Research addresses mental health, substance use in supportive housing

Closeup of an affordable housing block.
Combining housing, case management, and other supportive services, permanent supportive housing caters to those who are homeless, many of whom struggle with serious mental illnesses and substance use disorders.

As cities across the state and country are struggling to deal with a worsening homelessness crisis, a group of WSU scientists is helping to improve outcomes for people in permanent supportive housing. Working with housing providers in Spokane, Seattle, and Los Angeles, researchers in the Promoting Research Initiatives in Substance Use and Mental Health (PRISM) Collaborative are leading projects aimed at addressing homelessness. 

Combining housing, case management, and other supportive services, permanent supportive housing caters to those who are homeless, many of whom struggle with serious mental illnesses and substance use disorders. These programs also offer housing to people with serious mental illnesses who are formerly incarcerated, which is the focus of a new study led by Liat Kriegel, an assistant professor in the Elson S. Floyd College of Medicine.

Funded by a four-year, $710,000 grant from the National Institute of Mental Health, Kriegel’s study will explore how the geography of permanent supportive housing can support formerly incarcerated people with serious mental illnesses as they reintegrate into their communities.

“Formerly incarcerated people who have mental illnesses tend to rely on public spaces and use interactions in those spaces as a support system during their re-entry from prison,” said Kriegel, who trained as a social worker before switching to a career in research. “Unfortunately, supportive housing often exists in places that we consider risky, like areas with high rates of poverty, substance use, and crime. But these places can also be positive, providing opportunities for community, resources, and support.”

Kriegel said the study will explore ‘risk environments’ associated with permanent supportive housing, which is where individual, interpersonal, and structural factors interact to increase or reduce risk—in this case, the risk of reincarceration. She will conduct qualitative interviews with 80 formerly incarcerated participants with serious mental illnesses who live in permanent supportive housing run by Volunteers of America and Catholic Charities in Spokane and at other programs in Los Angeles. Both cities have been plagued by rapidly rising housing prices and increased homelessness in recent years. In addition, she will conduct more informal ‘go-along’ interviews with 20 of those participants and will use participatory mapping to map out places that participants find important and where they spend a lot of time and experience belonging. These places will be shown in relation to areas with higher or lower risk of drug overdose and arrest in an effort to create a community resilience index. 

“This project will help us think about how the spaces around and within permanent supportive housing contribute to community participation, treatment engagement, psychiatric distress, and substance use,” Kriegel said. “The goal is to use these outcomes to work with people with lived experience and providers to design an intervention that could better support community integration for formerly incarcerated people who have serious mental illnesses in these settings.”

Liat Kriegel

In another four-year project that started this past fall, Kriegel serves as the lead evaluator for Volunteers of America’s newly established Whole-Person Health Home, a Certified Community Behavioral Health Clinic that will provide on-site behavioral health services to Spokane-area youth and adults who are either chronically homeless or at high risk of becoming homeless. Funded by the federal Substance Abuse and Mental Health Services Administration, this clinic is part of a national effort to make integrated mental health and substance use treatment more accessible to communities that need them. 

“There aren’t many places where people can access mental health and substance use treatment under one roof, which sometimes forces people to prioritize one over the other,” Kriegel said. “Being able to provide integrated, comprehensive care is really important.”

Another example of a housing project with integrated care is Catholic Charities Rising Strong program, which provides supportive housing and drug treatment and other services to help families with children stay together as parents recover from addiction. Led by PRISM director and College of Medicine professor Michael McDonell, a team of WSU researchers is completing a five-year project to evaluate that program. 

Meanwhile, McDonell is working with the City of Seattle and Plymouth Housing—a nonprofit housing and support center for people experiencing chronic homelessness—to start an onsite, state-funded contingency management pilot program aimed at reducing drug use. One of the most effective treatments for stimulant use, contingency management provides people with gift cards and other incentives each time they test negative for drug use. 

One of several contingency management pilot programs being implemented around the state, the program at Plymouth Housing will be the only one to operate in a housing facility instead of in a clinical setting.

“Within PRISM we work off of the premise that housing is a right,” said Kriegel. “Research shows that when you provide housing first so that people have a safe place to live, they’re more likely to experience better outcomes, including improved physical and mental health, reduced or safer use of drugs and alcohol, and better quality of life.” 

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