Studies regarding supported housing and the built environment for people with mental health problems: A mixed-methods literature review

Micropolitics of Mental Health Recovery: An Assemblage Analysis of People's Experiences of Becoming Well

Mental health recovery takes place in a social and material world. However, socio-material contexts have often been absent from recovery studies. The present study was conducted in Norway, a Scandinavian welfare country. We interviewed people at meeting places who had experiences as service users, focusing on their experiences of becoming well, and analyzed their recovery stories using an assemblage framework. Our analysis identified four constitutive dimensions that promote mental health recovery: an atmosphere of togetherness, doings as more than the act, personal development, and integration in society. We discuss how these dimensions might be seen as social, relational, and material forces that create important micropolitics that challenge the individualistic professionalization of the recovery concept.

"And Now that I Feel Safe…I'm Coming Out of Fight or Flight": A Qualitative Exploration of Challenges and Opportunities for Residents' Mental Health in Substance Use Recovery Housing

Co-occurring mental health concerns are prevalent among substance use recovery housing residents. We sought to explore how residents with co-occurring mental health and substance use needs experience recovery housing. We conducted semi-structured interviews with residents (N = 92) in recovery homes across Texas and developed themes through thematic analysis. Residents note that living in a group home can exacerbate anxiety and paranoia, especially during periods of high turnover. Overwhelmingly, however, residents believe recovery housing improves their mental health. Residents use their shared lived experiences to support one another. Residents also express appreciation for the transition period offered by recovery housing, allowing them to solidify their recoveries before fully re-entering society. Participants describe recovery homes as a critical support for their co-occurring mental health and substance use concerns. These results provide key insights on how to better support mental health in recovery housing.

The role of emotion in urban development decision-making: A qualitative exploration of the perspectives of decision-makers

People's feelings about their neighbourhoods are important for health, but they may be undervalued in urban development decision-making. This study explores how decision-makers understand and respond to residents' emotions. Reflexive thematic analysis was conducted on a secondary dataset consisting of 123 interviews with influential professionals in urban development decision-making. We developed three themes and one subtheme: '(mis)understanding residents' emotions', 'neglecting the health impact of positive emotions', 'avoidance of emotion in community engagement' and 'sanitized emotions'. We recommend decision-makers engage directly with residents' emotions during urban development processes to ensure healthier place-making.

Using drugs alone in single room occupancy housing: Understanding environmental drivers of overdose risk

BACKGROUND

Across North America most overdose deaths occur in housing, largely due to individuals using drugs alone. In cities, fatalities are disproportionately concentrated in low-income housing, including single room occupancy (SRO) housing. While research has highlighted how SROs operate as risk environments for various poor outcomes, there has been little attention to specific drug use practices (i.e., using alone) associated with overdose vulnerability in these spaces. This study explores how environmental contexts of SROs shape overdose risks, with specific attention to practices of using drugs alone.

METHODS

In-depth semi-structured interviews were conducted with 30 people who use drugs (PWUD) living in Vancouver SROs. Interviews covered topics such as social-structural environments of housing, drug use practices, and housing-based harm reduction. Thematic analysis drew on the intersectional risk environment framework.

RESULTS

Narratives positioned SROs as extensions of public space, with similar expectations of risks and behaviours as in public spaces. For some participants, using alone in their room was characterized as a practice in claiming privacy within the context of a public existence. Participants highlighted how certain features of SRO's social-structural environments were routinely leveraged against them (e.g., security cameras, staff surveillance), suggesting using alone as a tactic to minimize risks of hyper-surveillance and punitive policies. Further, participants discussed using alone as "safer," describing how this practice mitigated place-based risks of social-structural harms (e.g., violence, criminalization) in ways that eclipsed overdose risk.

CONCLUSION

Using drugs alone may be understood as a spatial negotiation of vulnerability to diverse harms produced by environmental contexts of SROs. Interventions accounting for broader contextual factors (e.g., improvements housing quality/quantity, providing a safer supply of drugs) that render using alone as instrumental to survival, and that reduce the implicit threat of punishment from intensive surveillance and control practices are critical to reduce vulnerability to overdose and other harms.

Using alone at home: What's missing in housing-based responses to the overdose crisis?

BACKGROUND

Against the backdrop of North America's overdose crisis, most overdose deaths are occurring in housing environments, largely due to individuals using drugs alone. Overdose deaths in cities remain concentrated in marginal housing environments (e.g., single-room occupancy housing, shelters), which are often the only forms of housing available to urban poor and drug-using communities. This commentary aims to highlight current housing-based overdose prevention interventions and to situate them within the broader environmental contexts of marginal housing. In doing so, we call attention to the need to better understand marginal housing as sites of overdose vulnerability and public health intervention to optimize responses to the overdose crisis.

HARM REDUCTION AND OVERDOSE PREVENTION IN HOUSING

In response to high overdose rates in marginal housing environments several interventions (e.g., housing-based supervised consumption rooms, peer-witnessed injection) have recently been implemented in select jurisdictions. However, even with the growing recognition of marginal housing as a key intervention site, housing-based interventions have yet to be scaled up in a meaningful way. Further, there have been persistent challenges to tailoring these approaches to address dynamics within housing environments. Thus, while it is critical to expand coverage of housing-based interventions across marginal housing environments, these interventions must also attend to the contextual drivers of risks in these settings to best foster enabling environments for harm reduction and maximize impacts.

CONCLUSION

Emerging housing-focused interventions are designed to address key drivers of overdose risk (e.g., using alone, toxic drug supply). Yet, broader contextual factors (e.g., drug criminalization, housing quality, gender) are equally critical factors that shape how structurally vulnerable people who use drugs navigate and engage with harm reduction interventions. A more comprehensive understanding of these contextual factors within housing environments is needed to inform policy and programmatic interventions that are responsive to the needs of people who use drugs in these settings.

"It's not just the residents who need to be motivated for activity": a qualitative study of the perspectives of staff on providing activity support for people with psychiatric disabilities in supported housing in Sweden

Background

The goals for staff in Supported Housing for people with psychiatric disabilities include helping to develop the residents' independence and self-confidence in activities. However, staff have expressed frustration about providing this type of support when motivating residents to engage in meaningful activities and also about the difficulty in finding suitable levels of independence within a housing setting with limitations.

Objective

The aim is to explore the views and experiences of housing staff in Supported Housing on how they can stimulate and support engagement in activities for people with psychiatric disabilities.

Methods

Twenty-six members of staff from 20 supported housing units in 10 municipalities in Sweden were interviewed in five focus groups. A semi-structured interview guide was used, and the transcribed material was analyzed using qualitative content analysis.

Results

Three main categories emerged from the analysis: Multi-faceted factors influencing the staff's provision of activity support, Staff's approach for supporting activities, and Staff's struggles to develop their work. Obstacles to participating in activities in the community were identified. Many contrasting factors were found, such as spontaneous or structured activities and individual or group activities, which affected the staff's ability to motivate to activity.

Conclusion

A broad approach encompassing in-house training including a focus on values, recruitment policies, staff supervision and interventions focusing on both residents and staff are ways to support staff in motivating residents toward being more active within Supported Housing.

Stimulating creativity in the classroom: examining the impact of sense of place on students' creativity and the mediating effect of classmate relationships

BACKGROUND

Although previous studies have found a close relationship between sense of place and creativity, few studies have been conducted considering the micro-environment of the classroom. The mediating role of classmate relationships in the association between students' sense of place and creativity remains unclear.

METHODS

This study explores classmate relationships as a mediating factor in the relationship between sense of place and creativity. Therefore, we considered a sample of 1555 Chinese high-school students and used a paper-based questionnaire survey. Data analysis was performed using SPSS 24.0, PROCESS 3.2 plugin, and AMOS.

RESULTS

Sense of place in the micro-environment of the classroom has a significant positive predictive effect on creativity. Sense of place also has a significant positive predictive effect on peer relationships. The mediation analysis reveals that peer relationships play a mediating role in the relationship between the sense of place and creativity.

CONCLUSIONS

This study revealed the associations between sense of place, classmate relationships, and creativity. Creativity is better expressed in students with a strong sense of place in the classroom. Moreover, a student's sense of place can enhance their creativity by influencing their peer relationships. These findings enrich the research in educational psychology within the classroom, providing new insights for fostering creativity.

Driving the determinants of older people's mental health in the context of urban resilience: a scoping review

BACKGROUND

Population aging is a pervasive phenomenon occurring rapidly worldwide, while sustainable development goals are considered the mental health among older adults.

METHODS

To investigate the factors affecting mental health, we conducted a scoping review of the 47 papers published between 2015 and 2022 to explore various dimensions affecting older adults' mental health.

RESULTS

Our finding mirrors four dimensions of creating healthy and sustainable environments for older adults: person, place, processes, and resilience-related health in the living environment. The person dimension includes individual characteristics, attitudes and behaviors, and health status. The place dimension is divided into five categories: land use, access, physical form, public open spaces, and housing, while the process consists of the social, cultural, and economic environments. Resilience-related health dimension emphasizes the impact of natural and man-made disasters on older people's mental health.

DISCUSSION

These findings can provide policymakers insights into developing community-based environmental intervention strategies to promote mental health among older adults and support healthy and active aging.

Promoting Meaning and Recovery for Psychosis: Comparison of Metacognitively-Oriented Psychotherapists and Clinicians in Psychiatric Rehabilitation

Introduction

Recovery from psychosis is an expected and desired outcome in psychiatric rehabilitation that may involve subjective outcomes related to personal recovery. While a considerable amount of qualitative research has examined patients' experience of recovery oriented approaches, there are less studies examining clinicians' perspectives. Examining the clinician point of view is important for both supporting clinicians within recovery-oriented practice, as well as for understanding underlying therapeutic processes. The aims of this study were to explore clinician experience of offering different psychiatric rehabilitation treatments for individuals with psychosis, and to understand similarities and differences of clinicians whose work differed in its recovery emphasis.

Methods

Open-ended interviews were conducted with 10 psychotherapists providing Metacognitive Reflection and Insight Therapy (MERIT), a recovery oriented form of integrative psychotherapy focused on subjective aspects of recovery, and 10 clinicians providing standard psychiatric rehabilitation services.

Results

Thematic analysis revealed important similarities and differences between these two groups of providers. There were seven themes found for MERIT therapists: Comfort with uncertainty, Emphasis on collaboration, Being part of therapeutic change, Connecting with clients, Emphasis on patient autonomy, Experiencing growth, and Therapist use of self-awareness. There were four themes found for psychiatric rehabilitation clinicians: Value of a structured approach, Focus on a strengths-based approach, Witnessing behavioral change, and Building rapport to support the work.

Discussion

As expected, both similarities and differences arose between clinician groups. Results indicated that both groups focused on the therapeutic relationship and monitoring progress and outcomes. Unexpectedly, MERIT therapists reported growth as well as comfort with uncertainty. These findings suggest that MERIT is a a psychotherapy that offers unique opportunities for creative and flexible exploration of meaning and agency that is both challenging and rewarding for clinicians. Implications for supporting healthy clinician practice and the development of services are discussed.

Managing high-risk behaviours and challenges to prevent housing loss in permanent supportive housing: a rapid review

Permanent supportive housing is an effective intervention for stably housing most people experiencing homelessness and mental illness who have complex support needs. However, high-risk behaviours and challenges are prevalent among this population and have the potential to seriously harm health and threaten housing tenures. Yet, the research on the relationship between high-risk issues and housing stability in permanent supportive housing has not been previously synthesized. This rapid review aimed to identify the housing-related outcomes of high-risk behaviours and challenges in permanent supportive housing settings, as well as the approaches used by agencies and residents to address them. A range of high-risk behaviours and challenges were examined, including risks to self (overdose, suicide/suicide attempts, non-suicidal self-injury, falls/fall-related injuries), and risks to multiple parties and/or building (fire-setting/arson, hoarding, apartment takeovers, physical/sexual violence, property damage, drug selling, sex trafficking). The search strategy included four components to identify relevant academic and grey literature: (1) searches of MEDLINE, APA PsycINFO, and CINAHL Plus; (2) hand searches of three journals with aims specific to housing and homelessness; (3) website browsing/searching of seven homelessness, supportive housing, and mental health agencies and networks; and (4) Advanced Google searches. A total of 32 articles were eligible and included in the review. Six studies examined the impacts of high-risk behaviours and challenges on housing tenancies, with overdose being identified as a notable cause of death. Twenty-six studies examined approaches and barriers to managing high-risk behaviours and challenges in PSH programs. These were categorized into eight types of approaches: (1) clinical, (2) relational/educational, (3) surveillant, (4) restrictive, (5) strategic, (6) design-based, (7) legal, and (8) self-defence. Consistent across all approaches was a lack of rigorous examination of their effectiveness. Further, some approaches that are legal, restrictive, surveillant, or strategic in nature may be used to promote safety, but may conflict with other program objectives, including housing stability, or resident empowerment and choice. Research priorities were identified to address the key evidence gaps and move toward best practices for preventing and managing high-risk behaviours and challenges in permanent supportive housing.

What are important ingredients for Intensive Home Support for people with severe mental illness according to experts? A concept mapping approach

BACKGROUND

Deinstitutionalization in mental health care has been an ongoing process for decades. More and more people with severe mental illness (SMI), who previously lived in residential supported housing settings and were formerly homeless, are now living independently in the community but need intensive support to enable independent living. The support provided by regular outpatient teams is inadequate for this target group. This study explored the ingredients for an alternative form of outpatient support: intensive home support (IHS).

METHODS

Concept mapping was used, following five steps: (1) brainstorming, (2) sorting, (3) rating, (4) statistical analysis & visual representation, and (5) interpretation. Purposive sampling was used to represent several perspectives, including researchers, professionals, peer workers, and policy makers.

RESULTS

Experts (n = 17) participated in the brainstorming step and the sorting and rating steps (n = 14). The 84 generated statements were grouped into 10 clusters:. (1) housing rights; (2) informal collaboration; (3) reciprocity in the community; (4) normalization and citizenship; (5) recovery; (6) sustainable funding; (7) equivalence; (8) flexible, proactive 24/7 support; (9) public health and positive health; and (10) integrated cooperation in support at home.

CONCLUSIONS

Given the diversity of the ingredients contained in the clusters, it seems that IHS should be designed according to a holistic approach in collaboration with several sectors. Additionally, IHS is not only the responsibility of care organizations but also the responsibility of national and local governments. Further research about collaboration and integrated care is needed to determine how to implement all of the ingredients in practice.

Built environment and schizophrenia re-hospitalization risk in China: A cohort study

BACKGROUND

Built environment exposure, characterized by ubiquity and changeability, has the potential to be the prospective target of public health policy. However, little research has been conducted to explore its impact on schizophrenia. This study aimed to investigate the association between built environmentand and schizophrenia rehospitalization by simultaneously considering substantial built environmental exposures.

METHODS

We recruited eligible schizophrenia patients from Hefei, Anhui Province, China between 2017 and 2019. The main outcome for this study was the time interval until the first recurrent hospital admission occurred within one year after discharge. For each included subject, we estimated the built environment exposures, including population density, walkability, land use mix, green and blue space, public transportation accessibility and road traffic indicator. Lasso (Least Absolute Shrinkage and Selection Operator) analysis was used to select the key variables. Multivariable Cox regression model was applied to obtain hazard ratio (HR) and its corresponding 95% confidence intervals (CI). Further, we also evaluated the joint effects of built environment characteristics on rehospitalization for schizophrenia by Quantile g-computation model.

RESULTS

A total of 1564 hospitalized schizophrenia patients were enrolled, with 347 patients (22.2%) had a rehospitalization within one-year after discharge. Multivariable Cox regression analysis indicated that the re-hospitalization rate for schizophrenia would be higher in areas with a high population density (HR: 1.10, 95%CI: 1.04-1.16). Nonetheless, compared to the reference (Q1), participants who lived in a neighborhood with the highest walkability and NDVI (Normalized Difference Vegetation Index) (Q4) had a 76% and 47% lower risk of re-hospitalization within one year (HR:0.24, 95%CI: 0.13-0.45; and 0.53, 95%CI:0.32-0.85), respectively. Moreover, quantile-based g-computation analyses revealed that increased walkability and green space significantly eliminated the adverse effects of population density increases on schizophrenia patients, with a HR ratio of 0.61 (95%CI:0.48,0.79) per one quartile change at the same time.

CONCLUSION

Our study provides scientific evidence for the significant role of built environment in schizophrenia rehospitalization, suggesting that optimizing the built environment is required in designing and building a healthy city.

From traditional counselling to health-promoting conversations? Registered nurses' experiences of providing health counselling to people living with severe mental ill-health in supported housing

People with severe mental ill-health have lower life expectancies than the rest of the population, partly due to unhealthy lifestyles. Counselling to help these people improve their health can also be complex, and registered nurses are key to its success. The aim of this study was to elucidate registered nurses' experiences of providing health counselling to people living with severe mental ill-health in supported housing. We conducted eight individual semi-structured interviews with registered nurses working in this context and subjected the responses to qualitative content analysis. The results show that registered nurses who counsel people with severe mental ill-health feel dispirited, but they defend their often fruitless endeavours and strive, through health counselling, to help these people meet healthier lifestyle goals. Shifting the focus from traditional health counselling to person-centred care using health-promoting conversations could strengthen registered nurses in their efforts towards improving lifestyles among people living with severe mental ill-health in supported housing. Therefore, to facilitate healthier lifestyles among this population, we recommend that community healthcare support registered nurses working in supported housing by educating them in the use of health-promoting conversations, including teach-back techniques.

Establishing the measurement properties of the Residential Environment Impact Scale (Version 4.0)

BACKGROUND

Developed as an environment assessment informed by the Model of Human Occupation, the Residential Environment Impact Survey considered the physical, social and activity features of the environment, evaluating the impact of the environment on resident's quality of life. Clinicians reported that the Residential Environment Impact Survey was a useful tool; however, it had not been structured to be a measurement tool and did not have established psychometric properties.

AIMS/OBJECTIVES

This study examines the psychometric properties of the restructured Residential Environment Impact Scale Version 4.0 (REIS), which measures the level of environment support provided to residents.

MATERIAL AND METHODS

The REIS was completed across residential sites for people with complex mental health needs. A many facets Rasch analysis was conducted to establish the reliability and validity of the REIS.

RESULTS

The REIS demonstrated reasonable psychometric properties, with items demonstrating internal scale validity and scale items following an expected pattern of increasingly challenging environment support.

CONCLUSIONS AND SIGNIFICANCE

Initial evidence suggests that the REIS provides a valid and reliable measure of environment support, providing a detailed assessment of how physical, social and activity elements of the environment support or inhibit participation and can be applied across a range of living environments.

Trauma-Informed Design of Supported Housing: A Scoping Review through the Lens of Neuroscience

There is growing recognition of the importance of the design of the built environment in supporting mental health. In this context, trauma-informed design has emerged as a new field of practice targeting the design of the built environment to support wellbeing and ameliorate the physical, psychological and emotional impacts of trauma and related pathologies such as Post Traumatic Stress Disorder (PTSD). With high levels of prevalence of PTSD among people escaping homelessness and domestic violence, a priority area is the identification and application of evidence-based design solutions for trauma-informed supported housing. This study sought to examine the scope of existing evidence on the relationship between trauma, housing and design and the correlation of this evidence with trauma-informed design principles, and to identify gaps and opportunities for future research. In response to the commonly articulated limitations of the evidence-base in built environment design research, we combined a scoping review of literature on trauma, housing and design with insights from neuroscience to focus and extend understanding of the opportunities of trauma-informed design. We found that while limited in scope, there is strong alignment between existing evidence and the principles of trauma-informed design. We also identify three areas of future research related to the key domains of safety and security; control; and enriched environments.

The significance of the social and material environment to place attachment and quality of life: findings from a large population-based health survey

Background

There is an international public health interest in sustainable environments that promote human wellbeing. An individual’s bond to places, understood as place attachment (PA), is an important factor for quality of life (QoL). The material environment, such as access to nature (AtN), access to amenities (AtA), or noise, and the social environment, such as social support or loneliness, has the potential to influence PA. The aim of the present study was to explore the relationship between these factors and QoL.

Methods

The study relied on data from 28,047 adults from 30 municipalities in Southern Norway obtained from the Norwegian Counties Public Health Surveys in 2019. Latent regression analyses were used to examine the relationship between the material and social environmental factors and QoL, mediated by PA.

Results

We found a relationship between social and material environmental factors and PA. Higher AtN and AtA scores were related to an increase in PA, whereas higher perception of noise problems was related to decreased PA scores. When social environment factors were added to the model, they were even stronger predictors of PA and, in turn, QoL through mediated effects. We also found a strong positive association between PA and QoL (unstandardized β = 0.88, 95% CI = 0.87–0.90, p < 0.001). The whole model explained 83% of the variance in PA and 65% of the variance in QoL.

Conclusions

Taken together, the findings suggest the relevance of material and social environmental factors for PA and QoL. Therefore, research on public health and QoL should include place-sensitive variables.

You realise you are better when you want to live, want to go out, want to see people: Recovery as assemblage

BACKGROUND

The lack of social and material perspectives in descriptions of recovery processes is almost common in recovery research.

AIM

Consequently, we investigated recovery stories and how people with mental health and/or addiction challenges included social and material aspects in these stories.

METHOD

We conducted focus group and individual interviews. We investigated how the participants narrated their stories and how they assembled places and people in their recovery stories.

RESULTS

We found that narratives of recovery became assemblages where humans and their environments co-exist and are interdependent.

CONCLUSION

As such, narratives about recovery are about everyday assemblages of well-being into which stories of insecurity are interwoven, without a start or stop point.

The Mediating and Buffering Effect of Creativity on the Relationship Between Sense of Place and Academic Achievement in Geography

Purpose

This study explored the relationship between sense of place and academic achievement in geography and used a mediation model to verify the mediating role of creativity in this relationship.

Methods

A total of 1,037 upper secondary school students were surveyed using the Sense of Place Scale, the Innovative Behavior Scale, and their geography test scores. SPSS (version 26.0) was used for descriptive statistical analysis and correlation analysis. The PROCESS plug-in (version 4.0) was used to test the mediating effect of creativity.

Results

(1) The correlation analysis showed that sense of place has a positive effect on academic achievement in geography and is related to creativity. Moreover, creativity exerts a positive effect on academic achievement in geography (2). The results of mediation analysis indicated that creativity plays mediating and buffering roles in the relationship between sense of place and academic achievement in geography after controlling for gender and residential address. The direct and indirect effects accounted for 65.708 and 34.292% of the total effect, respectively.

Conclusions

The results indicated that sense of place affected not only academic achievement in geography directly but also creativity indirectly. This conclusion provides certain ideas for the development of geography curriculums. Since academic achievement in geography is related to both sense of place and creativity, it is necessary to pay more attention to integrating sense of place in geography education and to foster creativity in curriculum development and teaching of geography.

Engaging U.S. Adults with Serious Mental Illness in Participatory Design Research Exercises

Clubhouses are non-clinical, community-based centers for adult members with serious mental illness. The evidence-based model assists adults with identifying employment, housing, education, and social opportunities; wellness and health-promoting activities; reducing hospitalizations and criminal justice system involvement; and improving social relationships, satisfaction, and quality of life. The model enables member participation in all Clubhouse operations, yet offers little guidance concerning facility design and member engagement in the design process. This case study explored the use of participatory design research exercises to (1) document member needs, preferences, and priorities to inform the design of a new midwestern U.S. Clubhouse facility and (2) meaningfully engage members (n = 16) in the design process. Four participatory design research exercises were developed, administered, and analyzed. Results revealed aesthetics and ambience; safety and security; ease of use and maintenance; adaptability, flexibility, and accessibility; and transportation as future priorities. Space and furnishing needs and priorities were also identified. Informal observations and participant feedback suggested that the participatory exercises meaningfully engaged members in a manner aligned with Clubhouse Model principles by centering member dignity, strengths, and work-oriented expectations. Future directions for research on Clubhouse design and member engagement in the design process are also discussed.

Predictors of change in housing status over 12 months among individuals using emergency shelters, temporary housing or permanent housing in Quebec, Canada

Homelessness is an ongoing societal and public health problem in Canada and other countries. Housing services help homeless individuals along the transition towards stable housing, yet few studies have assessed factors that predict change in individual housing trajectories. This study identified predictors of change in housing status over 12 months for a sample of 270 currently or formerly homeless individuals using emergency shelters, temporary housing (TH) or permanent housing (PH) resources in Quebec. Participants recruited from 27 community or public organisations were interviewed between January and September 2017, and again 12 months later. Sociodemographic variables, housing history, health conditions, service use and client satisfaction were measured. Directors and programme coordinators from the selected organisations also completed a baseline questionnaire measuring strictness in residential codes of living/conduct, interorganisational collaboration and overall budget. Independent variables were organised into predisposing, enabling and needs factors, based on the Gelberg-Andersen Behavioral Model. Multilevel logistic regressions were used to test associations with the dependent variable: change in housing status over 12 months, whether positive (e.g. shelter to TH) or negative (e.g. PH to shelter). Predictors of positive change in housing status were as follows: residing in PH, being female, having children (predisposing factors); having consulted a psychologist, higher frequency in use of public ambulatory services (enabling factors); and not having physical illnesses (needs factor). The findings support strategies for helping this clientele obtain and maintain stable housing. They include deploying case managers to promote access to public ambulatory services, mainly among men or individuals without children who are less likely to seek help; greater use of primary care mental health teams; the establishment of more suitable housing for accommodating physical health problems; and reinforcing access to subsidised PH programmes.

Fatores contextuais e implantação da intervenção Housing First: uma revisão da literatura

Resumo O Housing First (HF) tem se difundido no cenário internacional como uma intervenção baseada em evidência para superar a situação de rua entre pessoas com agravos de saúde mental. No Brasil, o HF tem sido adotado como referência no desenvolvimento de iniciativas voltadas para pessoas em situação de rua que fazem uso prejudicial de drogas. Estudos apontam a necessidade de maior compreensão da dinâmica implantação do modelo HF em diferentes cenários. De tal modo, utilizando o método de revisão de literatura, analisamos os fatores que facilitam e dificultam a implantação do HF. Foram selecionados 68 artigos, publicados entre 2003 e 2020, nas bases PubMed, Scopus, PsychoINFO, Embase, Lilacs e Scielo. Identificamos fatores em quatro dimensões: características da intervenção, contexto de implantação, aspectos institucionais e processo de implantação. A indisponibilidade de habitações, a falta de coordenação dos serviços necessários aos moradores e a resistência dos agentes implantadores aos princípios do HF são fatores que dificultam a implantação. Por sua vez, agentes com valores, atitudes e competências convergentes ao modelo e educação permanente aparecem como facilitadores. Apontamos a necessidade de se compreender e favorecer o processo de integração do HF aos sistemas de proteção social existentes.

Permanent Supportive Housing Design Characteristics Associated with the Mental Health of Formerly Homeless Adults in the U.S. and Canada: An Integrative Review

The built environment directly and indirectly affects mental health, especially for people transitioning from long-term homelessness to permanent supportive housing (PSH) who often experience co-occurring behavioral health challenges. Despite a rapid increase in PSH availability, little research examines influences of architecture and design within this context. This integrative review synthesized limited research on PSH design in the U.S. and Canada to identify built environment characteristics associated with PSH residents’ mental health, highlight gaps in the literature, and prioritize future research directions. A systematic search for peer-reviewed articles was conducted using nine databases drawing from multiple disciplines including architecture, environmental psychology, interior design, psychology, psychiatry, medicine, and nursing. Seventeen articles met inclusion criteria. Study design, methodology, built environment properties, place attributes, and relevant findings were extracted and iteratively analyzed. Three domains relevant to architecture and design were identified related to home, ontological security, and trauma sensitivity; dwelling unit type, privacy, control, safety, housing quality and location, and access to amenities; and shared common space. Integrative review results emphasize the potential of architecture and design to contribute to improved built environment quality and mental health outcomes among PSH residents. Methodological limitations and directions for future research are also discussed.

Human-Animal Relationships in Supported Housing: Animal Atmospheres for Mental Health Recovery

Being in a relationship with an animal can promote the well-being of people. For many individuals, this usually takes place at home. This study reports about homes for people with mental health problems (with or without co-occurring substance use), who live in supported housing operated by public landlords, entailing tenancies that are usually stricter regarding their pet policies than ordinary homes. We thus addressed the following research questions through ethnographic fieldwork at seven distinct places: which types of human–animal relationships occur in supported housing, and how do they affect the tenants? We analyzed the collected data informed by the Grounded Theory approach and found three types of human–animal relationships within supported housing affecting the tenants differently, namely, “no animals,” “visiting animals,” and “shared/sole ownership of animals.” Animals in the buildings can stage atmospheres that promote solidarity and connectedness among people. In contrast, situations in which animals are forbidden can create emotional tensions between tenants and staff or landlords. When discussing fostering animal atmospheres and limits to keeping pets, we concluded that animals can contribute to the mental health recovery of tenants by creating acknowledgment and rootedness. Therefore, public housing services need to guarantee equal rights to the tenants as they do with every citizen, including the right to keep a pet.

Exploring Intraindividual Profiles for Home Buildings Based on Architectural Compositional Elements and Psychological Health Factors: A Transdisciplinary Approach

Based on the transactional and salutogenic perspectives, we explored individual profiles that integrate psychosocial factors and compositional elements of the built home environment. Adults with different socio-demographic characteristics completed several self-report measures on psychological factors (personality traits, self-efficacy, mental health, and happiness) and architectural elements constituting the ideal home environment. Adopting an individual-centered perspective, three distinct intra-individual psycho-architectural (person-environment) profiles were found with different compositional preferences and psychosocial characteristics in terms of functioning, health, and well-being: endopathic (characterized by higher levels of psychosocial resources and well-being indicating a highly adapted and successful profile, and architectural preferences corresponding to their identities and experiences—expression through spaces), assimilative (characterized by average levels in all regulatory parameters indicating moderately adaptive individuals, and architectural preferences of spaces created in interactive processes—introjection of spaces), and additive individuals (characterized by a comparatively dysfunctional, poorer psychosocial profile, and architectural preferences in line with provoking a restorative effect—change with spaces). An awareness of the psychosocial features of the users for whom the homes are built can help in designing spaces to inhabit that are adapted to them for an enhancement of their overall well-being. Therefore, a better understanding of the interconnections between psychology and architecture will help in designing healthy spaces.

Association between housing environment and depressive symptoms among older people: a multidimensional assessment

Background

Depression is a common mental disorder among older people. This study aimed to assess the association between housing environment factors and depressive symptoms among older people using a multidimensional assessment method.

Methods

The study uses a population-based cross-sectional design. A total of 950 participants aged ≥ 60 years were selected using a complex multistage sampling design from 22 locations in China. All data were collected using questionnaires by face-to-face interviews. A total of 938 participants were included in the analysis, and 17.1% of males and 23.1% of females were identified as having depressive symptoms. The depressive symptoms were assessed using the 15-item Geriatric Depression Scale. The housing environment was assessed on the basis of four dimensions: physical, social, psychological, and cognition and physical function. Cumulative logistic regression analysis was used to evaluate the association between housing environment and depressive symptoms.

Results

The Cochran–Armitage trend test showed that the depressive symptom scores were linearly negatively associated with self-assessed housing environment, living arrangement, life satisfaction, and other physical environment factors and linearly positively associated with cognitive and physical function scores. The results of cumulative logistic regression analysis showed that the housing environment was significantly associated with depressive symptoms. The participants’ self-assessed housing environment was strongly associated with the levels of depressive symptom scores, and the odds ratio was 3.47 (95% CI, 1.14–10.82, P = 0.003).

Conclusion

The housing environment was significantly associated with depressive symptoms. Our results suggest that multi-dimensional assessment in the housing environment may be an effective way to develop intervention strategies of depressive symptoms among older people.

A scoping review to explore the experiences and outcomes of younger people with disabilities in residential aged care facilities

OBJECTIVE

In Australia, over 6,000 adults younger than 65 have been inappropriately placed in nursing homes designed to accommodate older adults. The primary aim of this review was to map the literature on the experiences and outcomes of young people with disability who are placed in aged care.

METHODS

A scoping review of the published literature from 2009-2018 was conducted using Embase, Medline, PsycINFO and Scopus.

RESULTS

Eleven articles were identified (7 qualitative, 3 mixed methods, 1 quantitative). Results demonstrated the inability of aged care facilities to meet the basic human needs of young people (e.g., privacy, physical, sexual, social, nutritional, emotional need) and highlighted the lack of choice young people with disability have in regards to rehabilitation and housing. There was limited data relating to the trajectory and support needs of young people placed in aged care facilities.

CONCLUSIONS

This review highlights the negative outcomes young people experience while living in aged care. Future research should investigate the trajectory and support needs of young people in aged care facilities. Systemic changes are required to meet the needs of young people with complex needs at risk of admission to aged care including timely rehabilitation and housing and support options.

Materialities in supported housing for people with mental health problems: a blurry picture of the tenants

Our daily lives and sense of self are partly formed by material surroundings that are often taken for granted. This materiality is also important for people with mental health problems living in supported housing with surroundings consisting of different healthcare services, neighbourhoods, buildings or furniture. In this study, we explored how understandings of tenants are expressed in the materialities of supported housing. We conducted ethnographic fieldwork in seven different supported accommodations in Norway and analysed the resultant field notes, interviews, photographs and documents using Situational Analysis. The analysis showed that supported housing materialities expressed a blurry picture comprising widening and narrowing understandings of tenants, both by others and by themselves. Widening understandings concerned how tenants were living their lives in their own ways in private rooms while maintaining a social life in common areas. Narrowing understandings pertained to understand the tenants based solely on their diagnosis and need for care and control in hospital-like buildings. The following discussion focusses on the ideas that underlie narrowing materialities and on the importance of striving for atmospheres that entail a sense of belonging.

Overview of "Systematic Reviews" of the Built Environment's Effects on Mental Health

Good mental health is related to mental and psychological well-being, and there is growing interest in the potential role of the built environment on mental health, yet the evidence base underpinning the direct or indirect effects of the built environment is not fully clear. The aim of this overview is to assess the effect of the built environment on mental health-related outcomes. Methods. This study provides an overview of published systematic reviews (SRs) that assess the effect of the built environment on mental health. We reported the overview according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Databases searched until November 2019 included the Cochrane Database of Systematic Reviews, EMBASE, MEDLINE (OVID 1946 to present), LILACS, and PsycINFO. Two authors independently selected reviews, extracted data, and assessed the methodological quality of included reviews using the Assessing Methodological Quality of Systematic Reviews-2 (AMSTAR-2). Results. In total, 357 records were identified from a structured search of five databases combined with the references of the included studies, and eleven SRs were included in the narrative synthesis. Outcomes included mental health and well-being, depression and stress, and psychological distress. According to AMSTAR-2 scores, the quality assessment of the included SRs was categorized as "high" in two SRs and as "critically low" in nine SRs. According to the conclusions of the SRs reported by the authors, only one SR reported a "beneficial" effect on mental health and well-being outcomes. Conclusion. There was insufficient evidence to make firm conclusions on the effects of built environment interventions on mental health outcomes (well-being, depression and stress, and psychological distress). The evidence collected reported high heterogeneity (outcomes and measures) and a moderate- to low-quality assessment among the included SRs.

The Anatomy of Health-Supportive Neighborhoods: A Multilevel Analysis of Built Environment, Perceived Disorder, Social Interaction and Mental Health in Beijing

Mental health is an exceedingly prevalent concern for the urban population. Mounting evidence has confirmed the plausibility of high incidences of mental disorders in socioeconomically disadvantaged neighborhoods. However, the association between the neighborhood built environment and individual mental health is understudied and far from conclusive, especially in developing countries such as China. The underlying mechanism requires in-depth analysis combining potential intermediates such as perceived environmental disorder and supportive social relationships. Using a health survey conducted in Beijing in 2017, this study investigates for the first time a socio-environmental pathway through which perceived disorder and social interaction account for the relationship between the built environment and mental health under the very notion of the neighborhood effect. The results from multilevel structural equation models indicate that individual mental health is influenced by the neighborhood-scale built environment through three pathways, independent of neighborhood socioeconomic disadvantages: (1) proximity to parks is the sole indicator directly linked to mental health; (2) population density, road connectivity and proximity to parks are indirectly associated with mental health through interactions with neighbors; and (3) population density, road connectivity and facility diversity are partially associated with perceived neighborhood disorder, which is indirectly correlated with mental health through interactions with neighbors. This study is a preliminary attempt to disentangle the complex relationships among the neighborhood environment, social interaction and mental health in the context of developing megacities. The relevant findings provide an important reference for urban planners and administrators regarding how to build health-supportive neighborhoods and healthy cities.