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Housing homeless people is widely seen as an important aspect of policies, and people living in institutions are increasingly encouraged to live independently within neighborhoods. Studies identify both positive effects of outpatient situations and barriers formed by self-stigma or financial cuts. Client-perspectives and policy outcomes for clients remain neglected topics, however.

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.