From institutions to homes: Evaluation of a housing with supportive services intervention for people with psychosocial disabilities with histories of homelessness

Long-term institutionalization of people with mental health conditions persists globally despite emerging rights-based reforms and a shift towards community-based care. In India, efforts to facilitate community-based alternatives are emerging. This paper evaluates the outcomes of a multi-site implementation of Home Again, a housing with supportive services intervention developed in India, for people with mental health issues who are long-term residents of state psychiatric facilities. Using a single group repeated measures design, changes in key outcomes were assessed for 214 participants enrolled across nine sites in India and one in Sri Lanka over a 12-month period. Statistically significant improvements were observed in disability, quality of life, community integration, clinical symptoms and hope. Qualitative findings underscore participants' complex experiences navigating the transition, marked by a delicate balance between freedoms and constraints. The study highlights the feasibility of implementing the intervention in diverse settings, its impact on participant outcomes, and the need for comprehensive strategies to address systemic barriers to full inclusion. The experience offers insights for scaling up complex, multi-faceted interventions for marginalized populations in resource-limited settings. • Home Again improved outcomes in disability, quality of life, community integration, symptoms, and hope across among those institutionalised long-term multiple sites • Participants from government institutions showed greater improvements in disability, symptoms, and hope than private facilities • Qualitative data reveal complex navigation between newfound freedoms and lingering constraints due to social norms • Duration of prior institutionalization predicted disability outcomes, suggesting benefits of early transition