Is housing first effective for people with serious mental illness and co-occurring substance use issues?

Housing First is a housing approach that prioritizes permanent housing for people experiencing homelessness and frequently serious mental illness and substance use issues. Housing First is guided by the belief that people need basic necessities such as food, shelter, and clothing before they are able to attend to other issues such as employment, managing budgets and substance use issues. It is guided by client choice in participation in services with the idea that exercising that choice makes a client more successful in maintaining housing and reaching life goals. Supportive services including substance use counseling and treatment are part of the model, but abstinence or even engagement in services is not required.

As compared to treatment first programs, there is evidence that housing first clients are significantly less likely to use or abuse substances. They are less likely to drop out of services once engaged in treatment as well. This supports the idea that having basic needs met such as housing allows people to take control and have autonomy over other areas of their lives. Evidence also demonstrates that housing first is an effective solution to homelessness.

For a comparison on treatment first versus Housing First, see this article: Substance Use Outcomes Among Homeless Clients with Serious Mental Illness: Comparing Housing First with Treatment First Programs (author manuscript; Community Ment Health J, 2011)

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