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Public service reductions associated with placement of homeless persons with severe mental illness in supportive housing
Open accessAbstract
This article assesses the impact of public investment in supportive housing for homeless persons with severe mental disabilities. Data on 4,679 people placed in such housing in New York City between 1989 and 1997 were merged with data on the utilization of public shelters, public and private hospitals, and correctional facilities. A series of matched controls who were homeless but not placed in housing were similarly tracked. Regression results reveal that persons placed in supportive housing experience marked reductions in shelter use, hospitalizations, length of stay per hospitalization, and time incarcerated. Before placement, homeless people with severe mental illness used about $40,451 per person per year in services (1999 dollars). Placement was associated with a reduction in services use of $16,281 per housing unit per year. Annual unit costs are estimated at $17,277, for a net cost of $995 per unit per year over the first two years.
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“Supportive housing initiatives specific to people leaving prison have been shown to be effective in reducing reincarceration (14).”
From Behavioral Health and Social Correlates of Reincarceration Among Hispanic, Native American, and White Rural Women (2013) · cites this paper as [14]
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Items 201–300 of 343
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“Initially, evaluations of PSH did not assess the question of community, focusing instead almost exclusively on cost–benefit studies (e.g. Culhane, Metraux, and Hadley 2002), outcomes in mental health (e.g. Benston, 2015; Pearson, Montgomery, and Locke 2009), physical health (e.g. Henwood et al.…”
MethodImpact of the MeckFUSE Pilot Project: Recidivism Among the Chronically Homeless
Listwan, S. J., Hartman, J. L., & LaCourse, A. (2018) · Justice Evaluation Journal · doi:10.1080/24751979.2018.1478236 · Cited by 12
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West, S., Patterson, D. A., Mastronardi, A. M., Brown, K., & Sturm, R. (2014) · Journal of Poverty · doi:10.1080/10875549.2014.923964 · Cited by 8
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“While supportive housing is increasingly viewed as an effective and cost efficient way to provide permanent, affordable housing for populations at risk of homelessness (Lipton et. al. 2000; Culhane et al. 2002), community opposition to the developments can be fierce.”
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Sick Enough? Mental Illness and Service Eligibility for Homeless Individuals at the Border
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“Other research is framed around how to best provide housing for the homeless, focusing on the effectiveness of the “housing first” philosophy (Padgett et al. 2016; Chen 2019), while others point to the cost-effectiveness of prioritizing homeless populations with disabilities (Culhane et al. 2002).”
BackgroundHas the US Child Welfare System Become an Informal Income Maintenance Programme? A Literature Review
Conrad, A. R., Gamboni, C., Johnson, V. J., Wojciak, A., & Ronnenberg, M. (2020) · Child Abuse Review · doi:10.1002/car.2607 · Cited by 8
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“The cost effectiveness of supportive housing, moreover, is well documented (Culhane et al., 2002; Pomeroy, 2005, 2007; Trainor et al., 2013).”
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Creating a Regional Model to Coordinate and Prioritize Access to Permanent Supportive Housing
Sylla, L., Franzen, R., Srebnik, D., Hoffman, M., & Shoenfeld, A. (2017) · Journal of Behavioral Health Services & Research · doi:10.1007/s11414-016-9527-6 · Cited by 8
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Faith, J., Panzarella, C., Spencer, R. C., Williams, C., Brewer, J., & Covone, M. (2010) · Journal of Behavioral Health Services & Research · doi:10.1007/s11414-008-9135-1 · Cited by 8
“Homelessness increases risks of incarceration and further hospitalization.(14) Performance-based contracting was initially undertaken to correct inefficiencies pertaining to occupancy and was later expanded to include client outcomes (e.”
BackgroundMiller‐Archie, S. A., Walters, S., Bocour, A., Moore, M. S., Wiewel, E. W., Singh, T., & Lim, S. (2022) · The Journal of Infectious Diseases · doi:10.1093/infdis/jiac292 · Cited by 7
The Role of Debt in the Maintenance of Homelessness
Maguire, N. (2022) · Frontiers in Public Health · doi:10.3389/fpubh.2021.810064 · Cited by 7
Parpouchi, M., Moniruzzaman, A., Buxton, J. A., & Somers, J. M. (2021) · Scientific Reports · doi:10.1038/s41598-021-96186-x · Cited by 5
Huffman, T., Leier, C., Generous, M. A., Hinrichs, M., & Brenneman, L. (2021) · doi:10.1080/00909882.2020.1839119 · Cited by 7
“Program types that better address the barriers include permanent supportive housing (Culhane et al., 2002), transitional jobs (Bloom et al., 2007), customized employment (Lehman et al., 2002), vocational rehabilitation (Draine et al., 2002), and social enterprises (Ferguson, 2007), among others.”
BackgroundPrioritizing Which Homeless People Get Housing Using Predictive AlgorithmsPreprint
Toros, H. (2017) · SSRN Electronic Journal · doi:10.2139/ssrn.2960410 · Cited by 5
“Cost savings from providing PSH to homeless people with mental disorders was shown to be substantial (Culhane, Metraux, and Hadley, 2002; Gilmer et al., 2009; Larimer et al., 2009; McLaughlin, 2011; Sadowski et.al, 2009).”
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Guest Editorial: The Promise of Homelessness Prevention
Moses, D. J., Kresky-Wolff, M., Bassuk, E. L., & Brounstein, P. J. (2007) · The Journal of Primary Prevention · doi:10.1007/s10935-007-0101-0 · Cited by 6
“Culhane et al. (2002) found that homeless people with severe mental illness used $40,451 per person, per year in services, which is seen by many as a conservative estimate.”
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“In one of the few supported housing outcome studies that examines criminal justice measures, Culhane, Metraux, and Hadley (2002) not only found that individuals placed in NY/NY housing had markedly reduced shelter use and hospitalization compared to a matched control group of individuals not placed…”
BackgroundLong-term and Recurrent Homelessness Among Women
Pleace, N., Bretherton, J., & Mayock, P. (2016) · Palgrave Macmillan UK eBooks · doi:10.1057/978-1-137-54516-9_9 · Cited by 7
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“…(Skeem et al., 2006 ; Tsemberis, Gulcur, & Nakae, 2004 ) ; reducing days in state mental hospitals, public city hospitals, jails, and prisons (Culhane et al., 2002 ) ; and improving mental health and abstinence (Gonzales & Rosenheck, 2002 ; Greenwood, Schaefer-McDaniel, Winkel, & Tsemberis,…”
Evaluation of New York/New York III permanent supportive housing program
Gouse, I., Walters, S., Miller‐Archie, S. A., Singh, T., & Lim, S. (2023) · Evaluation and Program Planning · doi:10.1016/j.evalprogplan.2023.102245 · Cited by 8
Developing an Implementation Typology of Moving On Initiatives
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Housing Is Mental Health Care: A Call for Medicaid Demonstration Waivers Covering Housing.
Mathis, J. (2020) · Psychiatric Services · doi:10.1176/appi.ps.202000252 · Cited by 6
Tiny Homes Are Huge for People Living With Serious Mental Illness
Wilson, A. B., Mahadevan, T., Villodas, M. L., Rodriguez, M. Y., Bailliard, A., & Cuddeback, G. S. (2020) · Research on Social Work Practice · doi:10.1177/1049731520961448 · Cited by 9
“This work has resulted in the development of permanent supportive housing, a service model that has proven effective at providing the services and supports that people living with SMI need to live independently in their communities (Culhane et al., 2002; Nelson, 2010; Tsemberis et al., 2004).”
BackgroundMiterko, P., & Bruna, S. P. (2020) · Housing and Society · doi:10.1080/08882746.2020.1818049 · Cited by 7
“Tsemberis & Eisenberg, 2000) as well as PSH to be more cost effective than allowing individuals experiencing chronic homelessness to remain unhoused (Culhane et al., 2002).”
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“As a further extension of this research, shelter data have been merged with data from multiple public service systems to show the cost-effectiveness of providing services-enriched housing for the most difficult to serve and disabled homeless persons (Culhane et al. 2002).”
MethodSelf-citationBest value, cost-effectiveness and local housing policies
Jones, C., & Pawson, H. (2009) · doi:10.1080/01442870902899970 · Cited by 6
“2001, Culhane et al. 2002). Pinkney and Ewing (2006) suggest that such a pathways approach provides a basis for evaluating cost-effectiveness of homeless prevention. This approach, emphasising the interdependency of structural and individual factors, was also proposed for an extensive research programme in Australia b…”
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Economic impact of faith-based residential addiction recovery for the homeless.
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“Published materials from HUD cited work by Culhane, Metraux, and Hadley (2002) showing the disproportionate costs to the homeless service system that individuals who are chronically homeless represent.”
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Culhane, D., Fitzpatrick, S., & Treglia, D. (2020) · Using Evidence to End Homelessness · doi:10.51952/9781447354109.ch007 · Cited by 5
“Thus, investment in more robust primary evaluations – both quantitative (‘experimental’) and qualitative (‘realistic’) in nature – needs to be a priority in the UK and elsewhere.”
Self-citationCost Savings of Housing First in a Non-Experimental Setting
Jadidzadeh, A., Falvo, N., & Dutton, D. J. (2020) · Canadian Public Policy · doi:10.3138/cpp.2019-017 · Cited by 7
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The New York City Mental Health Needs Assessment Study (MHNAS): Objectives, design, and methods
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Keep Your Sunny Side: A Street-Level Look at Homelessness
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“These costs include jail, shelter, emergency room visits and psychiatric services [33].”
BackgroundSocial Work Practice with Reentry from Incarceration
Kenemore, T. K. (2014) · Springer eBooks · doi:10.1007/978-1-4614-6681-9_15 · Cited by 5
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Modeling Health and Economic Outcomes of Providing Stable Housing to Homeless Adults With OUD
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Exchanging Housing Dollars for Health Care Savings: The Impact of Housing First on Health Care Costs
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“…and research centers from 2002 onward in New York, Oregon, Massachusetts, Maine, California, Rhode Island, and Illinois (Bamberger & Considine-Cortelyou, 2008; Culhane et al., 2002; Hirsch et al., 2008; Linkins et al., 2008; MHSA, 2007; Mondello et al., 2007; Moore, 2006; Nogaski et al., 2009).”
Facilitators and Barriers to Reunification Among Housing Unstable Families
Bai, R., Collins, C. C., Fischer, R. L., & Crampton, D. (2023) · Children and youth services review · doi:10.1016/j.childyouth.2023.106876 · Cited by 4
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“…coupled with permanent housing and other supportive services, furniture provisions may help secure cost savings through their positive influence on tenancy sustainment (Culhane & Byrne, 2010; Culhane et al., 2002; Kenway & Palmer, 2003; National Alliance to End Homelessness, 2017; Pleace, 2015).”
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Using Administrative Data for Research on Homelessness: Applying a US Framework to Australia
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Social services in interim housing programs and shelters
Sosin, M. R., George, C. C., & Grossman, S. F. (2012) · Housing Policy Debate · doi:10.1080/10511482.2012.697911 · Cited by 2
“2009 ), and may be effective (Culhane, Metraux, and Hadley 2002 ; Gulcur et al.”
BackgroundSERVICE CONTENT AS A DETERMINANT OF HOMELESS ADULTS’ PERCEPTIONS OF PROGRAM EFFICACY
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How Shall We Promote Citizenship and Social Participation?
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“Reductions are found as well in overall service use, including public shelters, public hospitals, Medicaid-funded services, veterans ’ inpatient services, psychiatric inpatient services, prisons and jails (Culhane et al., 2002a, 2002b).”
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Readiness assessments in moving on initiatives: a scoping review
Goodwin, J. M., Tiderington, E., & Noonan, E. (2021) · Journal of Social Distress and the Homeless · doi:10.1080/10530789.2021.1995938 · Cited by 2
“Evidence points to the cost savings of supportive housing compared to emergency shelter, hospitalizations, and average time incarcerated (Culhane et al., 2002).”
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Sitting in the waiting room: do people experiencing homelessness underutilize health services?
Scutella, R., Wood, G., & Johnson, G. (2020) · Housing and Society · doi:10.1080/08882746.2020.1835116 · Cited by 3
“…are heavy users of acute and emergency health services that aid survival strategies, but underutilize mental health or drug and alcohol services that could accelerate transitions out of homelessness (Culhane et al., 2002; D’Amore et al., 2001; Padgett et al., 1990, 1995; Kushel et al., 2002).”
BackgroundExamining the risk factors and needs of veterans involuntarily doubling-up with family or friends
Cusack, M. C., & Montgomery, A. (2019) · Housing and Society · doi:10.1080/08882746.2019.1650602 · Cited by 3
Where Has Housing Policy Debate Been?
Sanchez, T. W. (2015) · doi:10.1080/10511482.2015.1006030 · Cited by 3
Building Public Will: The Battle for Affordable—and Supportive—Housing
Ryan, C. M., Jeffreys, K., Ryczek, J., & Diaz, J. (2014) · Journal of Poverty · doi:10.1080/10875549.2014.923967 · Cited by 3
The Financial Viability of Housing for Mentally Ill Persons
Harkness, J., Newman, S., Galster, G., & Reschovsky, J. (2004) · Housing Policy Debate · doi:10.1080/10511482.2004.9521497 · Cited by 3
Housing for People with Serious Mental Illness
Leopold, J. (2019) · The Palgrave Handbook of American Mental Health Policy · doi:10.1007/978-3-030-11908-9_14 · Cited by 3
System Change Accomplishments of the Corporation for Supportive Housing's Returning Home Initiative
Fontaine, J., Roman, C. G., & Burt, M. (2010) · doi:10.1037/e718912011-001 · Cited by 3
“Although the existing target population for supportive housing—people with a history of homelessness, mental illness, and other disabilities—may also have a history of incarceration (Culhane et al. 2002; Metraux and Culhane 2004, 2006; Zugazawa 2004), the RHI focuses on people who cycle between incarceration and homel…”
BackgroundMcLaughlin, T. C. (2011) · Research on Social Work Practice · doi:10.1177/1049731510387307 · Cited by 2
“In a fourth study, Culhane et al. (2002) found that cost-saving reductions in the use of public services occurred when people with mental illness were housed in supportive housing projects.”
BackgroundInfluentialPassetti, L. L., Ramey, J. S., Hunter, B. D., & Godley, M. D. (2023) · Journal of Evidence-Based Social Work · doi:10.1080/26408066.2023.2202663 · Cited by 2
The impact of Housing First participation on police-reported crime and crime severity
Jadidzadeh, A., MacLellan, C., Kneebone, R., & Dutton, D. J. (2022) · Journal of Social Distress and Homelessness · doi:10.1080/10530789.2022.2047438 · Cited by 2
“Early evidence from New York City indicates that the cost of shelter for HF individuals was nearly completely o ff set by savings from reduced health care system utilization (Culhane, Metraux, & Hadley, 2002).”
BackgroundPsychological well‐being among at‐risk young adult Arabs in Israel
Sulimani‐Aidan, Y. (2021) · Health & Social Care in the Community · doi:10.1111/hsc.13688 · Cited by 4
“Making It Work”: Accommodation and Resistance to Federal Policy in a Homelessness Continuum of Care
Frank, J. M., & Baumohl, J. (2021) · Social Service Review · doi:10.1086/715928 · Cited by 4
Stenius-Ayoade, A., Eriksson, J. G., Kautiainen, H., Gissler, M., & Haaramo, P. (2019) · Scandinavian Journal of Public Health · doi:10.1177/1403494819854008 · Cited by 2
“there are some data showing that supportive housing reduces the use of hospital [9-11] and ED [8,10–12,17] services, but this association between supportive housing and health care service use has not been reported in all studies [5,13].”
BackgroundWalter, R. J., Caudy, M. S., Salcido, C. G., Ray, J. V., & Viglione, J. (2020) · Housing Theory and Society · doi:10.1080/14036096.2020.1754899 · Cited by 2
“Housing assistance has been linked to reduced rates of hospitalization, time incarcerated, recidivism, and correctional costs (Burt and Anderson 2005; Clifasefi, Malone, and Collins 2013; Culhane, Metraux, and Hadley 2002; Hamilton, Kigerl, and Hays 2015).”
BackgroundSupporting vulnerable households to achieve their housing goals: the role of impact investment
Heaney, R., Flatau, P. R., Muir, K., North, G., Ward-Christie, L., Webb, E., & Zaretzky, K. (2017) · AHURI Final Report · doi:10.18408/ahuri-821031 · Cited by 2
Policy essay on “Policing the Homeless
Rowe, M., & O'Connell, M. (2010) · Criminology & Public Policy · doi:10.1111/j.1745-9133.2010.00678.x · Cited by 2
Homelessness in Western Cities
Zufferey, C. (2016) · Palgrave Macmillan UK eBooks · doi:10.1057/978-1-137-51623-7_9 · Cited by 2
Farrell, D. C. (2013) · Springer eBooks · doi:10.1007/978-1-4614-6681-9_16 · Cited by 1
Policies to Address Homelessness: Housing First Approaches
Stanhope, V., Padgett, D., & Henwood, B. (2012) · Elsevier eBooks · doi:10.1016/b978-0-08-047163-1.00356-8 · Cited by 2
Policymaking and Caseload Dynamics: Homeless Shelters
McAllister, W., & Berlin, G. L. (2004) · doi:10.7916/d8c53sq7 · Cited by 2
“See Culhane et al 2002).”
Health and Economic Impacts of Stable Housing Provision for Older Adults
Gande, V., Goldhaber‐Fiebert, J. D., & Brandeau, M. L. (2026) · JAMA Health Forum · doi:10.1001/jamahealthforum.2026.0624 · Cited by 1
Maddock, L., & Pena, A. A. (2026) · Southern Economic Journal · doi:10.1002/soej.70031 · Cited by 1
Do Medicaid Expenditures Increase After Adults Exit Permanent Supportive Housing?
Cole, E., Hollander, M., Ennis, M., Donohue, J., James, A., & Roberts, E. (2022) · Housing Policy Debate · doi:10.1080/10511482.2022.2112609 · Cited by 1
“Observational studies have found PSH to be associated with reductions in inpatient, ED, and behavioral healthcare utilization, as well as fewer days of incarceration (Bamberger & Dobbins, 2014; Basu et al., 2012; Culhane et al., 2002; Larimer et al., 2009; Sadowski et al., 2009).”
BackgroundEVSİZLİK SORUNUNA İNSANİ BİR BAKIŞ VE ÇÖZÜM ÖNERİSİ: ''ÖNCE KONUT YAKLAŞIMI''
Korkmaz, A., Öçal, M., & Kutlu, Ö. (2022) · Mehmet Akif Ersoy Üniversitesi İktisadi ve İdari Bilimler Fakültesi Dergisi · doi:10.30798/makuiibf.1097609 · Cited by 1
Lessons in “Slow” Engagement From Staff and Administrators at a Prebooking Jail Diversion Program
Myers, N., Hutnyan, M., Wright, G., Lee, G., Woodward, P., Wilkey, J., Young, W., & Bromley, E. (2022) · Psychiatric Services · doi:10.1176/appi.ps.202100317 · Cited by 2
Signification and Performance Measurement: Making Sense of Mandated Performance Objectives
Fenley, V. M. (2021) · Public Administration Quarterly · doi:10.37808/paq.45.3.1 · Cited by 1
“…homelessness can result in a reduction in the use of more expensive emergency services, such as emergency departments, jails, and homeless shelters (Culhane, Metraux, & Hadley, 2002; Perlman & Parvensky, 2006; Mondello, M., Gass, A. B., McLaughlin, T., & Shore, N., 2007; Larimer et al., 2009;…”
Background
Metadata
- Authors
- Culhane, D. P., Metraux, S., & Hadley, T.
- Affiliations
- University of Pennsylvania (US)
- Venue
- Housing Policy Debate
- Publisher
- Informa UK Limited
- Published
- 2002-01
- Volume
- 13
- Issue
- 1
- Pages
- 107-163
- ISSN
- 1051-1482 (ISSN-L)
- 2152-050X
- OpenAlex
- W2118672011
- Cited by
- 515
- References
- 0
- Citations by year
- 2026: 7 · 2025: 7 · 2024: 16 · 2023: 10 · 2022: 12 · 2021: 30 · 2020: 32 · 2019: 23 · 2018: 20 · 2017: 54 · 2016: 21 · 2015: 30 · 2014: 26 · 2013: 30 · 2012: 33
- FWCI
- 34.04
- Type
- journal article
- Language
- en
- Open access
- green
- repository.upenn.edu
- Locations
- Housing Policy Debate (publishedVersion)
- Scholarly Commons (University of Pennsylvania) (submittedVersion)
- ScholarlyCommons (University of Pennsylvania) (submittedVersion)
- Topics
- Social Sciences › Sociology and Political Science › Homelessness and Social Issues
- Social Sciences › Urban Studies › Urban and Rural Development Challenges
- Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
- Keywords
- homeless people, severe mental illness, supported housing, public service utilization, shelter use, hospitalization, incarceration, cost-benefit analysis, public investment, New York City
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