To the Editor: In their commentary, Drs. Newman and Goldman provided an excellent introduction to suggested policy strategies regarding homeless persons with severe mental illness. The authors placed special emphasis on addressing housing issues prior to addressing issues associated with mental illness, offering appropriate access to housing for individuals with mental illness and supportive services for people with serious and persistent mental illness who have obtained housing.
Some additional points can be made regarding this topic. First, Drs. Newman and Goldman asserted that previous research suggests that individuals with mental illness function better in settings with fewer occupants and with a greater proportion of people with mental illness. However, they did not discuss the role of consumer choice in improved social functioning outcomes. There is a wide body of research (including research previously conducted by Drs. Newman and Goldman) that supports the consumer preference model, which focuses on permanent supportive housing, a desire to live independently, and a disregard for segregated settings (1–3). Therefore, it deserves mentioning that a more important role in housing policy may be to ensure that consumers have a part in the selection process of appropriate housing settings.
Drs. Newman and Goldman discussed the association between case management models and increased housing stability, and they commented on the lack of research insight into combining case management with housing arrangements. However, Clark and Rich (4) examined the effectiveness of comprehensive combined housing and case management services relative to case management alone and found improved outcomes for individuals with increased severity of symptoms. Drs. Newman and Goldman correctly highlighted the need for more rigorous studies in this area.
The improved care and treatment for individuals with severe and persistent mental illness remain a significant concern, and addressing homelessness is an integral part of this issue. I appreciate Drs. Newman and Goldman bringing renewed attention to this important topic.
O’Hara A: Housing for people with mental illness: update of a report to the President’s New Freedom Commission. Psychiatr Serv 2007; 58:907–9132.Tanzman B: An overview of surveys of mental health consumers’ preferences for housing and support services. Hosp Community Psychiatry 1993; 44:450–4553.
Newman S: Housing attributes and serious mental illness: implication for research and practice. Psychiatr Serv 2001; 52:1309–13174.
Clark C, Rich A: Outcomes of homeless adults with mental illness in a housing program and in case management only. Psychiatr Serv 2003; 54:78–83
The author reports no competing interests.
This letter (doi: 10.1176/appi.ajp.2008.08111617) was accepted for publication in November 2008.