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. Individuals with SMI who are unstably housed or homeless have resulting poor behavioral health outcomes, and are high utilizers of costly treatment and criminal justice resources. PSH is particularly effective in improving participants’ housing stability and reducing emergency department and inpatient hospital utilization.(*1)

The two core components of the PSH model are (1) affordable rental housing that is leased by the tenant under standard terms and (2) community-based supportive services designed to improve behavioral health conditions and maintain 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 FY 2023, the Virginia General Assembly appropriated over $45 million to DBHDS to fund PSH for very low-income individuals with SMI. DBHDS adopted federal evidence-based practice standards for PSH 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 1,921 individuals who were housed between February 6, 2016 and June 30, 2023. Findings in this report support the value of investment in PSH for this population:

• Nearly half (48 percent) of PSH participants were hospitalized in a state psychiatric hospital at some point in their lifetimes.

• 293 individuals were discharged from a state psychiatric hospital into DBHDS PSH, and overall, 393 individuals in PSH for at least 12 months had a state hospital admission in the year before move-in.

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

• Only 9.6 percent of those served since program inception have been discharged to an institutional setting or higher level of care.

• State hospital utilization decreased 76 percent the year after PSH move-in, resulting in avoided costs of $30.4 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