Housing Attainment With the Psychiatric Assistance for Transitional Homelessness in Shelters Program

Importance: The prevalence of mental illness is high among homeless populations, yet traditional clinic-based care is often inaccessible. For urban areas where housing-first models are difficult to implement because of high costs, integrated on-site psychiatric services in shelters may offer a feasible alternative. Objective: To examine clinical and demographic factors associated with housing attainment among individuals experiencing homelessness with mental illness participating in an on-site psychiatric service program. Design, Setting, and Participants: This 5-year retrospective cohort study analyzed data collected from October 2019 to October 2024. The study was conducted at the only public temporary shelter in Taipei, Taiwan. A sample of individuals with mental illness who voluntarily joined the program was identified. Exposure: Participants received integrated on-site psychiatric care through the Psychiatric Assistance for Transitional Homelessness in Shelters (PATHS) program, which included psychiatric assessment, pharmacological treatment, access to social welfare, and referrals for psychiatric hospitalization, all delivered within the shelter setting. Main Outcomes and Measures: The primary outcome was housing attainment, defined a priori as relocation to residential psychiatric rehabilitation facilities, original family, or rental house upon shelter exit. Categorical variables were compared using χ2 and Fisher exact tests. Results: Of 231 individuals initially identified, 3 individuals who died and 20 who remained in the shelter at the end of the study were excluded. Among the 208 included participants (90.0% of the initial sample; median IQR age, 54.0 44.3-62.0 years; 154 male 74.0%), alcohol use disorder predominated among men, whereas women had a higher prevalence of schizophrenia. Overall, 97 participants (46.6%) attained housing. Older age was significantly associated with housing attainment (odds ratio OR, 1.03; 95% CI, 1.01-1.05; P = .04). In contrast, alcohol use disorder (OR, 0.54; 95% CI, 0.29-0.99; P = .045) and opioid or methamphetamine use disorders (OR, 0.29; 95% CI, 0.14-0.62; P = .001) were associated with lower likelihood of housing attainment. Conclusions and Relevance: In this retrospective cohort study of 208 homeless individuals with mental illness, on-site psychiatric services provided a framework for bridging the gap between transitional shelters and housing attainment. These findings suggest that transitioning from universal models toward individualized interventions is essential to address the diverse needs of this population and improve housing success.