Homelessness and severe mental illness are closely linked, forming a cycle of marginalisation. In the UK, the proportion of homeless individuals with a mental health diagnosis rose from 45% in 2014 to 82% by 2021 (Homeless Link, 2021). Within this group, the experiences of homeless women are often overlooked. Crisis (2023) found that 64% of homeless women face mental health challenges, frequently related to trauma such as domestic abuse, sexual violence, and child loss. They are three times more likely to experience mental health problems than women in the general population, and their average age of death is just 43, compared to 83 years nationally (ONS, 2022).
Despite these stark realities, access to care remains fragmented. Ava Phillips’ Mental Elf blog highlights how both people who are homeless and hostel staff struggle to navigate health and social care systems, often feeling excluded and unsupported.
The current study responds with a phased housing model tailored to the complex needs of homeless women (Conger, 2025). Conducted in Bengaluru, India, the study aimed to provide a framework for improving mental health support and housing stability for homeless women that could inform practice more widely.
Women who are homeless are three times more likely to experience mental health problems than women in the general population, and their average age of death is just 43.
Methods
Conger et al. employed an innovative qualitative design to develop and validate a supported housing programme for homeless women with severe mental illness. Data were collected through semi-structured interviews with homeless women with severe mental illness (HWSMI; n=14) and mental health professionals (n=18), alongside observational visits to relevant organisations. They shortlisted 6 organisations working in this area and with this population to explore their working practices and the current issues they faced.
Thematic analysis (Braun and Clarke, 2006) was used to identify key themes, and a Theory of Change model (Breuer et al, 2016) was developed and reviewed by 7 national and 3 international experts including social workers, psychologists and psychiatrists.
Results
Conger’s research team identified five major themes and 80 subthemes, which informed the development of a three-phase supported housing programme. Nearly all HWSMI participants reported multiple hospitalisations, family rejection, and experiences of violence or abuse. Professionals noted that existing housing schemes were ill-equipped to support women with complex psychiatric and social needs.
First, the study identified the causes of homelessness and persistent barriers to reintegration, including family rejection, stigma, poverty, and systemic gaps in mental health services and housing provision.
Second, the impacts of homelessness were documented, including a decrease in overall wellbeing and daily living skills, alongside an increase in vulnerability to abuse and social isolation.
Third, an examination of current service models highlighted the importance of steps towards independence, incorporating transitional housing, permanent supportive housing, and community-based rehabilitation.
Fourth, the facilitators of successful reintegration, were identified. They included peer support networks, skill-development initiatives, access to healthcare and co-ordinated multi-sector action.
The study also emphasised the need for secure housing, psychosocial support, vocational opportunities, and legal assistance, grounded in dignity, autonomy, and choice.
These themes were then mapped to three phases of intervention:
1. Tertiary Care Phase
- Focused on stabilisation and psychiatric treatment within institutional settings.
- Barriers included lack of discharge planning, stigma, and absence of community-based alternatives.
- Professionals reported difficulties reintegrating women due to family rejection and safety concerns.
2. Transit Home Phase
- Proposed as a short-term, structured environment bridging hospital and community living.
- Emphasised skill-building, psychoeducation, and gradual autonomy.
- Participants highlighted the need for trauma-informed and gender-sensitive support.
3. Community Phase
- Planned as independent living with ongoing psychosocial support.
- Challenges included housing discrimination, financial insecurity, and limited access to mental health services.
- Professionals stressed the importance of peer support and community engagement.
Nearly all homeless women in this study reported multiple hospitalisations, family rejection, and experiences of violence or abuse.
Conclusions
The study concludes that a phased, gender-sensitive supported housing programme can significantly improve outcomes for homeless women with severe mental illness. By integrating tertiary care, transitional housing, and community reintegration, the model addresses both clinical and social determinants of recovery.
The authors conclude:
A supported housing programme tailored to the needs of homeless women with severe mental illness is feasible and necessary to promote sustained recovery and social inclusion.
While further feasibility testing is needed, this intervention offers a promising framework for mental health services in low-resource settings and highlights the urgent need for policy-level support.
This study concludes that a phased, gender-sensitive supported housing programme can significantly improve outcomes for homeless women with severe mental illness.
Strengths and limitations
Conger et al.’s study offers a valuable contribution to the field of community mental health, particularly within low-resource settings. Its strengths lie in a robust multi-source qualitative design, incorporating interviews with both service users and professionals, alongside observational visits to relevant organisations. This triangulation of data sources enhances the credibility and depth of the findings. A Theory of Change model was developed to map the intervention’s logic, outlining inputs, activities, outputs, and intended outcomes. Validated by experts, it enhanced the programme’s conceptual robustness. The rich narrative data illuminated systemic gaps and service user needs, and positions the intervention within a broader systems framework, which is especially important in complex social care environments.
However, several methodological limitations warrant closer scrutiny. Despite the study’s focus on some of the most structurally oppressed and intersectionally disadvantaged individuals, ethical considerations are not thoroughly addressed. While expert validation of the ToC model is noted, there is no evidence of participant involvement in shaping or reviewing the framework. This lack of meaningful coproduction means that the intervention may not adequately reflect the lived experiences of those it aims to support, and excluding these voices potentially limits the transformative potential of the intervention.
More clarity on the recruitment strategy is needed around inclusion and exclusion criteria or sampling methods as there is a risk of selection bias; particularly if participants were chosen based on accessibility or eloquence. This may skew findings towards those more able to engage, inadvertently excluding individuals with more severe mental health issues or communication barriers.
Although participant numbers are appropriate for a qualitative study, the absence of detail on how relationships between researchers and participants were managed weakens transparency. Furthermore, the study lacks a reflexive account of the researchers’ positionality and the influence this had on data collection and interpretation. Observer bias can shape thematic analysis, especially in sensitive contexts. The absence of participant validation or member checking further limits the study’s robustness. Also, no conflicts of interest or funding sources are disclosed, which restricts our ability to assess institutional bias, which is particularly important given the study’s policy implications. However, the bidirectional link between homelessness and mental illness is well-established, a multi-source approach and expert validation lends weight to the findings. Overall, the study addresses a key gap in community reintegration models for this population.
Given the vulnerability of these participants, working co-productively and explicitly outlining ethical safeguards would strengthen this study’s quality.
Implications for practice
This study provides evidence that supported housing programmes tailored to homeless women with severe mental illness are not only feasible but urgently needed. From a clinical standpoint, the phased model proposed – spanning tertiary care, transitional housing, and community reintegration – aligns with recovery-oriented principles and trauma-informed care. It addresses the chronic gaps we see in practice: women discharged from inpatient units with nowhere safe to go, cycling through shelters, hostels, or the streets, often re-traumatised and re-hospitalised.
Key facilitators for successful reintegration included:
- Access to transitional housing
- Gender-sensitive support programmes
- Community-based mental health services
- Legal and financial advocacy
These findings informed the design of a culturally relevant, trauma-informed supported housing programme with potential for adaptation in other low-resource settings. As a mental health professional with two decades of experience, I’ve witnessed firsthand how housing instability undermines recovery. Without a stable, safe environment, therapeutic gains made in hospital are quickly eroded. The study’s model offers a practical and humane alternative that centres dignity and continuity of care for marginalised and under-served women.
From a policy perspective, this research should prompt a fundamental re-evaluation of how housing is positioned within mental health services. Housing should be recognised as a core component of care, not an afterthought. In the UK, this means integrating supported housing into discharge planning, commissioning gender-specific transitional homes, and funding community-based mental health support that continues beyond hospital walls. The current fragmentation between health, housing, and social care systems fails those most in need.
The study also suggests new avenues for research:
- Feasibility and outcome evaluations of the proposed model in different cultural contexts
- Longitudinal studies on recovery trajectories of HWSMI in supported housing
- Co-production models that involve service users in designing housing interventions
Importantly, Conger et al’s work reminds us that recovery is relational and environmental. It’s not just about symptom reduction; it’s about dignity, safety, and belonging. For frontline practitioners, this means advocating for housing as a therapeutic intervention and listening deeply to the lived experiences of those we serve.
There is an ethical imperative for public and community health workers to move away from passive observation, towards actively challenging systems that criminalise poverty and neglect mental health needs (Padgett, 2020). Silence and neutrality in the face of housing injustice perpetuates physical and psychological harm. Health professionals have a remit to engage in policy advocacy, a duty of care to push for inclusive housing policies, and to amplify the voices of people with lived experience. The root causes of homelessness are complex, and the impact on vulnerable people is devasting – new ways of working more holistically which help health and social care professionals respond effectively are to be welcomed.
Housing should be recognised as a core component of care, not an afterthought, but the current fragmentation in the UK between health, housing, and social care systems fails those most in need.
Statement of interests
No conflicts noted.
Links
Primary paper
Conger, L.R. (2025). Development and validation of a supported housing programme for homeless women with severe mental illness. Asian Journal of Psychiatry, 85, 103654.
Other references
Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77–101.
Breuer E, Lee L, De Silva M, Lund C (2016) Using theory of change to design and evaluate public health interventions: a systematic review. Implement Sci: IS 11:63.
Crisis (2023) Women and homelessness: Experiences, barriers and mental health. London: Crisis UK (Accessed: 15 August 2025).
Homeless Link (2021) Health Needs Audit: Mental health and homelessness. London: Homeless Link (Accessed: 15 August 2025).
Office for National Statistics (2022) Deaths of homeless people in England and Wales: 2021 registrations. Newport: ONS. (Accessed: 15 August 2025).
Office for National Statistics (2023) People experiencing homelessness, England and Wales: Census 2021. Available at: (Accessed: 15 August 2025).
Padgett, D.K. (2020) Homelessness, housing instability and mental health: making the connections. BJPsych Bulletin, 44(5), pp.197–201.
United Nations General Assembly. Universal Declaration of Human Rights 1948. United Nations General Assembly, 1948.
United Nations. (2025). Goal 11: Make cities and human settlements inclusive, safe, resilient and sustainable. United Nations Sustainable Development Goals. (Accessed 15 Aug. 2025).
