“It Is a Big Load Off a Person’s Mind When They Know They Got a Home to Go Home to”: Exploring Participant Experiences of Housing and Health In Permanent Supportive Housing (PSH)

Background & Purpose: Permanent Supportive Housing (PSH) is a promising intervention that utilizes a Housing First model to provide safe, stable, and affordable housing to individuals experiencing homelessness with co-occurring substance use and mental health challenges. PSH provides permanent housing subsidies, along with case management and voluntary access to comprehensive supportive services, to address needs and support recovery goals. Despite evidence of effectiveness for reducing homelessness and increasing housing stability, little is known about the effects on participant health and well-being, including facilitators and barriers to housing stability and health outcomes. This study addressed these knowledge gaps and aimed to answer the following research questions: 1) How do participants conceptualize connections between housing and health in the context of PSH?, and 2) What facilitators and barriers do PSH participants experience related to housing stability and health?

Methods: This study utilized in-depth, semi-structured qualitative interviews with PSH participants across six agencies (n=32). Participants were recruited with assistance from agency staff using purposive sampling strategies. Each participant was invited to participate in a one-hour audio-recorded interview. Interviews were transcribed verbatim. All interviews occurred between October 2025 and April 2026. Multicycle coding was utilized to identify common barriers to and facilitators of housing stability and health. Data analysis occurred in Atlas.ti version 25.

Results: Analysis of interview data indicated three themes related to housing and health: 1) housing as a stable foundation for recovery, 2) housing as a refuge from chronic stress, and 3) housing as a mechanism of empowerment. Many PSH participants described housing as the missing piece of the puzzle in their recovery journey, providing a necessary foundation for meeting their basic needs and providing stability for themselves and their families. Participants also described the process of transforming their housing unit into a home, conceptualizing home as a safe, calm, and peaceful space that offered protection from chronic stressors and supported their health. Participants viewed housing as both a material and symbolic resource, providing them with shelter and a sense of dignity, worth, and self-determination, empowering them to care for themselves and others. Despite these benefits, participants noted ongoing challenges to their housing stability, including search and lease-up processes characterized by constrained choice and urgency to resolve immediate housing crises (e.g., living on streets, overcrowding, intimate partner violence). For some, this resulted in satisficing their shelter - settling for lower quality housing in neighborhoods that jeopardized their housing stability and health. This included living in poor conditions (e.g., water damage, mold), experiencing landlord discrimination and surveillance, and being exposed to broader neighborhood-based adversities (e.g., community violence). Participants suggested enhancing access to supportive housing resources, improving landlord engagement, and creating pathways to homeownership as strategies to promote housing stability and health.

Conclusions & Implications: Findings suggest that participants conceptualize health effects of PSH as multidimensional and multilevel. Addressing structural and institutional barriers to housing access and stability represent promising targets for promoting health. Finally, findings suggest that additional work remains to democratize housing to support health for marginalized populations.