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Chronic homelessness is a highly complex social problem of national importance. The problem has elicited a variety of societal and public policy responses over the years, concomitant with fluctuations in the economy and changes in the demographics of and attitudes toward poor and disenfranchised citizens. In recent decades, federal agencies, nonprofit organizations, and the philanthropic community have worked hard to develop and implement programs to solve the challenges of homelessness, and progress has been made. However, much more remains to be done. Importantly, the results of various efforts, and especially the efforts to reduce homelessness among veterans in recent years, have shown that the problem of homelessness can be successfully addressed. Although a number of programs have been developed to meet the needs of persons experiencing homelessness, this report focuses on one particular type of intervention: permanent supportive housing (PSH). Permanent Supportive Housing focuses on the impact of PSH on health care outcomes and its cost-effectiveness. The report also addresses policy and program barriers that affect the ability to bring the PSH and other housing models to scale to address housing and health care needs.
Accessible and affordable housing can enable community living, maximize independence, and promote health for vulnerable populations. However, the United States faces a shortage of affordable and accessible housing for low-income older adults and individuals living with disabilities. This shortage is expected to grow over the coming years given the population shifts leading to greater numbers of older adults and of individuals living with disabilities. Housing is a social determinant of health and has direct effects on health outcomes, but this relationship has not been thoroughly investigated. In December 2016, the National Academies of Sciences, Engineering, and Medicine convened a public workshop to better understand the importance of affordable and accessible housing for older adults and people with disabilities, the barriers to providing this housing, the design principles for making housing accessible for these individuals, and the features of programs and policies that successfully provide affordable and accessible housing that supports community living for older adults and people with disabilities. This publication summarizes the presentations and discussions from the workshop.
Estimates indicate that as many as 1 in 4 Americans will experience a mental health problem or will misuse alcohol or drugs in their lifetimes. These disorders are among the most highly stigmatized health conditions in the United States, and they remain barriers to full participation in society in areas as basic as education, housing, and employment. Improving the lives of people with mental health and substance abuse disorders has been a priority in the United States for more than 50 years. The Community Mental Health Act of 1963 is considered a major turning point in America's efforts to improve behavioral healthcare. It ushered in an era of optimism and hope and laid the groundwork for the consumer movement and new models of recovery. The consumer movement gave voice to people with mental and substance use disorders and brought their perspectives and experience into national discussions about mental health. However over the same 50-year period, positive change in American public attitudes and beliefs about mental and substance use disorders has lagged behind these advances. Stigma is a complex social phenomenon based on a relationship between an attribute and a stereotype that assigns undesirable labels, qualities, and behaviors to a person with that attribute. Labeled individuals are then socially devalued, which leads to inequality and discrimination. This report contributes to national efforts to understand and change attitudes, beliefs and behaviors that can lead to stigma and discrimination. Changing stigma in a lasting way will require coordinated efforts, which are based on the best possible evidence, supported at the national level with multiyear funding, and planned and implemented by an effective coalition of representative stakeholders. Ending Discrimination Against People with Mental and Substance Use Disorders: The Evidence for Stigma Change explores stigma and discrimination faced by individuals with mental or substance use disorders and recommends effective strategies for reducing stigma and encouraging people to seek treatment and other supportive services. It offers a set of conclusions and recommendations about successful stigma change strategies and the research needed to inform and evaluate these efforts in the United States.
Housing has emerged as a popular and central topic of research, mental health system development, and social and mental health policy in recent years. The field has rapidly evolved in a number of ways: first, with the introduction and popularization of the Housing First approach; second, there are now a growing number of randomized controlled studies to evaluate the lives of people living in this housing; and third, there is increasing recognition of housing as a cornerstone of mental health policy and community mental health systems. Housing, Citizenship, and Communities for People with Serious Mental Illness provides the first comprehensive overview of the field. The book covers theory, research, practice, and policy issues related to the provision of housing and the supports that people rely on to get and keep their housing. A special focus is given to issues of citizenship and community life as key outcomes for people with serious mental illness who live in community housing. The book is grounded in the values, research traditions, and conceptual tools of community psychology. This provides a unique lens through which to view the field. It emphasizes housing not only as a component of community mental health systems but also as an instrument for promoting citizenship, social inclusion, social justice, and the empowerment of marginalized people. It serves as a resource for researchers, practitioners, and policy-makers looking for up-to-date reviews and perspectives on this field, as well as a sourcebook for current and future research and practice trends.
Volume numbers determined from Scope of the guidelines, p. 12-13.
In the devastation that follows a major disaster, there is a need for multiple sectors to unite and devote new resources to support the rebuilding of infrastructure, the provision of health and social services, the restoration of care delivery systems, and other critical recovery needs. In some cases, billions of dollars from public, private and charitable sources are invested to help communities recover. National rhetoric often characterizes these efforts as a "return to normal." But for many American communities, pre-disaster conditions are far from optimal. Large segments of the U.S. population suffer from preventable health problems, experience inequitable access to services, and rely on overburdened health systems. A return to pre-event conditions in such cases may be short-sighted given the high costs - both economic and social - of poor health. Instead, it is important to understand that the disaster recovery process offers a series of unique and valuable opportunities to improve on the status quo. Capitalizing on these opportunities can advance the long-term health, resilience, and sustainability of communities - thereby better preparing them for future challenges. Healthy, Resilient, and Sustainable Communities After Disasters identifies and recommends recovery practices and novel programs most likely to impact overall community public health and contribute to resiliency for future incidents. This book makes the case that disaster recovery should be guided by a healthy community vision, where health considerations are integrated into all aspects of recovery planning before and after a disaster, and funding streams are leveraged in a coordinated manner and applied to health improvement priorities in order to meet human recovery needs and create healthy built and natural environments. The conceptual framework presented in Healthy, Resilient, and Sustainable Communities After Disasters lays the groundwork to achieve this goal and provides operational guidance for multiple sectors involved in community planning and disaster recovery. Healthy, Resilient, and Sustainable Communities After Disasters calls for actions at multiple levels to facilitate recovery strategies that optimize community health. With a shared healthy community vision, strategic planning that prioritizes health, and coordinated implementation, disaster recovery can result in a communities that are healthier, more livable places for current and future generations to grow and thrive - communities that are better prepared for future adversities.
"This is a terrific book―moving, clear, and compassionate. It not only illustrates the way psychiatric illness is shaped by culture, but also suggests that social environments can be used to improve the course and outcome of the illness. Well worth reading." — T. M. Luhrmann, author of Of Two Minds: An Anthropologist looks at American Psychiatry Bethel House, located in a small fishing village in northern Japan, was founded in 1984 as an intentional community for people with schizophrenia and other psychiatric disorders. Using a unique, community approach to psychosocial recovery, Bethel House focuses as much on social integration as on therapeutic work. As a centerpiece of this approach, Bethel House started its own businesses in order to create employment and socialization opportunities for its residents and to change public attitudes toward the mentally ill, but also quite unintentionally provided a significant boost to the distressed local economy. Through its work programs, communal living, and close relationship between hospital and town, Bethel has been remarkably successful in carefully reintegrating its members into Japanese society. It has become known as a model alternative to long-term institutionalization. In A Disability of the Soul, Karen Nakamura explores how the members of this unique community struggle with their lives, their illnesses, and the meaning of community. Told through engaging historical narrative, insightful ethnographic vignettes, and compelling life stories, her account of Bethel House depicts its achievements and setbacks, its promises and limitations. A Disability of the Soul is a sensitive and multidimensional portrait of what it means to live with mental illness in contemporary Japan.