housing environment of people with severe mental illness : a study of supported housing facilities in Sweden

Doctoral thesis, 2015

Supported housing facilities (SHF) are among the most common housing solutions for people with severe mental illness (SMI). A poor level of physical-environment qualities and the re-creation of institutional atmospheres in these settings have been found in recent studies. The research focus in the psychiatric field has, however, largely neglected these topics and the available knowledge does not provide sufficient evidence to draw any conclusions in terms of which physical environmental aspects support the well-being of people with SMI. The aim of this thesis is thus to reduce this knowledge gap and identify physical-environment affordances for psychosocially supportive housing facilities. The HEI model and a salutogenic approach are the thesis’ theoretical backgrounds that have led to the identification of physical-environment affordances, which have proven to be crucial for people’s well-being. Such affordances are operationalized in terms of visual pleasantness, homelikeness and indirect environmental effects. SHF (N = 20) were investigated with a multi-place approach by experts (N = 5), user-group panel (N = 3), people with SMI (N = 72) and staff (N = 117) (social actors). Four papers contribute to test the influence of the selected affordances on people with SMI: comparison of the views of different social actors (Paper I), evaluation of their impact on social climate (Paper II), observed behaviors (Paper IV) and on place attachment and quality of life (Paper III). Results suggest that SHFs with perceived greater physical affordances (visual pleasantness and indirect environmental effects) were associated with positive social climate perceptions. Moreover, the indirect environmental effects were found to be supportive for observed behaviors of interactions, attachment to place and quality of life responses. Place attachment and social climate mediated the effects of the physical environment. These findings suggest that future planning of SHF should focus on a housing design that sustains possibilities for social interaction, privacy regulation and restoration (indirect environmental effects) in order to support well-being outcomes among people with SMI. Methodological, theoretical and practical design implications are discussed.