Exploring the Relationship between Housing and Medication in Supportive Housing Programs

Background: Housing is increasingly recognized as a health intervention for people experiencing homelessness and diagnosed with mental illnesses. With health care reform, states are pursuing strategies to redirect Medicaid funds into supportive housing programs. However, for many programs access to permanent housing is contingent on participation in treatment. This study explores the relationship between housing and medication from the perspective of case managers. 

Methods:  This NIMH-funded qualitative study interviewed 24 case managers working in a supportive housing program. Fifty-four in-depth, semi-structured interviews were conducted with case managers as their consumers entered housing, six months later, and at 12 months if the consumer remained in housing. Coding and thematic analyses explored case manager views of mental illness, medication and housing.

Results:  These themes emerged:  1) Part of the Program: most case managers viewed the program as treatment which necessitated taking medication 2) Monitoring and Persuasion:  a frequent task for case managers was ensuring consumers were adherent to medication and employing strategies to persuade “non-compliant” consumers to take medication 3) Difficult Consumers:  consumers perceived to lack insight into their mental illness were labeled difficult and likely to fail in the program

Discussion:  Case manager perspectives revealed that medication was still understood to be the primary intervention in these programs and moreover, housing was contingent on acceptance and treatment of mental illness with medication. This approach runs counter to the evidence that housing alone promotes wellness and the values of recovery that promote consumer choice and offering people a broad range of supports.