SUPPORTIVE HOUSING:
The Most Effective and Integrated Housing for
People with Mental Disabilities 1
Introduction
People with mental disabilities can successfully live in the community like
everyone else, as envisioned by the Americans with Disabilities Act. Supportive
housing makes this possible. Supportive housing gives them their own apartment
or home while making available a wide variety of services to support recovery,
engagement in community life and successful tenancy.
A growing body of evidence confirms that supportive housing works for people
with mental disabilities, including those with the most severe impairments.
Indeed, these individuals may benefit the most from supportive housing.
Supportive housing gets much higher marks than less integrated alternatives;
research confirms that people with disabilities vastly prefer living in their own
apartment or home instead of in group homes or buildings housing primarily
people with disabilities. Moreover, supportive housing is less costly than other
forms of government-financed housing for people with disabilities. Studies have
shown that it leads to more housing stability, improvement in mental health
symptoms, reduced hospitalization and increased satisfaction with quality of life,
including for participants with significant impairments, when compared to other
types of housing for people with mental disabilities. 2 Supportive housing has
been endorsed by the federal government, including the U.S. Department of
Housing and Urban Development, 3 the Surgeon General, 4 the U.S. Department
of Health and Human Services 5 and the National Council on Disability. 6
The Basic Principles of Supportive Housing
Three basic principles guide supportive housing. 7 First, supportive housing gives
participants immediate, permanent housing in their own apartments or homes.
Unlike most other housing for people with disabilities, there is no limit on how
long the person can stay in the residence, and temporary absences do not lead
to disenrollment. Treatment compliance or sobriety is not a requirement for
receiving or remaining in housing. 8 Supportive housing participants have the
same rights and responsibilities as any other tenant. They may lose their unit, for

example, for disruptive behavior or drug use. Supportive housing staff, however,
try to avoid this situation by providing supports and the accommodations
necessary to help ensure successful tenancy.
Supportive housing provides housing first, allowing participants the opportunity to
focus on recovery next. Adequate, stable housing is a prerequisite for improved
functioning for people with mental disabilities and a powerful motivator for people
to seek and sustain treatment. 9 Studies find that providing immediate, permanent
housing leads to more long-term housing stability when compared to housing
conditioned on treatment. 10
Second, individuals in supportive housing have access to a comprehensive array
of services and supports, from crisis mental health services to cooking tutors. 11
Services are provided as needed to ensure successful tenancy and to support
the person’s recovery and engagement in community life. Services and supports
are provided in the home and other natural settings, allowing individuals to learn
and practice skills in the actual environment where they will be using them. 12
Services are available whenever people need them, including after working hours
and on weekends when necessary. Service providers are highly flexible and
supports are highly individualized. A creative “whatever it takes” approach is
pursued. No “program” attendance is required and services are increased,
tapered or discontinued as decided by the individual in consultation with the
provider. As a result, individuals “buy in” to the treatment plan—the most
important predictor of plan success. 13
Available services and supports include mental health and substance abuse
treatment and independent living services, including help in learning how to
maintain a home and manage money as well as training in the social skills
necessary to get along with others in the community. Medication management,
crisis intervention and case management are also available. Peer-support
services are especially effective in securing good results. 14 For individuals who
are unable to do certain tasks, such as cooking and cleaning on their own,
personal care and/or home-care services are provided until no longer needed.
Assertive Community Treatment (ACT) teams serve the clients with the greatest
challenges, including individuals with serious mental illnesses who have coexisting problems such as homelessness, substance abuse or involvement with
the judicial system. 15 ACT teams are interdisciplinary and mobile, typically
including a social worker, psychiatrist, substance abuse counselor, nurse,
vocational counselor and housing specialist. They develop individualized
treatment plans with their clients and provide services around-the-clock in
consumers’ homes and in the community. Among the services ACT teams may
provide are: case management, initial and ongoing assessment, psychiatric
services, rehabilitation services, employment and housing assistance, family
support and education, substance abuse services, and other supports critical to
an individual’s ability to live successfully in the community. ACT teams have
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been widely recognized as one of the most effective ways to provide services to
individuals with mental illnesses. They can be covered by Medicaid. 16
Third, supportive housing facilitates full integration into the community.
Individuals are encouraged to integrate into the community through employment,
volunteer work and social activities. People are encouraged to participate in
neighborhood activities or become members of community organizations of their
choosing. Vocational training, training in managing symptoms in the workplace
and conflict-management skills are available to those ready to seek employment.
Research has shown that employment can be critical to recovery; it helps
individuals with mental disabilities live autonomously, build meaningful personal
relationships, become integrated into society, improve self-esteem and learn to
control symptoms. 17 Moreover, unlike the case with traditional disability housing,
supportive housing participants do not live and interact only with other mental
health clients; nor are they in an identifiable mental health program. 18
Supportive Housing Works
Supportive housing is effective for various reasons. First, housing is a key aspect
of well-being and recovery. 19 People with mental disabilities cannot be expected
to succeed without a safe, secure home, particularly if they are struggling to
recover from a mental illness. 20 Moreover, stable housing can act as a motivator
for people to seek services and supports and to engage in and sustain
treatment. 21
Second, supportive housing is built around individuals’ preferences and
strengths. Client-driven planning provides an opportunity for individuals to gain
control over their lives and determine their own path of recovery. Supportive
housing participants are involved in the process of choosing their housing unit,
rather than unilaterally being placed in a residence. 22 The services offered are
highly flexible and individualized to meet the participant’s needs and preferences,
rather than defined by a “program.” Research shows that greater choice of
residence not only correlates positively with consumer satisfaction but also is a
significant predictor of housing stability. 23 It also establishes that consumer
choice and buy-in to service plans is a great predictor of success. A “good” plan
that is not accepted by a consumer is not likely to work. 24
Supportive housing takes advantage of the clear preferences of people with
mental disabilities about how they want to live. Studies show that consumers
prefer living in their own homes, either alone or with one or two roommates,
rather than in congregate settings with many other people with mental
disabilities, particularly when they receive supports to help them engage socially
in their own communities. 25 “They want to be able to choose, among other things,
the type of housing in which they live, the neighborhood, with whom they live (if
they choose not to live alone), what and when to eat, whether or not to

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participate in mental health services (and, if they want services, to choose the
ones they want) and how to schedule their days.” 26
Hence, it is no surprise that study after study has found that supportive housing
programs work for people with mental disabilities, even those who are hardest to
house, such as chronically homeless individuals with mental illnesses. 27
Research has shown that providing immediate, permanent housing leads to more
long-term housing stability when compared to traditional housing programs. 28
Other positive outcomes for supportive housing participants include reduced
hospitalization, decreased involvement with the criminal justice system,
participants’ greater satisfaction with their quality of life and improvement in
mental health symptoms. 29
Supportive Housing Reduces Costs
Supportive housing is less costly than other forms of government-financed
housing for people with disabilities. Even for clients with the greatest challenges,
quality supportive housing, including necessary community treatment and
support services, compares favorably with the cost of traditional mental health
housing and services. 30 Supportive housing also costs far less than other places
where people with mental disabilities end up: The cost of serving a person in
supportive housing is half the cost of a shelter, a quarter the cost of being in
prison and a tenth the cost of a state psychiatric hospital bed. 31 Moreover, most
of the cost of supportive housing can be funded through existing programs,
including Medicaid and federal housing and rental assistance programs. 32
Supportive housing reduces costs in several ways. It saves money by
utilizing apartments or houses available for rent on the market. Unlike other
housing for people with disabilities, such as group homes or buildings designated
exclusively for people with disabilities, supportive housing does not require
investment for new construction or purchase and rehabilitation. Moreover,
supportive housing’s use of scattered-site rental units avoids the delay and
expense of fighting neighborhood opposition to the siting of permanent housing
for people with disabilities, as often occurs. 33 In addition, supportive housing
saves money by reducing participants’ use of expensive resources, such as day
programs, shelters, inpatient psychiatric hospitals, public hospitals, and prisons
and jails, which can cost tens of thousands of dollars per person in a year. 34
Implications
Supportive housing should be the primary housing option available though
mental disability service systems. In most communities, this will require a
substantial shift, including replacing existing congregate settings with scatteredsite supportive housing. Public officials and stakeholders should work to ensure
that housing, when provided as a service, has the following characteristics:

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•
•
•
•
•

Housing units are scattered-site or scattered in a single building.
A wide array of flexible, individualized services and supports is available to
ensure successful tenancy and support participants’ recovery and
engagement in community life.
Services are delinked from housing. Participants are not required to use
services or supports to receive or keep their housing.
Participants have a say in choosing their housing unit, any roommates (if
they choose not to live alone) and which services and supports (if any)
they want to use.
Participants have the same rights and responsibilities as all other tenants.
They should be given any accommodations necessary to help ensure
successful tenancy.

To achieve this end, mental health systems must play an active role, both by
contracting with supportive housing providers and helping them secure rental
subsidies and by declining to finance or support the expansion of congregate
housing, including through building purchases.
Conclusion
Supportive housing is what people with disabilities want. It is the most integrated
type of housing and helps people with mental disabilities be a successful part of
the community—an opportunity to which they are entitled under the Americans
with Disabilities Act. Supportive housing programs are the most clinically and
cost-effective and offer the most integrated housing available for people with
mental disabilities. Public officials and stakeholders should push for supportive
housing and turn into reality the desire of people with mental disabilities to live in
the community like everyone else.

1

This paper was developed by the Bazelon Center for Mental Health Law under a grant to the University of
Pennsylvania from the Department of Education, NIDRR grant number H133B080029 (Salzer, PI). However,
the contents do not necessarily represent the policy of the Department of Education, and you should not
assume endorsement by the Federal Government.

2

See Rogers, Sally, et al., Systematic Review of Supported Housing Literature 1993-2008, The Center for
Psychiatric Rehabilitation, 2009.

3

U.S Dept. of Housing and Urban Dev. Office of Policy Dev. and Research. The Applicability of Housing
First Models to Homeless Persons with Serious Mental Illness. July 2007: 102-03. Available at
http://www.huduser.org/publications/homeless/hsgfirst.html.

4

U.S. Surgeon General. Mental Health: A Report of the Surgeon General. 1999: chapter 4. Available at
http://www.surgeongeneral.gov/library/mentalhealth/chapter4/sec6.html#human_services.

5

U.S. Dept. of Health and Human Services. Substance Abuse and Mental Health Services Admin.
Transforming Housing for People with Psychiatric Disabilities: Report. 2006.
6
National Council on Disability. Inclusive Livable Communities for People with Psychiatric Disabilities, 17
Mar. 2008: 17-26. Available at http://www.ncd.gov/newsroom/publications/index.htm.
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7

There is not consensus about the name for this service – some people use the term “supportive” housing
while others call it “supported” housing. Fidelity to the basic principles set out in this paper – not the
terminology – is what is important. In many communities, much of the housing that is called “supportive” or
“supported” does not follow these basic principles.
8

The strict admission criteria and program rules of traditional mental health housing often deny housing to
those most in need. Pathways to Housing, Inc. “Providing Housing First and Recovery Services for
Homeless Adults with Severe Mental Illness.” Psychiatric Services, 56.10 (2005): 1303.

9

Tsemberis, Sam, Leyla Gulcur, & Maria Nakae. “Housing First, Consumer Choice, and Harm Reduction for
Homeless Individuals With a Dual Diagnosis.” American Journal of Public Health, 94:4 (2004): 655.

10

Tsemberis, Sam & Ronda F. Eisenberg. “Pathways to Housing: Housing for Street-Dwelling Homeless
Individuals with Psychiatric Disabilities.” Psychiatric Services 51:4 (2000): 487; Burt, Martha R. & Jacquelyn
Anderson. “AB2034 Program Experiences in Housing Homeless People with Serious Mental Illness.” Corp.
for Supportive Housing. (2005): 3. Available at
http://www.csh.org/index.cfm/?fuseaction=Page.viewPage&pageID=3621.

11

In some communities, existing “supportive” or “supported” housing is of uneven quality because the full
array of necessary services and supports is not available.
12

Tsemberis. supra note 10, at 488.

13

Id. Nelson, Geoffrey, John Lord, & Joana Ochocka. Shifting the Paradigm in Community Mental Health:
Toward Empowerment and Community. Univ. of Toronto Press. 2001.
14

Surgeon General, supra note 4.

15

Some supportive housing providers have their own dedicated ACT teams, while other individuals in
supportive housing receive ACT services through the mental health system.
16

U.S. Dept. of Health and Human Services. Medicaid Support of Evidence-Based Practices in Mental
Health Programs. (2005): 6-7. Available at
http://www.cms.hhs.gov/PromisingPractices/HCBSPPR/itemdetail.asp?filterType=none&filterByDID=99&sortByDID=1&sortOrder=ascending&itemID=CMS030888&intNumPerPage=2000.
17

“Promoting Independence and Recovery through Work: Employment for People with Psychiatric
Disabilities.” Briefing Document for the National Governors Association, Center for Best Practice (NGA)
Webcast Transforming State Mental Health Systems: Promoting Independence and Recovery through Work:
Employment for People with Psychiatric Disabilities. 31 July 2007. Rogers, S.E., et al. “A Benefit-Cost
Analysis of a Supported Employment Model for Person with Psychiatric Disabilities.” Evaluation and
Program Planning (1995). Bond, G.R., et al. “Implementing Supported Employment as an Evidence-Based
Practice.” Psychiatric Services, Mar. (2001).
18

National Council on Disability, supra note 6, at 23.

19

Id.

20

Id.

21

Tsemberis, supra note 9, at 655.

22

The federal government has recognized the importance of consumer choice in housing and the role of
housing in promoting recovery. U.S. Substance Abuse and Mental Health Services Administration. Blueprint
for Change: Ending Chronic Homelessness for Persons with Serious Mental Illnesses and Co-Occurring
Substance Use Disorders. Rockville, MD: SAMHSA, 2003. Available at
http://mentalhealth.samhsa.gov/publications/allpubs/sma04-3870/Chapter6.asp#C6TocEvidence.
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23

Srebnik, Debra et al. “Housing Choice and Community Success for Individuals with Serious and Persistent
Mental Illness.” 31 Community Mental Health J. 31(1995): 139.
24

Tsemberis. supra note 9, at 651. Nelson, supra note 13, at 160.

25

Yeich, Susan et al. “The Case for a “Supported Housing” Approach: A Study of Consumer Housing and
Support Preferences” Psychosocial Rehabilitation J. 18.2 (1994): 75-77. Tanzman, Beth. “An Overview of
Surveys of Mental Health Consumers’ Preferences for Housing and Support Services.” Hosp. & Community
Psychiatry 44 (1993): 450-55. National Council on Disability, supra note 6, at 21.
26

National Council on Disability, supra note 6, at 22-23. This paper is not intended to imply that all people
with mental disabilities prefer supportive housing. Some do not. Individuals with disabilities should have
choices, like everyone else, about their living options.
27

Id. at 654-55. U.S Dept. of Housing and Urban Dev., supra note 3, at 80-104.

28

Tsemberis. supra note 9, at 654-55.

29

U.S Dept. of Housing and Urban Dev., supra note 3, at 82-84. Culhane, Dennis P. Culhane, Stephen
Metraux, & Trevor Hadley. "The Impact of Supportive Housing for Homeless People with Severe Mental
Illness on the Utilization of the Public Health, Corrections, and Emergency Shelter Systems: The New YorkNew York Initiative" Housing Policy Debate 13.1 (2002): 137-38. Available at:
http://works.bepress.com/metraux/16. National Council on Disability, supra note 6, at 23. U.S. Dept. of
Health and Human Services, supra note 5, at 25.
30

Based on a survey of costs in several states.

31

Houghton, Ted, The New York/New York Agreement Cost Study: The Impact of Supportive Housing on
Services Use for Homeless Mentally Ill Individuals, (May 2001) 6-7. Available at
http://www.csh.org/index.cfm/?fuseaction=Page.viewPage&pageID=3251.
32

These include the Section 8, Section 811, Home, Shelter Plus Care, and Hope VI programs. See
www.nationalhomeless.org/publications/facts/Federal.pdf
33

Id. at 4. U.S. Dept. of Justice. “Department Sues Florida County for Refusing to Allow the Operation of Six
Homes for Individuals with Mental Illness and a History of Substance Abuse.” Disability Rights Online News
Aug. 2006. Available at http://www.ada.gov/newsltr0806.htm. U.S. Dept. of Justice. “Department Intervenes
to Secure Site for Adults with Mental Illness.” Disability Rights Online News Feb. 2006. Available at
http://www.ada.gov/newsltr0206.htm.
34

See Culhane, supra note, at 135-41.

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