Permanent supportive housing

In the homelessness context, permanent supportive housing (PSH), sometimes called supported housing, links subsidized housing with access to flexible, voluntary supportive services to help people with disabilities maintain stable housing and live productively in the community. PSH is generally targeted to people who are chronically homeless (disabled and homeless for long periods of time or repeatedly) or highly vulnerable because of chronic disabilities. It is intended to end their homelessness and improve well-being by ensuring they are stably housed.

PSH has been shown to be an effective intervention for people who have multiple barriers to finding and maintaining stable housing. As the concept of PSH has evolved, increasing emphasis has been placed on ensuring that it targets the highest need people, maintains low barriers to entry, and provides the same tenancy rights that any rental housing tenants would have (that is, eviction would be based on violation of the lease, and not on compliance with any program or service requirement). In some states, PSH for homeless people has played an important role in addressing the Supreme Court’s decision in the Olmstead case, which requires that people with certain disabilities be able to access the services they need while living in the community (as opposed to in an institution).

Permanent supportive housing may be single site (an entire building devoted to PSH), integrated site (a percentage of the units in a building dedicated to PSH), or scattered site (tenants lease individual units in the community)[1].  The approach to services provided in PSH may vary from on-site case coordination or management that ensures tenants’ access to a wide variety of services, to on-site location of those services.  These services are available on a flexible and voluntary basis and may change over time as tenants’ needs change. Services typically address the following: mental health, substance and alcohol use, health, independent living skills, employment, peer support, and community involvement and support.[2]

Medicaid is an important source of funding for the services provided to PSH residents. When appropriately targeted to individuals and families with high needs such as those who meet the definition of chronic homelessness or have serious and long-term disabilities or chronic health conditions, PSH has been shown to be successful in promoting housing stability[3] and also can be cost-effective. In some cases, PSH yielded significant savings in other systems such as hospital emergency services, sobering centers, and jails.[4]

Gretchen Locke has led several evaluations of PSH and is working on an up-to-date synthesis of the evidence that will be available on this website soon.

[1] Supportive Housing. Corporation for Supportive Housing.

[2] Supportive Services. Corporation for Supportive Housing.

[3] Aubry, Tim, Geoffrey Nelson, and Sam Tsemberis. Housing First for People with Severe Mental Illness Who are Homeless: A Review of the Research and Findings from the At Home-Chez Soi Demonstration Project. Can J Pscyhiatry 2015; 60: 467-474.

[4] Culhane, Dennis P., Stephen Metraux, and Trevor R. 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 York-New York Initiative. Housing Policy Debate, 2002; 13(1), 107-163; Larimer, Mary E., et al. Health Care and Public Service Use and Costs Before and After Provision of Housing for Chronically Homeless Persons with Severe Alcohol Problems. Journal of the American Medical Association. 2009; 301(13): 1349-1357.