Communities across the United States face a deepening mental health and substance use crisis, characterized by high prevalence of complex behavioral health conditions, frequent co-occurrence of disorders, and persistent barriers to accessing services and treatment. In Denver, the Housing to Health supportive housing program seeks to improve health and other outcomes for residents who have experienced chronic homelessness, frequent arrests, and many unmet health care needs. This paper presents findings from a longitudinal survey and qualitative interviews with study participants, highlighting participant experiences with behavioral health services and recommendations for improving health and well-being in supportive housing programs.

Why This Matters

Although randomized controlled trials have shown that supportive housing can reduce emergency services use and increase outpatient care, relatively little research has examined how supportive housing residents perceive the effects of housing on their health and well-being. Our research suggests that supportive housing residents’ perceptions of health and well-being are more nuanced than administrative measures of health care utilization suggest. Better understanding these perspectives may improve engagement with mental health and substance use services and lead to stronger outcomes for residents and programs.

What We Found

Our research found the following:

• Interview participants described prolonged periods of living in “survival mode” which often led them to normalize trauma and deprioritize health care in favor of self-medication and basic survival needs.
• Once in housing, many study participants reported decreased alcohol consumption and substance use and a desire to leave those challenges behind. Many study participants reported increased access to and quality of mental health care and substance use treatment while in supportive housing.
• Many study participants interpreted an increase in health care services and a greater awareness of chronic conditions as a decline in well-being rather than a step toward recovery. This points to low levels of health literacy among PSH residents and the importance of health education.
• Many study participants emphasized that their sense of well-being is closely related to their goals of engaging in purposeful activity or volunteering, contributing to their communities, and having positive relationships. Even when grappling with health challenges, study participants reported strong psychological well-being. However, study participants who later left supportive housing for unplanned reasons reported the lowest psychological well-being at baseline.
• Trauma-informed approaches, health literacy, and resident-defined indicators of well-being—particularly purpose, optimism, and meaningful activities—are key ingredients for supportive housing programs that promote long-term stability and recovery.

How We Did It

We administered a longitudinal survey over two years and conducted qualitative interviews with residents in Denver’s Housing to Health supportive housing program. We surveyed 90 residents at baseline, 54 residents one year after entering housing, and 32 residents two years after entering housing. To understand conditions at baseline, we present summary statistics among everyone who completed the baseline survey. To understand changes in resident responses over time, we present summary statistics among the subsample of residents who completed all three surveys and paired t-tests to determine statistical significance in changes across surveys. We also conducted 20 qualitative interviews with residents who had spent at least a year in supportive housing. We coded interviews and used emergent analysis to produce the qualitative themes described in this report. The surveys, all survey results, and the interview guide, are available in the report’s appendices.