Housing and Employment Outcomes for Mental Health Self-Direction Participants

Area of Science:

• Mental Health Services Research
• Health Services Administration
• Social Work

Background:

• Self-direction empowers individuals with mental health conditions to manage their own budgets and services.
• This approach aims to align service allocation with personal recovery goals and preferences.
• Previous research suggests self-direction is linked to better wellness and recovery outcomes, potentially at a lower cost.

Purpose of the Study:

• To compare employment and housing independence outcomes between individuals participating in mental health self-direction and a matched comparison group.
• To evaluate the effectiveness of self-direction in promoting tangible recovery goals.

Main Methods:

• A quasi-experimental design utilizing administrative data from a large mental health self-direction program.
• Coarsened exact matching was employed to create a comparable group of non-self-directing individuals (N=1,099) from a larger cohort (N=271 self-directing).
• Outcomes were assessed over an approximate four-year period, comparing the likelihood of positive changes between groups.

Main Results:

• Self-directing participants were significantly more likely to increase or maintain employment (20+ days/month) compared to non-participants (NNT=18).
• Participants in self-direction also demonstrated a greater likelihood of maintaining or achieving independent housing (NNT=16).
• These findings held after controlling for observed demographic, diagnostic, and other individual characteristics.

Conclusions:

• Mental health self-direction is associated with modest but significant improvements in employment and housing stability.
• The study supports the value of self-direction as an effective model within mental health services.
• Results contribute to understanding the impact of self-direction on key outcomes valued by individuals, families, and system administrators.