The Impact of Neighbourhood Characteristics and Support on Well-being, Housing Satisfaction, and Residential Stability for People with a Mental Illness.

The global burden of disease attributable to mental illness is high, and as a result people with serious mental illness are at greater risk of indicators of social exclusion, such as poverty, homelessness and social isolation. Since deinstitutionalisation began in the 1960s, a variety of housing and support models have been used for this group. „Housing first‟ models are proving superior to „continuum of care‟ models in achieving positive housing outcomes and improving indicators of social exclusion. Housing first programmes are also believed to be more effective as they offer consumers choice, are not contingent on treatment, and are, therefore, empowering and philosophically compatible with harm reduction and recovery approaches. The physical and social environments have also been found to influence housing satisfaction and well-being outcomes for this group, but are often poorly measured or inadequately defined in the few studies which have been conducted. As little recent New Zealand research has examined housing, support and environmental effects for people with serious mental illness, this twelve-month prospective cohort study provides a more current account of the experiences of this group. Thirty six participants were recruited from a group of people with serious mental illness referred to the Comcare Housing Service for assistance to obtain independent, community-based housing. An examination of the variables influencing housing and overall well-being ratings was conducted. Peace and Kell's (2001) sustainability framework, outlining four categories of resources required for this group to maintain housing, was also evaluated. The results demonstrate the success of housing support in improving outcomes for people with serious mental illness, particularly in terms of improved housing quality and satisfaction, and residential stability. They also provide further evidence that this group have high rates of homelessness and are frequently in situations where they are at risk of homelessness. The physical environment appeared to have little influence on housing satisfaction or other well-being measures, however, the social environment seemed to play a role in higher ratings on these outcomes. Participants rehoused by Comcare Housing reported higher housing satisfaction and fewer housing problems, indicating that the service was providing effective housing support. Peace and Kell‟s framework is a good model for conceptualising housing for this group, although environmental and neighbourhood effects need to be included in the model in order for it to have international applicability. The omission of those at risk of homelessness from the New Zealand definition is a serious concern and has policy implications as support to address housing issues for this group may be neglected due to their invisibility in the statistics