What you need to know
Permanent supportive housing (PSH) provides an affordable and safe place to live for people experiencing mental health or addiction challenges and/or those who are homeless. However, these individuals can have high-risk behaviours and challenges that can put their housing stability at risk. Research has not looked closely at the relationship between high-risk behaviours and housing stability in people living in supportive housing. This paper presents the findings of an analysis of 32 studies, looking at how high-risk behaviours and challenges impact the housing stability of PSH residents. It also presents strategies that agencies and residents use to prevent high-risk issues from occurring in PSH.
What is this research about?
This research dives into how we can best support individuals in permanent supportive housing. Some residents may exhibit behaviours that can jeopardize their housing stability. These behaviours are considered high-risk, as they can lead to serious harm to the individual, to others and to the property. By understanding and addressing high-risk behaviours, PSH staff can help create safer and more supportive housing settings.
The research aimed to answer the following questions:
- How do high-risk behaviours and challenges affect people’s ability to stay in permanent supportive housing?
- What methods are used and what difficulties are faced when trying to handle risky behaviours and challenges in permanent supportive housing programs?
What did the researchers do?
The researchers conducted a rapid review, which is a fast and systematic way to gather research information that can be easily shared with people who make decisions. The researchers selected articles and reports that looked at two types of high-risk behaviours and challenges:
- those that put individuals in danger (like overdoses or suicide attempts) and
- those that could harm multiple people or buildings (such as fire-setting or violent behaviour).
The researchers looked at academic journals and searched non-traditional online sources published between 1992 and 2022. Thirty-two articles were included in the review.
What did the researchers find?
Few studies have looked at the impacts of high-risk behaviours and challenges on housing stability in PSH. However, overdose was a concerning cause of death identified in two studies that needs to be addressed in PSH programs.
The researchers also identified eight types of approaches that PSH staff used to handle risky behaviours and challenges: clinical, relational/educational, surveillant, restrictive, strategic, design-based, legal, and self-defence. Below are examples of high-risk behaviours and challenges that could occur in PSH, along with organizational or support approaches that have been described in past research. More examples are included in the published journal article.
- Violence, aggression and interpersonal threats or abuse
- Restrictive: not allowing people with histories of violence to reside in PSH
- Design-based: having buildings only for women
- Restrictive and surveillant: using security cameras and allowing only one guest per resident at a time
- Clinical: completing assessments with people who want to live in PSH and making safety plans
- Prevention of falls
- Clinical: having experts check homes for safety risks during support visits
- Surveillant: keeping a close eye on intoxicated residents at-risk of falls
- Restrictive: limiting access to alcohol
- Apartment takeover and trespassing
- Relational/educational: direct actions, such as talking to and removing uninvited guests, or indirectly, by supporting residents to set boundaries
- Strategic: using above ground-floor apartments
- Surveillant: having patrols circulate buildings
- Restrictive: setting clear occupancy rules
- Overdose
- Clinical: having safe spaces where people can use drugs with supervision, prescribing opioid medications or providing naloxone kits
- Design-based: installing overdose response buttons in units
- Preventing fires
- Design-based: having fire alarms and technology that turns off stoves automatically
- Surveillant and restrictive: taking measures to promote fire safety, such as staff check-ins, but being mindful about how this is experienced for some residents
- Suicide risk
- Clinical: using the MINI Suicidality Subscale as a risk prediction measure
- Managing drug selling and availability
- Surveillant: using security cameras
- Property damage
- Relational/educational: speaking up for tenants when landlords become involved
- Surveillant: having PSH staff visit homes more often
- Hoarding
- Clinical: adding a hoarding specialist to the support team
The authors note that using strict rules or constant monitoring might go against the principles of some PSH programs. It’s crucial to involve PSH residents in creating risk management plans that enhance safety without compromising program values and goals.
Limitations of the research
The authors point out the articles they reviewed only focused on critical events and serious behaviours, excluding studies on additional interventions in PSH that could have implications for preventing high-risk behaviours and challenges. They limited their search for online sources to well-known organizations, potentially missing valuable insights from less prominent sources. These omitted sources might have offered additional approaches that could prove beneficial. The authors also noted that while they clustered a range of high-risk behaviours together, some may carry a higher level of risk than others. They also pointed out that they did not assess the articles’ risk of bias, which could impact the overall reliability and validity of this research.
How can you use this research?
This research identifies key priorities for future practice and policy, focusing on effective approaches for handling high-risk behaviours and challenges in PSH. The study calls for an exploration of foundational training competencies necessary for risk management in PSH settings. It raises questions about the effectiveness of current risk management approaches for addressing high-risk behaviours and challenges in PSH.
About the researchers
Nick Kerman, Ph.D. (1); Sean Kidd, Ph. D. (1); Christina Mutschler, Ph.D. (2); John Sylvestre, Ph.D. (2); Benjamin F. Henwood, Ph.D. (3); Abe Oudshoorn, Ph.D. (4); Carrie A. Marshall, Ph.D. (5); Tim Aubry, Ph.D. (2); Vicky Stergiopoulous, M.D. (1)
- Centre for Addiction and Mental Health, Toronto (Ontario), Canada
- School of Psychology, University of Ottawa (Ontario), Canada
- Suzanne-Dworak-Peck School of Social Work, University of Southern California, Los Angeles (California), United States
- Arthur Labatt Family School of Nursing, Western University, London (Ontario), Canada
- School of Occupational Therapy, Western University, London (Ontario), Canada