Housing First is an effective intervention for homeless individuals with mental illness & low intellectual functioning

What you need to know:

Historically, homeless people with mental illness and low intellectual functioning (IF) haven’t been considered good candidates for most housing programs. This study is the first to demonstrate that for homeless adults with mental illness, borderline or lower intellectual functioning did not significantly affect housing stability, either within Housing First, or other housing interventions. These findings highlight the need for wider consideration of homeless people with mental illness and low IF to be included in housing interventions, including Housing First.


Download the PDF version of the Research Snapshot here

What is this research about?

There is an overrepresentation of individuals with low intellectual functioning (IF) and other intellectual disabilities, around 12% - 37%, within the homeless population. The study compared the Housing First (HF) intervention to usual services in the community, referred to as the Treatment As Usual (TAU) group. More specifically, the study looked at whether or not housing stability differed for homeless individuals with mental illness and borderline or lower intellectual functioning (IF) compared to those with above borderline IF. Housing stability simply means the extent to which an individual can secure and maintain housing in the community.

What did the researchers do?

Researchers looked at housing stability for 172 individuals who have experienced homelessness and mental illness and participated in the At Home Chez Soi study. Participants were grouped by their level of support needs, borderline and lower IF or above-borderline IF, and were assessed over a 2 year period. Participants who received the HF intervention were given rent supplements to access housing of their choice and support via either an Assertive Community Treatment or Intensive Case Management Team, based on their need level. Participants in the control group—the TAU group were able to access other local services available in Toronto.

What did the researchers find?

Just as previous studies have indicated, the HF group had a higher percentage of housing stability over the two years follow-up period, compared to the TAU group. Additionally, the study  found that intellectual functioning didn’t have any influence on housing stability in either the HF and TAU groups. This means that housing and support interventions for homeless populations can be more inclusive of people with low intellectual functioning.

How can you use this research?

Service providers – including HF workers, homeless shelter workers, researchers, mental health workers, experts in the criminal justice field, and other interested professionals – would benefit from knowing about this research. The findings from this study suggest that housing programs that deliver services to homeless individuals can include those with mental illness and low IF.

Limitations and next steps

The Revised New Adult Reading Test (NART/NART-R) was used as a measure to identify level of IF in homeless individuals with mental illness. However, the NART and NART-R can only be used to assess literate, native English speakers. Thus, the sample group was not inclusive of the broader population of homeless individuals with low IF; this number is unknown. More research is needed to better understand the differences between homeless individuals with aboveborderline IF and homeless individuals with borderline and lower IF to better target appropriate interventions and increase access to housing and supports for these vulnerable groups.

About the researchers

Anna Durbin1,2,3
Yona Lunsky2,3,4
Ri Wang
Rosane Nisenbaum1,5
Stephen W. Hwang1,6
Patricia O’Campo1,5
Vicky Stergiopoulos1,2,4
1 Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Toronto
2 Department of Psychiatry, University of Toronto, Toronto
3 Institute for Clinical Evaluative Sciences, Toronto
4 Centre for Addiction and mental Health, Toronto
5 Dalla Lana School of Public Health, University of Toronto, Toronto
6 Division of General Internal Medicine, University of Toronto, Toronto


Intellectual disabilities, Housing First, homelessness, mental illness


This Research Snapshot is based on their article, “The Effect of Housing First on Housing Stability for People with mental Illness and Low Intellectual Functioning,” which was published in The
Canadian Journal of Psychiatry / La Revue Canadienne de Psychiatrie 2018. DOI: 10.1177/0706743718782940. This summary was written by Michelle Kim.

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