title: Life changes among homeless persons with mental illness: a longitudinal study of housing first and usual treatment.
abstract: OBJECTIVE
  This study compared the life changes of homeless people with mental illness participating in Housing First or treatment as usual and examined factors related to various changes.
  
  
  METHODS
  Semistructured narrative interviews were conducted with 219 participants in five Canadian cities at baseline; 197 were interviewed again at 18 months after random assignment to Housing First (N=119) or treatment as usual (N=78). Interviews were coded across 13 life domains, and each participant was categorized as reporting positive, mixed-neutral, or negative changes. Housing First and treatment as usual participants were compared with respect to change patterns. Thematic analysis was used to examine factors related to various changes.
  
  
  RESULTS
  The percentage of participants in Housing First reporting positive changes was more than double that for participants in treatment as usual, and treatment as usual participants were four times more likely than Housing First participants to report negative changes. Factors related to positive changes included having stable good-quality housing, increased control over substance use, positive relationships and social support, and valued social roles. Factors related to negative changes included precarious housing, negative social contacts, isolation, heavy substance use, and hopelessness. Factors related to mixed-neutral changes were similar to those for participants reporting negative changes but were less intense.
  
  
  CONCLUSIONS
  Housing First with intensive support was related to more positive changes among homeless adults with mental illness across five Canadian cities. Those with poor housing or support, more common in treatment as usual, continued to struggle. These findings are relevant for services and social change to benefit this population.
authors: Dr. Nelson, Dr. Macnaughton, and Mr. MacLeod are with the Department of Psychology, Wilfrid Laurier University, Waterloo, Ontario, Canada (e-mail: gnelson@wlu.ca). Dr. Patterson is with the Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada. Dr. Kirst is with the Institute of Health Policy, Management and Evaluation and Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada. Ms. Isaak is with the Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada. Dr. Nolin is with the Département d'Éducation, University of Moncton, Shippagan, New Brunswick, Canada. Dr. McAll is with the Département de Sociologie, Université de Montréal, Montréal, Quebec, Canada. Dr. Stergiopoulos is with the Department of Psychiatry, St. Michael's Hospital, University of Toronto, Toronto, Ontario. Dr. Townley is with the Department of Psychology, Portland State University, Portland, Oregon. Dr. Piat is with the Department of Psychiatry and the Department of Social Work, McGill University, Douglas Mental Health Institute, Montreal, Quebec. Dr. Goering is with the Department of Psychiatry, University of Toronto and the Centre for Addiction and Mental Health, Toronto, Ontario.
authors: Geoffrey
authors: G
authors: Nelson
authors: Dr. Nelson, Dr. Macnaughton, and Mr. MacLeod are with the Department of Psychology, Wilfrid Laurier University, Waterloo, Ontario, Canada (e-mail: gnelson@wlu.ca). Dr. Patterson is with the Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada. Dr. Kirst is with the Institute of Health Policy, Management and Evaluation and Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada. Ms. Isaak is with the Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada. Dr. Nolin is with the Département d'Éducation, University of Moncton, Shippagan, New Brunswick, Canada. Dr. McAll is with the Département de Sociologie, Université de Montréal, Montréal, Quebec, Canada. Dr. Stergiopoulos is with the Department of Psychiatry, St. Michael's Hospital, University of Toronto, Toronto, Ontario. Dr. Townley is with the Department of Psychology, Portland State University, Portland, Oregon. Dr. Piat is with the Department of Psychiatry and the Department of Social Work, McGill University, Douglas Mental Health Institute, Montreal, Quebec. Dr. Goering is with the Department of Psychiatry, University of Toronto and the Centre for Addiction and Mental Health, Toronto, Ontario.
authors: Michelle
authors: M
authors: Patterson
authors: Dr. Nelson, Dr. Macnaughton, and Mr. MacLeod are with the Department of Psychology, Wilfrid Laurier University, Waterloo, Ontario, Canada (e-mail: gnelson@wlu.ca). Dr. Patterson is with the Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada. Dr. Kirst is with the Institute of Health Policy, Management and Evaluation and Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada. Ms. Isaak is with the Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada. Dr. Nolin is with the Département d'Éducation, University of Moncton, Shippagan, New Brunswick, Canada. Dr. McAll is with the Département de Sociologie, Université de Montréal, Montréal, Quebec, Canada. Dr. Stergiopoulos is with the Department of Psychiatry, St. Michael's Hospital, University of Toronto, Toronto, Ontario. Dr. Townley is with the Department of Psychology, Portland State University, Portland, Oregon. Dr. Piat is with the Department of Psychiatry and the Department of Social Work, McGill University, Douglas Mental Health Institute, Montreal, Quebec. Dr. Goering is with the Department of Psychiatry, University of Toronto and the Centre for Addiction and Mental Health, Toronto, Ontario.
authors: Maritt
authors: M
authors: Kirst
authors: Dr. Nelson, Dr. Macnaughton, and Mr. MacLeod are with the Department of Psychology, Wilfrid Laurier University, Waterloo, Ontario, Canada (e-mail: gnelson@wlu.ca). Dr. Patterson is with the Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada. Dr. Kirst is with the Institute of Health Policy, Management and Evaluation and Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada. Ms. Isaak is with the Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada. Dr. Nolin is with the Département d'Éducation, University of Moncton, Shippagan, New Brunswick, Canada. Dr. McAll is with the Département de Sociologie, Université de Montréal, Montréal, Quebec, Canada. Dr. Stergiopoulos is with the Department of Psychiatry, St. Michael's Hospital, University of Toronto, Toronto, Ontario. Dr. Townley is with the Department of Psychology, Portland State University, Portland, Oregon. Dr. Piat is with the Department of Psychiatry and the Department of Social Work, McGill University, Douglas Mental Health Institute, Montreal, Quebec. Dr. Goering is with the Department of Psychiatry, University of Toronto and the Centre for Addiction and Mental Health, Toronto, Ontario.
authors: Eric
authors: E
authors: Macnaughton
authors: Dr. Nelson, Dr. Macnaughton, and Mr. MacLeod are with the Department of Psychology, Wilfrid Laurier University, Waterloo, Ontario, Canada (e-mail: gnelson@wlu.ca). Dr. Patterson is with the Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada. Dr. Kirst is with the Institute of Health Policy, Management and Evaluation and Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada. Ms. Isaak is with the Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada. Dr. Nolin is with the Département d'Éducation, University of Moncton, Shippagan, New Brunswick, Canada. Dr. McAll is with the Département de Sociologie, Université de Montréal, Montréal, Quebec, Canada. Dr. Stergiopoulos is with the Department of Psychiatry, St. Michael's Hospital, University of Toronto, Toronto, Ontario. Dr. Townley is with the Department of Psychology, Portland State University, Portland, Oregon. Dr. Piat is with the Department of Psychiatry and the Department of Social Work, McGill University, Douglas Mental Health Institute, Montreal, Quebec. Dr. Goering is with the Department of Psychiatry, University of Toronto and the Centre for Addiction and Mental Health, Toronto, Ontario.
authors: Corinne A
authors: CA
authors: Isaak
authors: Dr. Nelson, Dr. Macnaughton, and Mr. MacLeod are with the Department of Psychology, Wilfrid Laurier University, Waterloo, Ontario, Canada (e-mail: gnelson@wlu.ca). Dr. Patterson is with the Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada. Dr. Kirst is with the Institute of Health Policy, Management and Evaluation and Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada. Ms. Isaak is with the Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada. Dr. Nolin is with the Département d'Éducation, University of Moncton, Shippagan, New Brunswick, Canada. Dr. McAll is with the Département de Sociologie, Université de Montréal, Montréal, Quebec, Canada. Dr. Stergiopoulos is with the Department of Psychiatry, St. Michael's Hospital, University of Toronto, Toronto, Ontario. Dr. Townley is with the Department of Psychology, Portland State University, Portland, Oregon. Dr. Piat is with the Department of Psychiatry and the Department of Social Work, McGill University, Douglas Mental Health Institute, Montreal, Quebec. Dr. Goering is with the Department of Psychiatry, University of Toronto and the Centre for Addiction and Mental Health, Toronto, Ontario.
authors: Danielle
authors: D
authors: Nolin
authors: Dr. Nelson, Dr. Macnaughton, and Mr. MacLeod are with the Department of Psychology, Wilfrid Laurier University, Waterloo, Ontario, Canada (e-mail: gnelson@wlu.ca). Dr. Patterson is with the Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada. Dr. Kirst is with the Institute of Health Policy, Management and Evaluation and Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada. Ms. Isaak is with the Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada. Dr. Nolin is with the Département d'Éducation, University of Moncton, Shippagan, New Brunswick, Canada. Dr. McAll is with the Département de Sociologie, Université de Montréal, Montréal, Quebec, Canada. Dr. Stergiopoulos is with the Department of Psychiatry, St. Michael's Hospital, University of Toronto, Toronto, Ontario. Dr. Townley is with the Department of Psychology, Portland State University, Portland, Oregon. Dr. Piat is with the Department of Psychiatry and the Department of Social Work, McGill University, Douglas Mental Health Institute, Montreal, Quebec. Dr. Goering is with the Department of Psychiatry, University of Toronto and the Centre for Addiction and Mental Health, Toronto, Ontario.
authors: Christopher
authors: C
authors: McAll
authors: Dr. Nelson, Dr. Macnaughton, and Mr. MacLeod are with the Department of Psychology, Wilfrid Laurier University, Waterloo, Ontario, Canada (e-mail: gnelson@wlu.ca). Dr. Patterson is with the Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada. Dr. Kirst is with the Institute of Health Policy, Management and Evaluation and Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada. Ms. Isaak is with the Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada. Dr. Nolin is with the Département d'Éducation, University of Moncton, Shippagan, New Brunswick, Canada. Dr. McAll is with the Département de Sociologie, Université de Montréal, Montréal, Quebec, Canada. Dr. Stergiopoulos is with the Department of Psychiatry, St. Michael's Hospital, University of Toronto, Toronto, Ontario. Dr. Townley is with the Department of Psychology, Portland State University, Portland, Oregon. Dr. Piat is with the Department of Psychiatry and the Department of Social Work, McGill University, Douglas Mental Health Institute, Montreal, Quebec. Dr. Goering is with the Department of Psychiatry, University of Toronto and the Centre for Addiction and Mental Health, Toronto, Ontario.
authors: Vicky
authors: V
authors: Stergiopoulos
authors: Dr. Nelson, Dr. Macnaughton, and Mr. MacLeod are with the Department of Psychology, Wilfrid Laurier University, Waterloo, Ontario, Canada (e-mail: gnelson@wlu.ca). Dr. Patterson is with the Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada. Dr. Kirst is with the Institute of Health Policy, Management and Evaluation and Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada. Ms. Isaak is with the Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada. Dr. Nolin is with the Département d'Éducation, University of Moncton, Shippagan, New Brunswick, Canada. Dr. McAll is with the Département de Sociologie, Université de Montréal, Montréal, Quebec, Canada. Dr. Stergiopoulos is with the Department of Psychiatry, St. Michael's Hospital, University of Toronto, Toronto, Ontario. Dr. Townley is with the Department of Psychology, Portland State University, Portland, Oregon. Dr. Piat is with the Department of Psychiatry and the Department of Social Work, McGill University, Douglas Mental Health Institute, Montreal, Quebec. Dr. Goering is with the Department of Psychiatry, University of Toronto and the Centre for Addiction and Mental Health, Toronto, Ontario.
authors: Greg
authors: G
authors: Townley
authors: Dr. Nelson, Dr. Macnaughton, and Mr. MacLeod are with the Department of Psychology, Wilfrid Laurier University, Waterloo, Ontario, Canada (e-mail: gnelson@wlu.ca). Dr. Patterson is with the Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada. Dr. Kirst is with the Institute of Health Policy, Management and Evaluation and Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada. Ms. Isaak is with the Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada. Dr. Nolin is with the Département d'Éducation, University of Moncton, Shippagan, New Brunswick, Canada. Dr. McAll is with the Département de Sociologie, Université de Montréal, Montréal, Quebec, Canada. Dr. Stergiopoulos is with the Department of Psychiatry, St. Michael's Hospital, University of Toronto, Toronto, Ontario. Dr. Townley is with the Department of Psychology, Portland State University, Portland, Oregon. Dr. Piat is with the Department of Psychiatry and the Department of Social Work, McGill University, Douglas Mental Health Institute, Montreal, Quebec. Dr. Goering is with the Department of Psychiatry, University of Toronto and the Centre for Addiction and Mental Health, Toronto, Ontario.
authors: Timothy
authors: T
authors: MacLeod
authors: Dr. Nelson, Dr. Macnaughton, and Mr. MacLeod are with the Department of Psychology, Wilfrid Laurier University, Waterloo, Ontario, Canada (e-mail: gnelson@wlu.ca). Dr. Patterson is with the Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada. Dr. Kirst is with the Institute of Health Policy, Management and Evaluation and Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada. Ms. Isaak is with the Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada. Dr. Nolin is with the Département d'Éducation, University of Moncton, Shippagan, New Brunswick, Canada. Dr. McAll is with the Département de Sociologie, Université de Montréal, Montréal, Quebec, Canada. Dr. Stergiopoulos is with the Department of Psychiatry, St. Michael's Hospital, University of Toronto, Toronto, Ontario. Dr. Townley is with the Department of Psychology, Portland State University, Portland, Oregon. Dr. Piat is with the Department of Psychiatry and the Department of Social Work, McGill University, Douglas Mental Health Institute, Montreal, Quebec. Dr. Goering is with the Department of Psychiatry, University of Toronto and the Centre for Addiction and Mental Health, Toronto, Ontario.
authors: Myra
authors: M
authors: Piat
authors: Dr. Nelson, Dr. Macnaughton, and Mr. MacLeod are with the Department of Psychology, Wilfrid Laurier University, Waterloo, Ontario, Canada (e-mail: gnelson@wlu.ca). Dr. Patterson is with the Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada. Dr. Kirst is with the Institute of Health Policy, Management and Evaluation and Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada. Ms. Isaak is with the Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada. Dr. Nolin is with the Département d'Éducation, University of Moncton, Shippagan, New Brunswick, Canada. Dr. McAll is with the Département de Sociologie, Université de Montréal, Montréal, Quebec, Canada. Dr. Stergiopoulos is with the Department of Psychiatry, St. Michael's Hospital, University of Toronto, Toronto, Ontario. Dr. Townley is with the Department of Psychology, Portland State University, Portland, Oregon. Dr. Piat is with the Department of Psychiatry and the Department of Social Work, McGill University, Douglas Mental Health Institute, Montreal, Quebec. Dr. Goering is with the Department of Psychiatry, University of Toronto and the Centre for Addiction and Mental Health, Toronto, Ontario.
authors: Paula N
authors: PN
authors: Goering
mesh_terms: D000328:Adult; D002170:Canada; D005260:Female; D006703:Ill-Housed Persons / Q000523:psychology*; D006798:Housing; D006801:Humans; D008016:Life Change Events; D008137:Longitudinal Studies; D008297:Male; D001523:Mental Disorders / Q000523:psychology / Q000534:rehabilitation*; D008875:Middle Aged; D036301:Qualitative Research; D011897:Random Allocation; D012934:Social Isolation; D012944:Social Support; D019966:Substance-Related Disorders / Q000523:psychology / Q000534:rehabilitation*; D016896:Treatment Outcome