part of their committee discussion on ‘components of an effective pathway’. The committee decided not to specify Housing First interventions in the recommendations, because of the risk that homeless people, or others, may be offered only housing, and not the floating outreach component. The committee agreed that all people with treatment-resistant psychosis and functional impairments, including those who are homeless, should be offered rehabilitation, which may include the requirement for housing.
Synthesis of quantitative and qualitative data
During their discussion of the evidence, the committee intended to synthesise the quantitative and qualitative data, making judgements about the extent to which the combined findings could be used as a basis for recommendations.
However after discussion the committee did not use any of the quantitative evidence to make recommendations for this section. Instead they thought these findings supported recommendations being developed about ‘components of an effective pathway’ (see Evidence Report F).
Benefits and harms
The qualitative themes identified in the review were presented to the committee categorised into three topics/levels based on Maslow’s (1954) theory of the hierarchy of human needs. The foundation category was ‘meeting basic needs’, the second category was a ‘sense of belonging’, and the top level category was ‘reaching potential’. Maslow’s hierarchy suggests that interventions aiming to impact the higher levels of a person’s needs can be important, however the benefits will only be realisable if the lower levels of the hierarchy have already been met. The committee discussed this framework and agreed with its face-validity. The main implication of this model is to encourage services and practitioners to avoid misallocating time and resources to interventions which the service user is not yet in a position to benefit from. The Maslow framework encouraged the committee’s discussion to put more emphasis on themes and factors relating to meeting basic needs. They were most concerned to develop recommendations about ensuring service users have a place to stay which is stable (including financially stable), safe, and meet’s their mental health needs plus other important health or substance misuse needs. These recommendations were prioritised even in areas where the evidence was of poor quality because of the committee’s experience and core values that this would be best practice.
Financial factors were one of the first themes discussed by the committee. Rehabilitative service users are often financially unstable and vulnerable to falling between the gaps of incoherent welfare/benefits systems leading to broken tenancies, or of being at risk of frequent relocation as they move between different services with separate accommodation and funding streams. Although the evidence did not specifically refer to personal budgets, the committee were aware that some people using secondary mental health services will be eligible to receive personal budgets or direct payments as part of legislation in the Care Act 2014, for their care and support needs. Commissioners and local authorities need to develop coherent systems that prevents service users from periodically facing losing their accommodation or being shifted from place to place as they transition between services, because this kind of upheaval undermines the benefits of stability and can be distressing and inflammatory to existing psychological problems.
Upon considering the evidence, the committee discussed the important balance of having sufficient places for privacy while also offering opportunities to integrate with others and develop a sense of inclusion and community with their neighbours. They noted that some services in the UK may still offer dorms or two-person shared rooms, presenting a problem when symptoms mean someone needs to retreat.
Next the committee discussed the importance of fostering a sense of belonging for service users in their accommodation. This included the ability to settle long-term and personalise their accommodation. The committee discussed their own experience and the supporting evidence that people should be offered to live in an area where they already have some connection – such as friends, family and familiar spots. Being in a familiar area allows service users to keep and build on supportive connections. As part of this, the committee discussed that service users should be allowed to welcome visitors to their home. However consideration was also given that some existing relationships may be detrimental to service users, with a possible history of abuse or encouraging substance misuse. Some service users may appreciate being offered protection or distance from previous troubled relationships. The committee debated the merits of accommodation policies related to allowing/restricting certain visitors or behaviours, and avoiding harm while granting service users reasonable autonomy to make potentially unwise decisions about drugs or the company they keep.
The committee made less use of findings about ‘reaching potential’, relating to what makes a person move from the basics of survival to a place of thriving within the community. These themes were incorporated into the development of recommendations about supporting community participation and personal self-sufficiency, but mostly the committee were wary about diluting the recommendations with lower-priority topics based on mostly low quality evidence.
Cost effectiveness and resource use
No relevant studies were identified in a systematic review of the economic evidence.
The recommendations regarding patient involvement in choice of housing in supported housing have the potential to greatly enhance a patient’s quality of life without necessarily adding additional costs. For those being discharged who were initially detained, the adequate provision of supported housing reflects the principles of Section 117 of the Mental Health Act 1983 (as amended). The financial implications are likely to vary area by area, depending on current availability of adequate supported accommodation. Local Authorities with under provision of supported housing that service users feel are of sufficient quality may require additional resources in enabling provision of such services.
Other considerations
The committee gave strong consideration to protected characteristics. The Equality Act (2010) requires that factors like disability, sex and religion be considered and adjusted for in all services. Failing to account for protected characteristics could be highly detrimental to the safety, comfort levels, and quality of life of service users – posing great risks to their stability and recovery. The committee was wary that rehabilitation service users are disproportionately likely to have other health disabilities. Available amenities in terms of religion may also be an important factor for some service users. Evidence plus the committee’s experience also suggested that sex and gender are especially important protected considerations as the rehabilitation population tends be male in majority and female service users’ needs may be overlooked. The committee thought many female service users may have a preference for single-sex accommodation. As vulnerable women this population may be disproportionately likely to have been previous victims of sexual or domestic assault.
Quantitative References
Aubry 2016
Aubry, T., Goering, P., Veldhuizen, S., Adair, C. E., Bourque, J., Distasio, J., Latimer, E., Stergiopoulos, V., Somers, J., Streiner, D. L., et al.,, A Multiple-City RCT of Housing First With Assertive Community Treatment for Homeless Canadians With Serious Mental Illness, Psychiatric services (Washington, D.C.), 67, 275–281, 2016 [PubMed: 26620289]Goldfinger 1999
Goldfinger, S. M., Schutt, R. K., Tolomiczenko, G. S., Seidman, L., Penk, W. E., Turner, W., Caplan, B., Housing placement and subsequent days homeless among formerly homeless adults with mental illness, Psychiatric Services, 50, 674–9, 1999 [PubMed: 10332905]Killaspy 2019
H, Killaspy., S, Priebe., P, McPherson., Z, Zenasni., L, Greenberg., P, McCrone.,, S, Dowling., I, Harrison., J, Krotofil., C, Dalton-Locke., R, McGranahan.,, M, Arbuthnott., S, Curtis., G, Leavey., G, Shepherd., S, Eldridge and M, King., Predictors of moving on from mental health supported accommodation in England: national cohort study., The British journal of psychiatry, 1–7, 2019 [PubMed: 31046864]Somers 2017
Somers, J. M., Moniruzzaman, A., Patterson, M., Currie, L., Rezansoff, S. N., Palepu, A., Fryer, K., A randomized trial examining housing first in congregate and scattered site formats, PLoS ONE, 12 (1) (no pagination), 2017 [PMC free article: PMC5226665] [PubMed: 28076358]Tsemberis 2003
Tsemberis, S. J., Moran, L., Shinn, M., Asmussen, S. M., Shern, D. L., Consumer preference programs for individuals who are homeless and have psychiatric disabilities: a drop-in center and a supported housing program, American Journal of Community Psychology, 32, 305–317, 2003 [PubMed: 14703266]
Qualitative References
Bengtsson-Tops 2014
Bengtsson-Tops, A., Ericsson, U., Ehliasson, K., Living in supportive housing for people with serious mental illness: a paradoxical everyday life, International Journal of Mental Health Nursing, 23, 409–418, 2014 [PubMed: 24802100]Browne 2005
Browne, G., Courtney, M., Housing, social support and people with schizophrenia: a grounded theory study, Issues in Mental Health Nursing, 26, 311–26, 2005 [PubMed: 16020049]Chopra 2011
Chopra, P., Herrman, H. E., The long-term outcomes and unmet needs of a cohort of former long-stay patients in Melbourne, Australia, Community Mental Health Journal, 47, 531–541, 2011 [PubMed: 20931282]Green 2002
Green, C. A., Vuckovic, N. H., Firemark, A. J., Adapting to psychiatric disability and needs for home- and community-based care, Mental Health Services Research, 4, 29–41, 2002 [PubMed: 12090304]Henwood 2015
Henwood, B. F., Derejko, K. S., Couture, J., Padgett, D. K., Maslow and mental health recovery: a comparative study of homeless programs for adults with serious mental illness, Administration and policy in mental health, 42, 220–228, 2015 [PMC free article: PMC4130906] [PubMed: 24518968]Hill 2010
Hill, A., Mayes, R., McConnell, D., Transition to independent accommodation for adults with schizophrenia, Psychiatric rehabilitation journal, 33, 228–231, 2010 [PubMed: 20061259]Humberstone 2002
Humberstone, V., The experiences of people with schizophrenia living in supported accomodation: A qualitative study using grounded theory methodology, Australian and New Zealand Journal of Psychiatry, 36, 367–372, 2002 [PubMed: 12060185]Lindstrom 2011
Lindstrom, M., Lindberg, M., Sjostrom, S., Home bittersweet home: the significance of home for occupational transformations, International Journal of Social PsychiatryInt J Soc Psychiatry, 57, 284–99, 2011 [PubMed: 20068023]Mancini 2013
Mancini, M. A., Wyrick-Waugh, W., Consumer and practitioner perceptions of the harm reduction approach in a community mental health setting, Community Mental Health Journal, 49, 14–24, 2013 [PubMed: 22009266]Padgett 2007
Padgett, D. K., There’s no place like (a) home: ontological security among persons with serious mental illness in the United States, Social Science & Medicine, 64, 1925–36, 2007 [PMC free article: PMC1934341] [PubMed: 17355900]Parker 2017
Parker, S., Dark, F., Newman, E., Hanley, D., McKinlay, W., Meurk, C., Consumers’ understanding and expectations of a community-based recovery-oriented mental health rehabilitation unit: a pragmatic grounded theory analysis, Epidemiology and Psychiatric Sciences, 1–10, 2017 [PMC free article: PMC6998963] [PubMed: 29199920]Petersen 2015
Petersen, Kirsten Schultz, Friis, Vivi Soegaard, Haxholm, Birthe Lodahl, Nielsen, Claus Vinther, Wind, Gitte, Recovery from mental illness: A service user perspective on facilitators and barriers, Community Mental Health Journal, 51, 1–13, 2015 [PubMed: 25344345]Piat 2018
Piat, M., Sabetti, J., Padgett, D., Supported housing for adults with psychiatric disabilities: How tenants confront the problem of loneliness, Health & social care in the community, 26, 191–198, 2018 [PubMed: 29052342]Piat 2017
Piat, M., Seida, K., Sabetti, J., Padgett, D., (Em)placing recovery: Sites of health and wellness for individuals with serious mental illness in supported housing, Health and Place, 47, 71–79, 2017 [PubMed: 28759807]Rambarran 2013
Rambarran, D. D., Relocating from out-of-area treatments: service users’ perspective, Journal of Psychiatric & Mental Health NursingJ Psychiatr Ment Health Nurs, 20, 696–704, 2013 [PubMed: 22957942]Roick 2006
Roick, C., Gartner, A., Heider, D., Dietrich, S., Angermeyer, M. C., Heavy use of psychiatric inpatient care from the perspective of the patients affected, International Journal of Social Psychiatry, 52, 432–446, 2006 [PubMed: 17278345]
Appendices
Appendix A. Review protocols
Review protocols for review question 6.1: What features of supported accommodation and housing promote successful community living in people with complex psychosis and related severe mental health conditions?
Appendix B. Literature search strategies
Literature search strategies for review question 6.1: What features of supported accommodation and housing promote successful community living in people with complex psychosis and related severe mental health conditions?
Databases: Embase/Medline/PsycINFO
Quantitative
Qualitative
Appendix C. Quantitative clinical and qualitative evidence study selection
Quantitative clinical study selection for 6.1: What features of supported accommodation and housing promote successful community living in people with complex psychosis and related severe mental health conditions?
Qualitative study selection for 6.1a: What features of supported accommodation and housing promote successful community living in people with complex psychosis and related severe mental health conditions?
Appendix D. Clinical evidence tables
Clinical evidence tables for review question 6.1: What features of supported accommodation and housing promote successful community living in people with complex psychosis and related severe mental health conditions?
Table 6. Quantitative evidence tables (PDF, 194K)
Clinical evidence tables for review question 6.1: What features of supported accommodation and housing promote successful community living in people with complex psychosis and related severe mental health conditions?
Table 7. Qualitative evidence tables (PDF, 455K)
Appendix E. Forest plots and Thematic map
Forest plots for review question 6.1: What features of supported accommodation and housing promote successful community living in people with complex psychosis and related severe mental health conditions?
Figure 13. Comparison 6: Supported housing versus residential care. Reduction in support needs
Figure 14. Comparison 7: Floating outreach versus supported housing. Reduction in support needs
Figure 15. Comparison 8: Floating outreach versus residential care. Reduction in support needs
Thematic map for qualitative review: 6.1 What features of supported accommodation and housing promote successful community living in people with complex psychosis and related severe mental health conditions?
Appendix F. GRADE CERQual tables
GRADE tables for review question 6.1: What features of supported accommodation and housing promote successful community living in people with complex psychosis and related severe mental health conditions?
Table 8. Comparison 1: Housing First versus Treatment as usual
Table 9. Comparison 2: Group housing versus independent apartments
Table 10. Comparison 3: Congregate Housing First versus Treatment as usual
Table 11. Comparison 4: Scattered Housing First versus Treatment as usual
Table 12. Comparison 5: Pathways to housing versus Treatment as usual
Table 13. Comparison 6: Supported housing versus residential care
Table 14. Comparison 7: Floating outreach versus supported housing
Table 15. Comparison 8: Floating outreach versus residential care
GRADE CERQual tables for review question 6.1a: What features of supported accommodation and housing promote successful community living in people with complex psychosis and related severe mental health conditions?
Table 16. Summary of evidence (GRADE-CERQual), Topic I. Meeting basic needs
Table 17. Summary of evidence (GRADE-CERQual), Topic II. A place to belong
Table 18. Summary of evidence (GRADE-CERQual), Topic III. Reaching their potential
Appendix G. Economic evidence study selection
Economic evidence study selection for review question 6.1: What features of supported accommodation and housing promote successful community living in people with complex psychosis and related severe mental health conditions?
A global health economic literature search was undertaken, covering all review questions in this guideline. However, as shown in Figure 17, no evidence was identified which was applicable to this review question.
Appendix H. Economic evidence tables
Economic evidence tables for review question 6.1: What features of supported accommodation and housing promote successful community living in people with complex psychosis and related severe mental health conditions?
No evidence was identified which was applicable to this review question.
Appendix I. Economic evidence profiles
Economic evidence profiles for review question 6.1: What features of supported accommodation and housing promote successful community living in people with complex psychosis and related severe mental health conditions?
No evidence was identified which was applicable to this review question.
Appendix J. Economic analysis
Economic evidence analysis for review question 6.1: What features of supported accommodation and housing promote successful community living in people with complex psychosis and related severe mental health conditions?
No economic analysis was conducted for this review question.
Appendix K. Excluded studies
Excluded clinical and economic studies for review question 6.1: What features of supported accommodation and housing promote successful community living in people with complex psychosis and related severe mental health conditions?
Clinical studies (quantitative)
Table 19. Excluded clinical studies and reasons for their exclusion (quantitative)
Clinical studies (qualitative)
Table 20. Excluded clinical studies and reasons for their exclusion (qualitative)
Economic studies
A global economic literature search was undertaken for this guideline, covering all 18 review questions. The table below is a list of excluded studies across the entire guideline and studies listed were not necessarily identified for this review question.
Table 21. Excluded studies from the economic component of the review
Appendix L. Research recommendations
Research recommendations for review question 6.1: What features of supported accommodation and housing promote successful community living in people with complex psychosis and related severe mental health conditions?
No research recommendations were made for this review question.
Appendix M. Quotes extracted from the qualitative papers
Qualitative papers for review question 6.1: What features of supported accommodation and housing promote successful community living in people with complex psychosis and related severe mental health conditions?
Final
Evidence review
This evidence review was developed by the National Guideline Alliance which is part of the Royal College of Obstetricians and Gynaecologists
Disclaimer: The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or service users. The recommendations in this guideline are not mandatory and the guideline does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.
Local commissioners and/or providers have a responsibility to enable the guideline to be applied when individual health professionals and their patients or service users wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with compliance with those duties.
NICE guidelines cover health and care in England. Decisions on how they apply in other UK countries are made by ministers in the Welsh Government, Scottish Government, and Northern Ireland Executive. All NICE guidance is subject to regular review and may be updated or withdrawn.
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