Housing First for Those With Chronic Mental Illness

To the Editor: I commend Sandra Newman, Ph.D. and Howard Goldman, M.D., Ph.D. (1) for their thoughtful commentary published in the October 2008 issue of the Journal . Drs. Newman and Goldman helpfully formulated the primary issues concerning housing provisions for individuals with chronic mental illness: availability, access, and stability. The authors also provided a review of some of the relevant literature and recommended an expansion of relevant research.

However, I would suggest a revision to the statistic, as reported in the commentary, that there are “870,000 homeless persons with mental illness over the course of a year” ( 1 , p. 1245), which was based on a national estimate, reported by Burt and Aron (2) , of 2.3 to 3.5 million homeless individuals per year overall. Data reported in an article by Malcolm Gladwell (3) suggest that only 10% of the homeless population at any given time is chronically homeless and that the remainder of this population is merely transient, and thus 80% of individuals in this population are homeless only once in their lifetimes and another 10% are homeless episodically for brief periods. Therefore, our public policy agenda should possibly consider providing housing for this fractional group.

In summary, reducing this target population to a manageable size is obviously critical to policy formulation. Providing appropriate housing and support services (perhaps through assertive community treatment teams if the research Drs. Newman and Goldman support is consistent with this modality) will be critical if the assurance of independent life in the community, promised under deinstitutionalization decades ago, is to be realized.