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Providing housing and supports for people with psychiatric disabilities, particularly those who are homeless, is a major public policy challenge. This article summarizes the ways in which the concept of these needs is rapidly shifting in the mental health field. The article is based on research on the effectiveness of non-facilitybased community support and rehabilitation approaches, the findings of other disability fields, and the emergence of mental health consumers" own preferences for expanded choices, normal housing, and more responsive services, including consumer-operated services. These new sources of knowledge are facilitating a paradigm shift in which people with psychiatric disabilities are no longer seen as hopeless, or merely as service recipients, but rather as citizens with a capacity for full community participation and integration.August 1990 ° American Psychologist

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This article presents a conceptual and historical overvi ew of residential servi ces for individuals with psychiatric disability and chal l enges the appropriateness and effecti veness of the "continuum of services" model. The authors propose that the goal of residential servi ces should be to assi st all peopl e with psychiatric disabilities to choose, get, and keep normal housing and that rehabilitation technology is currently available to accomplish this goal. Data are presented that indicate that despite high costs, most state mental health systems are continuing to make large scal e i nvestments in facility-based residential programs.A living situation that feels like home is often a primary source of stability and security in our lives. Nest-building is a powerful instinct; most people in the world today spend a great deal of time selecting their dwelling space, customizing and decorating, and establishing rules for relating to neighbors. Unfortunately, mental health professionals have generally overlooked the importance of these factors for people with psychiatric disabilities. Only recently have we begun to recognize that until people's housing needs are met, other treatment or rehabilitation interventions are seriously jeopardized .The history of mental health services shows a persistent disregard for the need of persons with psychiatric disability to choose housing alternatives consistent with their personal desires or goals. For almost 200 years (from the late 1700s to the mid-1900s), institutionalization was the dominant social response to people with deviant behavior. The assumption underlying institutional services (whether they were called "asylums," "state hospitals," or "mental health institutes") was that people with acute mental illness would be treated, cured, and sent home, and that people with chronic mental illness would receive custodial services, probably forever. In neither case was it the responsibility of mental health professionals to worry about where or how a client was to find normal, stable housing.

This article summarizes current thinking in the field about the types of housing environments which are most relevant both to the overall goal of community integration, and to the variety of specific support needs of individuals with psychiatric disabilities. Within the context of a "supported housing" approach, which focuses on maximizing consumers choices and preferences, using integrated regular housing stock, and making a full array of community supports available, the authors propose a number of specific criteria which can be useful to community mental health organizations in planning for, or selecting housing.