A study from Providence CORE and Health Share of Oregon links housing instability and serious mental illness to increased health care use among adult Medicaid members in the Portland Metropolitan region.
The links between housing and health are well established. But what happens when housing instability and significant behavioral health needs overlap?
New research from Providence CORE, Health Share of Oregon, and Central City Concern links this combination with significantly higher health care utilization and rates of hospitalization. Plus, longer hospital stays and more frequent readmissions.
These and other findings from the study were published in the Journal of Urban Health. They point to a need for more effective and integrated interventions that address health care, behavioral health, and housing needs.
Read highlights from the study below. Or read the full paper in the Journal of Urban Health.
Research at the intersection of housing & behavioral health
Building on past research collaborations, CORE, Health Share of Oregon, and Central City Concern teamed up to examine health care use among adult Medicaid members in the Portland metro area. The researchers wanted to understand what health care use and key outcomes looked like for people experiencing housing insecurity, substance use disorder (SUD) or psychosis, and both.
The findings were striking. People experiencing both housing insecurity and SUD or psychosis had higher rates of acute care utilization than any other group during 2023.
They found that 29.7% of those experiencing both housing insecurity and SUD or psychosis had at least one inpatient hospital admission, meaning one or more nights in the hospital. That's more than twice the rate observed among people with SUD or psychosis who were housing secure (12.4%), more than three times the rate among people facing housing insecurity without SUD or psychosis (9.5%), and nearly ten times the rate among people with neither condition (3.0%).
This group also experienced:
- Higher rates of hospitalizations for conditions often manageable through outpatient care
- More frequent hospital readmissions within 30 days
- Longer average hospital stays
“For many of the members we worry about most, housing, physical health, and behavioral health are deeply interconnected,” said Joseph Hardman, MD, Chief Medical Officer for Health Share of Oregon. “This research gives us a clearer picture of those relationships and highlights opportunities to improve care for people with the most complex needs.”
From evidence to action: potential strategies
According to Megan Holtorf, Data & Analytics Manager at CORE, "This research highlights the need for policies that recognize housing as a health care intervention for people with significant behavioral health needs. Integrated approaches that address both health and housing needs are especially important for patients facing these challenges.”
Holtorf points to several potential strategies:
- Comprehensive case management with improved access to physical, behavioral, and mental health services and integrated with housing programs and services.
- More access to evidence-based treatment for SUD through hospitals and emergency rooms.
- More access to 24/7 shelters with on-site health and behavioral health support
- Increasing availability of post-hospital medical respite care
- Developing low-barrier permanent supportive housing options
- Strengthening transitional recovery housing linked to case management and care coordination
Future research opportunities
Building on this work, the researchers suggest future studies could examine how different types of housing instability (e.g., temporary vs. chronic) affect health outcomes and care utilization.
To further explore the intersection of health and housing, CORE will use housing sector data from the Homeless Management Information System with health care claims data to understand this population’s needs and experiences.
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