O'Hara Ann
Technical Assistance Collaborative, Inc., 535 Boylston St., Suite 1301, Boston, MA 02116, USA.
Psychiatr Serv. 2007 Jul;58(7):907-13. doi: 10.1176/ps.2007.58.7.907.
A significant barrier to participation in community life for people with serious mental illness is the lack of decent, safe, affordable, and integrated housing of their choice linked with supportive services. The nation's affordable housing and mental health systems have historically failed to address consumers' housing needs and choices. The lack of housing has resulted in disproportionately high rates of homelessness and chronic homelessness. The author summarizes these issues, which were examined by the Subcommittee on Housing and Homelessness of the President's New Freedom Commission, and discusses the subcommittee's recommendations to end chronic homelessness among people with mental illness, expand access to affordable housing resources for consumers, and promote evidence-based practices. There has been uneven progress nationwide in ameliorating the widespread and multidimensional housing and homelessness problems that were exposed in the subcommittee's paper. The permanent supportive housing model, including "housing first" approaches, has proven effective in preventing and ending homelessness among consumers, but efforts to expand the supply are hampered by significant reductions in federal funds for housing. State and local mental health systems are also struggling to re-configure service system resources to better address housing and homelessness issues. Apparent reductions in chronic homelessness will be short-lived unless affordable housing policies and mental health services are reoriented to both prevent and end homelessness for people with mental illness.
对于患有严重精神疾病的人来说，参与社区生活的一个重大障碍是缺乏他们所选择的、体面、安全、负担得起且配套支持性服务的综合性住房。从历史上看，国家的经济适用房和心理健康系统未能满足消费者的住房需求和选择。住房短缺导致无家可归和长期无家可归的比例过高。作者总结了这些由总统新自由委员会住房与无家可归问题小组委员会研究的问题，并讨论了该小组委员会为消除患有精神疾病者的长期无家可归现象、扩大消费者获得经济适用房资源的机会以及推广循证实践所提出的建议。在改善小组委员会报告中所揭示的广泛而多层面的住房和无家可归问题方面，全国范围内的进展并不均衡。永久性支持性住房模式，包括“住房优先”方法，已被证明在防止和消除消费者的无家可归现象方面有效，但扩大供应的努力受到联邦住房资金大幅削减的阻碍。州和地方的心理健康系统也在努力重新配置服务系统资源，以更好地解决住房和无家可归问题。除非重新调整经济适用房政策和心理健康服务，以预防和消除患有精神疾病者的无家可归现象，否则长期无家可归现象看似减少的情况将是短暂的。
