Impact of supported housing on neuropsychological functioning of individuals experiencing homelessness and mental illness

To date, a limited number of studies have assessed the impact of a supported housing on neuropsychological functioning of individuals experiencing homelessness and mental illness. This study uses a randomized controlled design to examine the effects of scattered site Housing First on neurocognitive outcomes in this population. A total of 902 participants enrolled in the At Home/Chez Soi study completed neuropsychological testing at 6 and 24 months after random assignment to Housing First or treatment as usual. The neuropsychological battery included measures of verbal learning and memory, processing speed, and cognitive flexibility. Multivariate regression models were used to compare study arms with respect to change in neurocognitive outcomes over time and to identify baseline demographic, clinical or homelessness variables associated with observed changes in these domains.  At 24 months, participants in both the Housing First intervention and the treatment as usual group continued to experience significant global cognitive impairment.  No differences in any of the neurocognitive outcome measures were observed between the study arms at 24 months.  Improvements in neurocognitive functioning were associated with a younger age, female gender, attaining at least a high school education, Caucasian ethnicity, and a prolonged course of homelessness.

Neuropsychological performance was not associated with psychosis or substance use disorders. These findings show that a Housing First intervention does not improve neurocognitive impairment over time. The lack of effect of the intervention on neuropsychological functioning suggests that individuals experiencing homelessness and mental illness may need additional supports to improve neuropsychological impairment.