160 semi-structured peer-to-peer interviews involving participants of shelter and protected housing (adults diagnosed with serious mental illness and with histories of substance use and institutionalization or homelessness, who use services) from a wide range of urban and rural settings, show the relative effectiveness of deinstitutionalization policies.

Most participants exhibit limited support for direct housing policies, since preparation for re-housing and ongoing support are missing. Some participants experience clear motivators though, while others experience clear social and health-related obstacles. We conclude contexts should explicitly incorporate institutional change, including provision of preparatory and ongoing services meeting structural conditions, preventing recurrent homelessness.