Housing attributes and serious mental illness: Implications for research and practice

Objectives: This paper critically reviews studies of the relationship between housing attributes and serious mental illness, highlights important gaps in the research, generates hypotheses to be tested, and suggests a research agenda. Methods: Studies published between 1975 and March 2000 were identified through computerized searches, previous literature reviews, and consultation with mental health and housing researchers. Criteria for inclusion included the presentation of quantitative evidence, a systematic sample of known generalizability, and systematic analytic techniques. Results and conclusions: The 32 studies that met these criteria relied on one or more of three conceptualizations of the role of housing: housing attributes or assessments as an outcome or dependent variable; housing attributes as inputs or independent variables in a model in which the outcome pertains to a nonhousing factor, such as a mental health outcome; or housing as both an input and an outcome. Three studies found no long-term effect of improved housing adequacy on housing satisfaction above and beyond case management. Three studies found better outcomes for settings that have fewer occupants. Another study suggested that persons who live in small-scale, good-quality, noninstitutional environments are less likely to engage in disruptive behavior when a larger proportion of other tenants also have serious mental illness. The strongest finding from the literature on housing as an input and an outcome was that living in independent housing was associated with greater satisfaction with housing and neighborhood. Most of the studies had methodological weaknesses, and few addressed key hypotheses. There is a critical need for a coherent agenda built around key hypotheses and for a uniform set of measures of housing an input and an outcome.