Permanent supportive housing: A safe space for mental health recovery and healing

In the decades since deinstitutionalisation and the closing down of mental hospitals in many Western nations, the goal of community integration became paramount in the treatment of persons with serious mental illnesses (SMI) such as schizophrenia and bipolar disorder. Unfortunately, inadequate outpatient treatment facilities combined with a looming housing affordability crisis in the 1970s to set the stage for widespread homelessness among individuals with SMI in the US and other nations. In response, permanent supportive housing (PSH) came to occupy an important place in the array of services for persons experiencing homelessness and needing medical or mental health services. The combination of having a stable place to live and access to needed services - most often intended for persons with a serious mental illness - is a defining characteristic of PSH. The historic expanse of PSH, as necessitated by the homelessness ‘epidemic’ beginning in the 1980s, included an emancipatory version - Housing First (HF) - that supports consumer empowerment, voluntary services including harm reduction, and scatter-site non-institutional living. The success of HF underscores the salience of ‘ontological security’, i.e., inhabiting a space that is private, safe and secure for recovery and enhanced community integration. However, the availability of PSH is limited to only one-third of eligible participants and research has yet to unequivocally demonstrate benefits of PSH beyond housing stability. The rise of disability rights and person-centered care signified by Housing First offers a more humane and empowering approach to working with unhoused individuals.