Stable housing and meaningful employment support are cornerstones in the recovery process for any individual struggling with mental illness and/or substance use disorders. Within our healthcare system, these must be seen as basic needs that provide stability, purpose, and a sense of agency – instrumental in the journey towards recovery – helping individuals rebuild lives, regain self-esteem, and reintegrate into the community.
There are several proven and evidence-based housing and employment support(s) models, for example, Housing First or Individual Placement and Support (IPS), that are effective across different populations (veterans, families, individuals with substance use disorders) and communities/settings. We must better appreciate the importance of these core bedrock principles from several perspectives.
Stable Housing = Foundation for Recovery
Safety and Security: Stable housing provides a safe and secure environment, which is crucial for individuals dealing with mental health challenges or recovering from substance use disorders. It offers a space free from the stressors and triggers that can exacerbate these conditions and should be viewed as a fundamental human right. Housing is more than just having a roof over one’s head; it is about dignity and creating space for growth and overall wellbeing.
Consistency and Routine: Having a stable place to live helps establish routines and consistency, which are beneficial for overall wellbeing. Regular routines aid in a whole host of essential aspects: school or employment related, medication adherence, attendance to regular follow-up appointments and other aspects of treatment, and even planning for shopping, meal preparation, and exercise, which are the building blocks of a person’s recovery journey.
Social and Community Support: Stable housing means being part of and integrated into a community, providing better social support and a deeper sense of belonging. We know this is vital for reducing isolation and loneliness and promoting social integration.
Improved Outcomes: Research shows that individuals with stable housing are less likely to experience relapses and require hospitalization, directly impacting their overall health and well-being1 and models, such as Housing First, which integrate housing and support services, show higher rates of housing stability.2
Meaningful Employment = Path to Recovery
Sense of Purpose and Self-Esteem: Employment offers a sense of purpose and achievement, significantly boosting self-reliance and self-worth. For individuals recovering from mental illness or substance use disorders, this can be a critical aspect of regaining control over their lives and their overall recovery.
Structure and Engagement: Work provides a structured routine and keeps individuals engaged and focused. This structure benefits one’s mental wellbeing, offering the opportunity to increase self-confidence, generate personal income, and better integrate into the community.
Financial Independence: Employment can assist in achieving financial independence and reducing stress associated with financial insecurity. This independence can lead to improved access to healthcare, better living conditions, and enhanced quality of life.
Social Interaction and Skill Development: The workplace is a social environment where individuals can interact with others, build relationships, develop new skills, and boost self-confidence. These aspects are important for personal development and social reintegration.3
Improved Outcomes: Employment has been shown to play a critical role in behavioral health care, with gainful employment improving an individual’s overall mental health, even for those with serious mental illnesses.4 Studies have also shown that individuals with severe mental illness who hold competitive jobs demonstrate benefits such as improved self-esteem and better symptom control.5
Synergistic Effect of Housing and Employment
Stable housing and meaningful employment reinforce each other. A stable home environment makes maintaining employment easier, while employment can lead to better housing opportunities and longer-term stability. Housing and employment address multiple facets of an individual’s life, contributing to a more holistic approach to recovery, addressing not just the immediate needs but also the long-term wellbeing.
Integrated service models that address housing and employment are a more person-centered and holistic approach to treatment and psychosocial rehabilitation. These models recognize that addressing only one aspect of a person’s needs (such as clinical treatment without considering housing or employment or other health-related social needs determinants) is insufficient for sustainable recovery. These models are based on the understanding that recovery is multifaceted, involving clinical treatment and social, economic, and personal wellbeing. Integrated service models focus on the individual’s needs, preferences, and goals, offering personalized support, increasing agency and empowerment, and promoting autonomy and self-determination in their recovery journey.
It has been demonstrated that combining housing and employment services leads to better outcomes in terms of stable living conditions, sustained employment, increased income, improved mental health, reduced substance use, and ultimately, by preventing homelessness and repeated hospitalizations, these models can be cost-effective in the long term. Regrettably, though, these models can be resource-intensive—the diverse needs and situations of individuals mean that services must be highly adaptable and responsive—requiring adequate funding, trained staff, and coordination among multiple agencies and systems of care. System barriers, such as limited affordable housing, housing and employment discrimination, and bureaucratic complexities, compound the challenges.
New flexibilities under Medicaid allow health-related social needs, such as housing, transposition, employment, education, and meals, to be considered covered benefits. The behavioral health sector, across a wide swathe of stakeholders (practitioners, government entities, payers, community-based organizations, hospital systems, employers, schools, etc.), must advocate for legislation, policies, and funding mechanisms that support integrated service models. We must strive for better cross-sector/inter-agency collaboration and reduce systemic health and racial inequities and barriers. We must all join in the effort to reimagine recovery by developing integrated service models as an essential component of our healthcare system.
Jorge R. Petit, MD, is a Behavioral Healthcare Leader and Author. For more information, visit his website: www.drjpetit.org, blog: Behavioral Health: Matters, LinkedIn: Dr. Jorge Petit, MD, or Substack: https://drjrpetit.substack.com.
- Polcin DL, Korcha R. Housing Status, Psychiatric Symptoms, and Substance Abuse Outcomes Among Sober Living House Residents over 18 Months. Addict Disord Their Treat. 2017 Sep;16(3):138-150. doi: 10.1097/ADT.0000000000000105. PMID: 29056875; PMCID: PMC5646694.
- Lachaud, J., Mejia-Lancheros, C., Nisenbaum, R., Stergiopoulos, V., O’Campo, P., & Hwang, S. W. (2021). Housing First and Severe Mental Disorders: The Challenge of Exiting Homelessness. The ANNALS of the American Academy of Political and Social Science, 693(1), 178-192. https://doi.org/10.1177/0002716220987220
- Drake RE, Wallach MA. Employment is a critical mental health intervention. Epidemiol Psychiatry Sci. 2020 Nov 5;29:e178. doi: 10.1017/S2045796020000906. PMID: 33148366; PMCID: PMC7681163.
- Bush PW, Drake RE, Xie H, McHugo GJ, Haslett WR. The long-term impact of employment on mental health service use and costs for persons with severe mental illness. Psychiatry Serv. 2009 Aug;60(8):1024-31. doi: 10.1176/ps.2009.60.8.1024. PMID: 19648188.
- Drake, R. E., & Wallach, M. A. (2020). Employment is a critical mental health intervention [Editorial]. Epidemiology and Psychiatric Sciences, 29, Article e178. https://doi.org/10.1017/S2045796020000906