2025 Theses Master's

Housing First. Now What? Continuity of Care, Deinstitutionalization, and the Evolution of Mental Health Care in New York City

Fainaru, William

Mental health care in New York City has transitioned from institutional settings to a community-based model of care, with supportive housing providers now playing a pivotal role in providing treatment. This shift emphasizes community integration as a pillar of recovery; yet unlike clinical institutions, cities are dynamic, shaped by the volatility of real estate markets. This study argues that housing market instability disrupts the continuity of mental health care, undermining the Housing First model.

The central research question is: How effective is supportive housing in New York at protecting residents from displacement, particularly residents with mental health diagnoses? This study investigates how real estate volatility, housing insecurity, and displacement pressures systematically disrupt the effectiveness of supportive housing and undermine the Housing First model. By integrating ethnographic research and semi-structured interviews with residents, this research offers a comprehensive evaluation of supportive housing, exploring the limitations of the program and the lived experiences of its residents.

Supportive housing sits at the nexus of housing and mental health care, offering a microcosm of New York's psychiatric system. This research draws on the concepts of “niching” and the “life-space network” to understand how supportive housing residents acclimate to their communities. I explore the difficulties residents find in adapting to neighborhoods plagued by displacement and housing insecurity. These conditions ultimately threaten the cohesion between housing and mental health care, undermining continuity of care and jeopardizing the goals of the Housing First model.