Parallel to the development of locating congregate housing in increasingly remote areas has been the move away from congregate housing and toward scatter-site independent housing. Mental health consumers residing in independent scatter-site housing live alone in their own apartments located throughout the community where affordable units can be found. Services are typically off-site and there are considerably fewer program rules (Tsemberis and Eisenberg, 2000
). Independent housing is designed to allow individuals to live in “normal” settings interspersed with general community members, and is intended to maximize opportunities to take advantage of natural local supports and resources (Ridgway and Zipple, 1990
The prevalence of independent scatter-site housing varies by location, but there is evidence that it is becoming the predominant housing model for people with severe mental illness in North America. For example, in Robbins et al.’s, (2006)
study of housing among 1,000 persons with severe mental illness presenting for outpatient treatment in 5 regionally disparate U.S. cities (Tampa, Worcester, San Francisco, Durham and Chicago), living in an independent apartment was the predominant type of housing (housing approximately 50% or more of the sample) in the 4 of the sites. Similarly, evidence of the growth of independent scatter-site housing in New York City is supported by data provided by the New York State Office of Mental Health “Patient Characteristics Survey” (New York State Office of Mental Health, 2006
). Comparing data from the 1999 and 2003 surveys, it is found that the number of individuals living in independent scatter-site housing (classified as “supported housing” in the survey) in New York City increased from 2,359 to 4,207. Although the number of other types of housing units also increased during this period, the proportion of total units that were independent scatter-site increased from 31% in 1999 to 38% in 2003 (New York State Office of Mental Health, 2006
An acknowledgement of the existence of independent scatter-site housing programs has not yet emerged in the mental health geography literature, which is still in large part concerned with the “post-asylum” congregate settings that arose in the wake of deinstitutionalization (Wolch and Philo, 2000
). There are several reasons why mental health geography can enhance the field’s understanding of the impact that residence in independent scatter-site housing has on community integration. First, there is the potential impact that neighborhood variables such as local social capital (Lochner, Kawachi, and Kennedy, 1999
) and socioeconomic characteristics have on people with mental illness. Early research with individuals residing in group homes suggested that residing in communities with a predominance of political liberalism and an apparently healthy dose of social disorganization was associated with better community integration (as opposed to residing in more conservative, higher income, and well-organized working-class neighborhoods) among people with severe mental illness (Segal, Baumhol, and Moyles, 1980
). However, it is not clear to what extent this was a byproduct of residence in the old “service dependent ghettos” where people with mental illness had a history of living, or if it was due to reduced community stigma in these types of settings.
Several community characteristics may be relevant that could be addressed in future studies. The study of social capital should be updated to address the contemporary understanding of “neighborhood factors,” which has identified neighborhood collective efficacy, concentrated socioeconomic disadvantage, immigrant concentration and residential instability as neighborhood characteristics that are predictors of crime and health outcomes (Sampson, Raudenbush, and Earls, 1997
; Browning and Cagney, 2002
). These characteristics might also predict psychological community integration among people with mental illness. “Built environment” characteristics, such as the presence of graffiti, lack of recreation space, abandoned buildings, and environmental characteristics such as noise, and crowding, have also been found to be significant predictors of depressive symptoms in community samples (Weich et al., 2002
; Halpern, 1995) and their impact should therefore be studied among people with severe mental illness, as depressive symptoms may be expected to impact psychological community integration, and fear of crime may impact social integration. The possibility that stigmatizing attitudes towards people with mental illness varies by neighborhood, and that variation in these attitudes can impact community integration (which Segal et al.’s 
; study implied) also needs to be explicitly examined. Some preliminary research has also suggested that the degree of “fit” between an individual with mental illness and the neighborhood where he or she finds housing, rather than any specific characteristics of the community per se, is the most important factor in determining community integration (Yanos, Barrow, and Tsemberis, 2004
), but this hypothesis needs to be studied further.
An additional issue of concern is that the economic realities of independent scatter-site housing often dictate that many individuals with mental illness will move into areas that they have been previously unfamiliar with, and where they may lack family and other social support. Supporting this view is a recent analysis of the movement patterns of the population of persons residing in the province of Manitoba, Canada; this analysis indicated that people with severe mental illness were twice as likely as others to move to a different postal code within a three-year period (Lix et al., 2006
). The reality of frequent movement raises concern that people with mental illness may experience “displacement” as they relocate to new settings. Studies of the psychology of “displacement” (Fullilove, 1996
) suggest that relocation into unfamiliar settings can create a sense of loss and rootlessness. The process by which people with mental illness encounter and do (or do not) adjust to such displacement needs to be formally studied.