Key Takeaways

• In a 259-resident Santa Clara County cohort of people experiencing homelessness, remaining in permanent supportive housing (PSH) for 2 years was associated with significant improvements in quality of life, health satisfaction, mental health symptoms, PTSD symptoms, substance use, and social isolation.
• Older age, being male, and lower baseline mental health and PTSD symptoms were associated with a greater likelihood of remaining in PSH rather than moving to other stable non-PSH housing. Lower baseline mental health symptoms also predicted a greater likelihood of remaining in PSH rather than returning to homelessness.
• The effects of PSH on health outcomes were not significantly moderated by demographics. The authors concluded that while PSH shows promise for improving health outcomes and supporting housing retention, strategies are needed to improve mental health and substance use service delivery within PSH.

Longer-term residence in permanent supportive housing (PSH) was associated with improvements across multiple mental, physical, and social health outcomes among people experiencing homelessness in a study by Chang and colleagues that followed 259 residents in Santa Clara County, California, for 2 years. The analysis also examined factors associated with remaining in PSH compared with transitioning to other stable non-PSH housing or returning to homelessness, as well as whether demographic characteristics influenced health outcome changes over time.

PSH was described by the authors as a community-based housing model that provides stable housing alongside voluntary supportive services, including case management, healthcare, mental health care, and substance use treatment. Older age, being male, and lower baseline mental health and PTSD symptom burden were associated with a greater likelihood of remaining in PSH rather than moving to other stable non-PSH housing. Lower baseline mental health symptoms also predicted a greater likelihood of remaining in PSH rather than returning to homelessness.

Among residents who remained in PSH for 2 years, the authors reported significant improvements in quality of life, health satisfaction, mental health symptoms, PTSD symptoms, substance use, and social isolation. These improvements were not significantly moderated by demographic characteristics.

Overall, the authors concluded that the findings demonstrate the promise of PSH in supporting housing retention and improving residents' health outcomes, while highlighting the need for strategies to strengthen mental health and substance use service delivery within PSH.

Clinician Questions

What health outcomes were associated with 2 years in permanent supportive housing in the Santa Clara County cohort?

Among residents who remained in permanent supportive housing for 2 years, significant improvements were reported in quality of life, health satisfaction, mental health symptoms, PTSD symptoms, substance use, and social isolation.

Which baseline factors were linked to remaining in permanent supportive housing?

Older age, being male, and lower baseline mental health and PTSD symptoms were associated with a greater likelihood of remaining in permanent supportive housing rather than moving to other stable non-PSH housing. Lower baseline mental health symptoms also predicted a greater likelihood of remaining in permanent supportive housing rather than returning to homelessness.

Did demographic characteristics influence the health benefits associated with permanent supportive housing?

No. The authors reported that the effects of permanent supportive housing on health outcomes were not significantly moderated by demographic characteristics.