"Housing is a fundamental human right, but a roof over one's head is not enough" – Dissertation sheds new light on issues in mental health rehabilitation housing services
The study examined the development of housing service use over a 23-year period. The analysis revealed that the use of housing services increased at a similar pace as the reduction in psychiatric hospital beds. As the decrease in hospital beds slowed down, the use of lightly supported housing services continued to rise. At the same time, outpatient psychiatric visits also increased, but not nearly enough to compensate for the reduction in hospital beds.
“The reduction of psychiatric hospital beds and the expansion of outpatient care have been topics of discussion for a long time. However, it now seems that the resources for outpatient care have been insufficient, and housing services are being used to fill the gaps in treatment,” Jahangiri notes.
Mental health rehabilitation housing services (ASPA) were developed in response to the downsizing of psychiatric hospital care to ensure that patients suffering from severe mental health issues would continue to receive the support, care, and rehabilitation they need in outpatient settings. Despite these services being available for decades, there is little evidence-based data on their rehabilitative impact, and very few studies have focused on their actual effectiveness.
Few transitioned to lighter services
As part of his doctoral research, Jahangiri conducted a unique field study in Porvoo (the Porvoo ASPA Project), which, for the first time, allowed for the examination of the rehabilitative impact of housing services in a longitudinal study setting.
“Unfortunately, the conclusion was that only one-fifth of the residents were able to transition to lighter services. This is a concerning result, as the purpose of housing services is to rehabilitate individuals back to more independent living. It now seems that these services have become somewhat more custodial, with less rehabilitation occurring than expected,” says Jahangiri.
The Porvoo ASPA Project also allowed for the first-time testing of the international STAX-SA housing service classification system in Finland. This system classifies housing services based on the level of support they provide. STAX-SA is an important tool for evaluating service effectiveness, as it enables international comparative research. According to the findings, STAX-SA works well for classifying more intensive service housing and communal living arrangements, but is less suited to categorizing services that offer minimal support, such as supported and semi-supported housing. Jahangiri suggests that the classification system should be further developed to better measure these lighter forms of services, as they are the ones that have seen the most significant growth.
Jahangiri emphasizes that multidisciplinary collaboration is essential for improving housing services. He highlights that cooperation between professionals from different fields is crucial for effectively supporting residents.
"Housing is a fundamental human right, but a roof over one's head is not enough. As a society, we need to invest significantly more in the rehabilitation of mental health patients to give them the opportunity for a more independent and better life. Moreover, the long-term effectiveness of these services requires further research and development,” Jahangiri stresses.
Read more about the thesis defence