103 The effects of supported housing for individuals with mental disorders INTRODUCTION Individuals with mental disorders often lead unstable lives in terms of their social and physical living environment. Severe mental illness is associated with economic inactivity [1-3], social insurance benefit receipt [4], having limited family relationships [5] and homelessness [6, 7]; and family members might experience negative health and labour market consequences [8]. Inpatient mental health treatment offers curative or longterm clinical care, which is costly and limits autonomy [9, 10]. On the other hand, living independently means limited structure and support, which may contribute to mental health deterioration. Supported housing offers an alternative, intermediate model, typically consisting of a structured, semi-independent living environment without mental health treatment, which may be used on an outpatient basis. However, there is currently limited evidence on the effect of such arrangements on health care use and other outcomes [9, 11]. Supported housing in the Netherlands offers a comprehensive package, including housing, personal and domestic care, guidance, and daily activities. Mental health treatment is not provided by supported housing but can be obtained in the form of regular outpatient treatment. Supported housing is meant for a broad range of individuals who need a well-structured living environment [12], including those with personality disorders such as borderline, autism spectrum disorder, individuals who have recovered from substance use disorder, schizophrenia, attention-deficit/hyperactivity disorder, mood disorder, and behavioral problems with aggression [13]. This group includes homeless individuals but also individuals who lived in an inpatient institution or in a private household before. Supported housing and other types of treatment are accessible regardless of income: the Netherlands has generous coverage of treatment and support for individuals with mental and substance use disorders. During the study period, outpatient and inpatient mental health treatment up to a year were covered as universal health benefits through mandatory private health insurance, while home care and long-term inpatient mental health treatment were universally covered through public long-term care insurance with low levels of patient cost sharing [14]. In this paper, we estimate the effects of eligibility for the publicly funded Dutch supported housing program (Beschermd Wonen) on care use, mortality, employment and income of the people with mental disorders, and on spillovers to their parents. In the study period, eligibility was determined by an independent national agency. We use data on nearly 8,000 applications to supported housing by adults younger than 80 years old, between 2011 and 2013. The data include the outcome of the assessment and links all applications to their assessor. These application data were linked to administrative data on demographic characteristics, long-term care use, mental health treatment records and mortality of the applicants; and to health insurance claims and economic outcomes of both applicants and their parents. We use conditionally random assignment of applications to 4
RkJQdWJsaXNoZXIy MjY0ODMw