Determinants of Housing Stability in Serious Mental Illness: An Integrative Review and Implications for Mental Health Nursing.

Abstract

Housing stability is a critical determinant of health and recovery for adults with serious mental illness, yet the mechanisms that support sustained tenancy remain incompletely understood. This integrative review synthesized evidence published from 2015 to 2025 on individual, contextual, and relational determinants of housing stability among adults with serious mental illness, with or without co-occurring substance use disorders. Guided by Whittemore and Knafl's methodology, the review included 26 empirical studies representing supportive housing, Housing First, transitional housing, and related community-based settings across the United States, Canada, and Germany. Findings showed that housing stability was shaped by interacting factors across three domains. Individual determinants included psychiatric symptom burden, substance use, trauma and early adversity, coping, resilience, and person-environment fit. Contextual determinants included housing quality, placement speed, housing type, service intensity, program fidelity, neighborhood conditions, and structural barriers. Relational determinants included social support, peer engagement, and therapeutic alliance. Overall, the review suggests that housing stability is a recovery-relevant, multidimensional process and that mental health nursing research and practice should address housing instability through trauma-informed, recovery-oriented, and relationship-centered approaches.