The Impact of Substance Abuse Problems and Serious Mental Illness/Serious Emotional Distress on Post-Discharge...

Behavioral and cognitive disorders can undermine housing stability, a key determinant of mental health recovery, with persistent disparities across demographic and socioeconomic groups. This study examined the associations of substance abuse problems (SAP) and serious mental illness/serious emotional distress (SMISED) with residential status at discharge from mental health facilities.

This cross-sectional study used the utilized data from the Substance Abuse and Mental Health Services Administration (SAMHSA). Descriptive statistics were used to summarize demographic characteristics, whereas univariate and multivariable logistic regression models were employed to assess associations between the covariates and the residential outcome, adjusting for a variety of demographic characteristics.

In the adjusted multivariable model, SAP was linked to 40% increased odds of non-private discharge (adjusted odds ratio [aOR] = 1.40, 95% confidence interval [CI]: 1.18-165), and SMISED had about two-fold increased odds (aOR = 2.10, 95% CI: 1.44-3.05) compared to discharge in private residence. For individuals with SAP, unemployed Hispanic/Latino clients showed the highest odds of non-private discharge compared to employed clients (aOR = 3.74, 95% CI: 1.65-8.46). For individuals with SMISED, unemployed Black clients had approximately four-fold higher odds (aOR = 4.02, 95% CI: 2.00-8.37) of non-private discharge, compared with employed clients.

These findings suggest that housing stability after discharge reflects the combined effects of clinical severity and socioeconomic disadvantage, with higher risk associated with substance use, unemployment, and racial inequities. Integrated mental health and housing interventions, including culturally responsive policies, are needed to improve residential stability among vulnerable populations.