“Housing is health care”: The impact of supportive housing on the costs of chronic mental illness

Some individuals with serious mental illness experience severe, long-term symptoms of their disease. They may lack insight into their condition, not adhere to treatment, and have high support needs, among other challenges. These individuals can be considered to have a chronic form of serious mental illness. Without appropriate treatment, support, and housing, they can experience recurrent crisis episodes, homelessness, and frequent interactions with emergency, criminal justice, and health systems, incurring great public expense.

This study examines how housing and in-home supports affect public spending on individuals with chronic mental illness in Maricopa County, Arizona. It does so through a comparative analysis of average costs per person per year across three housing settings: permanent supportive housing, housing with unknown in-home support, and chronic homelessness. Specifically, it analyzes costs for housing, health care, and criminal justice during the period of 2014-2019. It also features a small-sample (small-N) case study of a housing setting that provides individualized, 24/7 in-home support to individuals with chronic mental illness (CMI) who have high support needs, examining average costs per person before and after moving into that setting (2016-2019). Finally, the study outlines recommendations from interviews with dozens of experts who work with and care for individuals with CMI in Maricopa County about reducing costs and improving care.