Quality of life after housing first for adults with serious mental illness who have experienced chronic homelessness Benjamin F. Henwood a,n , Jason Matejkowski b , Ana Stefancic c , Jonathan M. Lukens d a University of Southern California, School of Social Work, 1150S. Olive Street, #1429, Los Angeles, CA 90015-2211, USA b University of Kansas, School of Social Work, Lawrence, KS, USA c Pathways to Housing Inc., New York, NY, USA d Salem State University, School of Social Work, Salem, MA, USA article info Article history: Received 11 October 2013 Received in revised form 24 July 2014 Accepted 28 July 2014 Available online 1 August 2014 Keywords: Life satisfaction Supportive housing Community integration abstract This 1-year longitudinal study of adults who have recently transitioned from homelessness to Permanent Supportive Housing (PSH) focuses on quality of life as a primary outcome of interest. Eighty of 103 new tenants participated in structured interviews at the time of entry into their new home and at 12-months post-housing. t-tests assessed differences in community participation and quality of life measures at the 2 time points. Mixed effects models examined the impact of community participation on quality of life. Results show that time in independent housing was significantly associated with several domains of quality of life. Symptom severity was also significantly and negatively related to quality of life domains. Community participation was significantly related to frequency of social contacts only. These findings suggest that community participation is not critical to improving quality of life, and that despite concerns that individuals may feel isolated and lonely when living independently, satisfaction with one's living situation and family relationships nevertheless improves with housing tenure. & 2014 Elsevier Ireland Ltd. All rights reserved. 1. Introduction Permanent Supportive Housing (PSH) through a housing first (HF) approach has been recognized as the “clear solution” to chronic homelessness (U.S. Interagency Council on Homelessness, 2010), which is disproportionately experienced by adults with serious mental illness (Link et al., 1994). A HF approach refers to immediate access to affordable, permanent housing that is accompanied by supportive health and social services and has been credited for the decreased number of chronically homeless persons documented since 2006 (U.S Department of Housing and Urban Development, 2010, 2013). HF embraces a harm reduction philosophy and stands in contrast to traditional approaches that typically require adherence to treatment and abstinance from substances before granting access to permanent housing options (Tsemberis et al., 2004). In addition to being effective at ending homelessness (Tsemberis et al., 2004; Pearson et al., 2009) and consistent with basic human rights (United Nations, 1976), studies have found that HF is cost-effective when targeting people with complex health and social needs (Culhane et al., 2002; Culhane, 2008). Transitioning to permanent housing provides tenants a fresh start that they largely regard as positive at the outset particularly given a poor quality of life experienced while homeless (Henwood et al., 2013). Whether quality of life continues to improve once one's basic need for shelter and health services has been addressed has not been widely reported on in the literature (Tsemberis, 2010; Tsai et al., 2012b). New challenges that tenants experience specifically around how to organize day-to-day life can make improved quality of life difficult (Padgett, 2007). Employ- ment, for example, provides structure to life and is highly valued, but employment rates among individuals with psychiatric disabil- ities remain extremely low at about 15% (Mueser et al., 2011; Twamley et al., 2003), which negatively impacts quality of life (Marwaha and Johnson, 2004; Rüesch et al., 2004). Positive social relationships can also occupy one's focus and lead to improved quality of life yet formerly homeless tenants living in PSH often have depleted social networks (Hawkins and Abrams, 2007). High rates of co-occurring psychiatric and substance use disorder also present obstacles for improved quality of life (Xie et al., 2006). Nevertheless, results from a recent randomized control trial show that quality of life significantly improves when entering HF as compared to usual care over the course of a year, with the majority of change occurring within the first 6 months (Patterson et al., 2013). A broader focus on community integration among individuals with serious mental illness living in PSH has often overshadowed basic questions about life satisfaction and quality of life (Mandiberg, 2012; Tsai et al., 2012a). Given limited employment Contents lists available at ScienceDirect journal homepage: www.elsevier.com/locate/psychres Psychiatry Research http://dx.doi.org/10.1016/j.psychres.2014.07.072 0165-1781/& 2014 Elsevier Ireland Ltd. All rights reserved. n Corresponding author. Tel.: þ1 213 821 6449. E-mail address: bhenwood@usc.edu (B.F. Henwood). Psychiatry Research 220 (2014) 549–555