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Study Examines Effect of Housing Vouchers on Homeless Veterans with Mental Illness


BACKGROUND:
As treatment of homeless adults with mental illness has shifted to community-based approaches, attention to housing has become central to rehabilitation and recovery. Beginning in 1986, homeless adults were offered rental subsidies in the form of housing vouchers made available through federal funds. The Housing and Urban Development-Veterans Affairs Supportive Housing (HUD-VASH) program is similar and was created for homeless Veterans with mental illness. This study examined how homeless Veterans with mental illness obtain housing without a voucher, and whether greater employment earnings or better clinical outcomes were associated with such housing success. Data were obtained from a three-year prospective experimental study of HUD-VASH and included 419 homeless Veterans who had received a diagnosis of a major psychiatric or substance use disorder. Investigators conducted a secondary analysis of the data to examine housing status at the time of the original 3-month follow-up interview. Veterans were classified into four groups: 1) independently housed without a voucher (n=96), 2) independently housed with a voucher (n=93), 3) housed in another individual’s place (n=60), and 4) not yet housed (i.e., living in institution, homeless; n=170). Investigators also assessed socio-demographics and quality of life.

FINDINGS:

  • Veterans who obtained independent housing without a voucher worked more days and had higher employment income than those with a voucher, but they were less satisfied with their housing.
  • Veterans who used vouchers lived in housing with the highest rent, but paid less of their own income toward rent because of their vouchers. They also reported the highest quality of life with respect to their living situation, higher satisfaction with their housing, and higher safety scores.
  • Veterans who were ‘not yet housed’ had lower scores on quality of life related to family, leisure, life satisfaction, and living situation than all other groups.
  • About one-third of Veterans who obtained independent housing without a voucher lived with others, most often with a family member, and reported lower total rent costs, but paid the greatest share of the rent themselves.
  • Approximately 80% of participants were diagnosed with alcohol or drug dependency. There were no differences in psychiatric, substance abuse, or legal outcomes between groups at three months; however, data over all three years shows that Veterans who were not housed had higher psychiatric, substance abuse, and work problems over time than all other groups.

LIMITATIONS:

  • This study was observational and could not determine causality. Relevant baseline differences may have existed that were not measured and therefore were not included in the analyses.
  • The association among specific psychiatric disorders, housing, and outcome were not evaluated.
  • In 2008, the HUD-VASH program began providing vouchers for families, but related outcomes have not been studied.

AUTHOR/FUNDING INFORMATION:
Drs. Tsai and Rosenheck are part of VA’s New England Mental Illness Research, Education, and Clinical Center, HSR&D’s Pain Research, Informatics, Medical Comorbidities, and Education Center, and the VA National Center on Homelessness among Veterans. Dr. Kasprow is part of VA’s Northeast Program Evaluation Center.


Tsai J, Kasprow W, and Rosenheck R. Exiting Homelessness without a Housing Voucher: A Comparison of Independently Housed and other Homeless Veterans. Psychological Services 2011 May;8(2):114-122.

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What are HSR&D Publication Briefs?

HSR&D requires notification by HSR&D-funded investigators about all articles accepted for publication. These journal articles are reviewed by HSR&D and publication briefs or summaries are written for a select number of articles that are then forwarded to VHA Central Office leadership to keep them informed about important findings or information. Articles to be summarized are selected by HSR&D based on timeliness of the findings, interest of leadership, or potential impact on the organization. Publication briefs are written for only a small number of HSR&D published articles. Visit the HSR&D citations database for a complete listing of HSR&D articles and presentations.