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 participants’ 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 2022, the Virginia General Assembly appropriated more than $34 million to the Department of Behavioral Health and Developmental Services (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 1,430 individuals who were housed between February 6, 2016 and June 30, 2022.

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

• Nearly half (49.1 percent) of PSH participants were hospitalized in a state psychiatric facility at some point in their lifetimes.

• 272 individuals were discharged from a state psychiatric hospital into DBHDS PSH, and overall, 359 individuals in PSH for at least twelve months had a state hospital admission in the year before move-in.

• 91 percent of individuals served in PSH remained stably housed for at least one year.

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

• State hospital utilization decreased by 76 percent the year after PSH move-in, resulting in avoided costs of $27.6 million.
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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-people-live-and-thrive-in-the-community#_ftn27