Permanent supportive housing (PSH) is an evidence-based practice for adults with serious mental illness (SMI) that has been implemented, refined, and studied for more than three decades. A notable subset of individuals with SMI are unstably housed or are homeless and, as a result, have poor behavioral health outcomes and are high utilizers of costly treatment and criminal justice resources. Multiple peer-reviewed research studies, including eight randomized controlled trials, have found that PSH is particularly effective in improving participant’s housing stability and reducing their emergency department and inpatient hospital utilization.(*1)

The two core components of the PSH model are (1) affordable rental housing and (2) community-based supportive services designed to assist individuals with improving behavioral health conditions and maintaining housing. PSH is widely endorsed as a critical resource to prevent unnecessary institutional stays and facilitate discharges from institutions for persons with disabilities as required by the Americans with Disabilities Act, as interpreted by the U.S. Supreme Court’s Olmstead decision.

In state fiscal year 2020, the Virginia General Assembly appropriated more than $17 million to DBHDS to fund permanent supportive housing for very low-income individuals with SMI. DBHDS adopted evidence-based practice standards for Permanent Supportive Housing from the federal Substance Abuse and Mental Health Services Administration (SAMHSA) to define the program model, operating standards, and evaluation framework for Virginia’s PSH program.

This report describes key characteristics of the program and its participants as well as statewide outcomes for the 950 individuals who were housed between February 6, 2016 and July 1, 2019.

Findings in this report support the value of investment in PSH for this population:

• One hundred forty-seven individuals were discharged from a state behavioral health hospital into DBHDS PSH, and overall, 228 individuals in PSH had a state hospital admission in the year before move-in.

• At least 95 individuals served in PSH were on the extraordinary barrier list (EBL) in the year before move-in.

• PSH providers are effectively prioritizing individuals with extensive histories of homelessness and repeated, long-term use of institutional care before move-in.

• Eighty-six percent of individuals served in PSH remained stably housed.

• Only 6 percent of those served have been discharged to an institutional setting or higher level of care.

• State hospital utilization decreased 82 percent the year after PSH move-in, resulting in avoided costs of $9.5 million.

• A DBHDS cross-system cost impact analysis identified a 29 percent decrease in private hospital, state hospital, jail, and Community Services Board (CSB) costs after one year of PSH.

• After PSH costs were included in this analysis, a total cost reduction of $1,375 was identified for each individual housed.
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(*1) Center for Budget and Policy Priorities. (2016). Supportive Housing Helps Vulnerable People Live and Thrive in the Community. Retrieved from http://www.cbpp.org/research/housing/supportive-housing-helps-vulnerable-peoplelive-and-thrive-in-the-community#_ftn27