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Home arrow Language & Literature arrow The open door : homelessness and severe mental illness in the era of community treatment


Despite having similarities, there are many differences, both subtle and obvious, in how supportive housing programs across the country are defined and operationalized. Areas in which they differ are fourfold: housing first or housing readiness, whether the housing environment is "high demand” or "low demand,” the intensity of supportive services, and whether the duration of housing is temporary or permanent.

Admission Criteria: Housing First or Housing Readiness

In the decade following the funding of the McKinney-Vento Homeless Assistance Act, it was common practice to encourage people with psychiatric disabilities to progress from homelessness to permanent housing through a series of step-by-step residential programs, from transitional housing to various types of supervised community residences and apartments, until they had demonstrated several months of sobriety, had mastered basic living skills and personal self-care, and were motivated to adhere to mental health treatment (Caton et al., 2007). Unfortunately, a limitation of this approach is that many chronically homeless people were not able or willing to meet these demands (Barrow et al., 2004; Kertesz et al., 2006). Alternatively, the housing-first approach places people directly into permanent housing without preconditions or the stipulation that they be engaged in mental health treatment prior to receipt of housing (Tsemberis, 1999). The housing-first approach has grown in popularity and has influenced the operation of both single-site and scatter-site permanent supportive housing programs (Burt & Anderson, 2005; Clifasefi et al., 2013). There remains, however, considerable variability in the admission criteria and procedures for many supportive housing programs.

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