Delivering Mental Healthcare Within Supportive Housing

The YWCA Elm Centre is a not-for-profit housing complex with 300 mixed housing units for women and gender diverse people and their children. In partnership with Women’s College Hospital (WCH), they added collaborative psychiatric care to the existing WCH-YWCA primary care collaboration to address mental healthcare needs within the supportive housing setting.  Prior to this, there was no formal collaboration between a psychiatrist and the YWCA.

The paper, titled Delivering collaborative mental health care within supportive housing: implementation evaluation of a community-hospital partnershipexamines how adding a psychiatrist to existing support services for housing, community mental health and primary care, can make a difference in supportive housing settings.

This paper was recently recognized internationally.

We spoke to several of the team members, including WCH’s Dr Lucy Barker, a scientist and psychiatrist who led the evaluation, WCH’s Dr. Sheila Wijayasinghe, a family physician who leads the primary care collaboration, as well as YWCA’s Danielle Nakouz, to hear their perspectives on the importance of this partnership in addressing unmet mental health needs in permanent supportive housing settings.

What are potential challenges that may happen if mental health support isn’t provided in permanent housing support settings?

Danielle Nakouz (YWCA): All too often, hospital settings feel inaccessible to those who are most vulnerable and have high acuity needs. The concern is that without pilots or programs such as this, tenants who are experiencing mental health complexity will continue to deteriorate to the point of impacting their tenancies.

What are the benefits of integrating mental health support services within supportive housing settings?

Dr. Barker (WCH): There’s a huge need for mental health supports within supportive housing settings. And it’s important that people have a wide range of options to be able to meet their needs. We wanted to ensure that there was a collaboration in place so that the staff working in supportive housing would have additional support and connections to resources, and that the tenants would ultimately be better supported.

Danielle Nakouz (YWCA): This model was particularly important to our program as it acted as a critical eviction prevention measure for tenants whose mental health complexity manifests in their tenancies, making them very vulnerable to housing instability. It’s widely understood that if mental health interventions are successful, then there is a reduction of cost and pressure on healthcare systems.

Why was this partnership important?

Dr. Barker (WCH): For those of us in psychiatry who have been involved, it’s been a huge privilege to learn from our colleagues in housing who work with people in the community. It’s helped to understand what the most pressing mental health needs are and how we can best serve this population.

Daniella Nakouz (YWCA): This partnership was unique and successful as it brought psychiatry into community as opposed to community needing to get to psychiatry, which can often be a barrier to those experiencing serious and persistent mental illness. The partnership supported tenants to restabilize in their own community before needing to consider more intrusive interventions, which can cause significant trauma for people experiencing mental health crisis.

Having on-site psychiatry support built new skills and intervention techniques for staff, which in turn, supported the resiliency and prevention of burnout amongst staff. It’s important to note that this also offered an opportunity for healthcare to learn, adapt and tailor their training and skills on how to provide care within community. The mutual learning was really a joy to be a part of.

How has the collaboration with the YWCA influenced WCH’s understanding and approach to addressing mental health needs in supportive housing settings?

Dr. Wijayasinghe (WCH): The individuals we care for at the YWCA have often had negative experiences with the healthcare system and have sadly faced unacceptable levels of discrimination.  By providing outreach care, we are hoping to rebuild trust to allow for reconciliation and reconnection.  By providing care on-site and from receiving feedback from the case management team at the YWCA, we are continuously learning and adapting to the evolving needs of the community within the building.  

What are your hopes for supportive housing settings when it comes to mental health?

Dr. Wijayasinghe (WCH): I hope we can continue to build our program and consider expanding this model to other WCH partner sites.  Beyond the care that is offered to patients, further evaluation of our capacity-building sessions for the case management team could also offer opportunities to support other agencies who do this important work as well.  

Danielle Nakouz (YWCA): To effectively support individuals, a “housing first” approach that includes psychiatry as an integral part of the program must be adaptable and innovative. Customized care plans should be developed for each person.

By fully integrating mental health support within supportive housing, the aim is to reduce the likelihood of frequent hospitalizations or evictions. This approach would also help bridge the existing gaps between community services and healthcare. 

Thank you, Dr. Barker, Dr. Wijayasinghe and Danielle!