Housing Opportunities for Persons with Mental Illness

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HousingOpportunities for Persons with Mental
Illness

• Carol Wilkins
• Director of Intergovernmental Policy
• Corporation for Supportive Housing
• www.csh.org

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People Disabled by Mental Illness Are Often
Priced Out of Housing

• In 2000, people with disabilities receiving SSI
  needed to pay on a national average 98 of
  their SSI benefits to rent a 1-bedroom apartment
• In 2000, there was not one single housing market
  in the country where a person with a disability
  receiving SSI benefits could afford to rent a
  modest efficiency or 1-bedroom unit
• Because of their extreme poverty, the 3.5 million
  non-elderly people with disabilities receiving
  SSI benefits cannot afford decent housing
  anywhere in the country without some type of
  housing assistance
• Source Technical Assistance Collaborative Priced
  Out in 2000 The Crisis Continues

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Expanding Housing Opportunities and Choices

• Improve access to housing created or subsidized
  through mainstream housing programs
• Target resources to creating permanent housing
  for people with disabilities
• Enforce Fair Housing protections against
  discrimination
• Build community acceptance for housing for people
  with special needs
• Strengthen partnerships between agencies that
  finance and deliver housing and services
• Create 150,000 units of supportive housing to end
  long-term homelessness within 10 years

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Supportive Housing Housing Services

• Housing
• Permanent not time limited
• Affordable generally tenants pay 30 of income
  for rent
• Independent private living space and lease with
  normal tenant rights responsibilities
• Services
• Flexible and responsive to tenants needs
• Maximize independence and housing stability
• Participation is not a condition of tenancy
• Services Property Management Tenants
• Effective Partnerships

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Supportive Housing for the people who

• But for housing cannot access and make effective
  use of treatment and supportive services in the
  community and
• But for supportive services cannot access and
  maintain stable housing in the community

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Target Population(s)

• Individuals and families who
• Are very poor
• Have persistent health conditions or multiple
  barriers to housing stability
• Are homeless and/or do not have access to
  appropriate and stable housing in the community
  and
• Would be unable to access or retain housing
  without tightly linked services

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A Range of Models Strategies

• Apartment or SRO buildings developed by
  non-profit owners for people with special needs
• Single family homes may be shared
• Rent subsidized apartments leased in the private
  market
• Units set aside for people with special needs in
  mixed income housing developments
• Units secured by project sponsors through
  long-term lease with private owners
• Services integrated within existing affordable
  housing

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A range of services to support tenants in their
goals

• A broad array of services available
• Mental health and substance use management and
  recovery
• Vocational and employment
• Money management benefits advocacy
• Coordinated support / case management
• Life skills
• Community building and tenant advocacy
• Medical and wellness

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Services are voluntary for the tenants not the
staff

• Tenants choose as much or as little services as
  they desire without having to move as their
  service needs change
• Engagement is an ongoing activity to establish
  and sustain relationships
• Begin with tenants practical needs and personal
  goals
• Service strategies anticipate and help to manage
  the risks and consequences associated with
  substance use and relapse
• Building a strong and safe community to reinforce
  norms of behavior and hope for recovery and
  growth
• Supportive housing tenants must pay rent and meet
  other lease obligations
• Participation in services can help tenants meet
  their obligations, solve problems, and avoid
  eviction
• Evictions are for failure to pay rent or for
  problem behavior not for choices about
  participation in services

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Supportive housing provides opportunities for
tenants to

• Access appropriate care for and manage chronic
  health and mental health conditions
• Take steps toward achieving and maintaining
  sobriety
• Achieve housing stability
• Work
• Socialize
• Be leaders in their community
• Connect with the wider world
• Pursue goals and interests

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Expanding housing opportunities for people with
co-occurring disorders

• Eligibility criteria for the housing (or
  subsidies) targets people with disabilities and
  those who are homeless for the long-term
• Outreach, marketing and tenant selection
  procedures and program rules facilitate access
• Supportive services and property management
  practices are designed to help people achieve
  housing stability and reduce reliance on
  emergency care
• Requires strategies for effectively engaging and
  housing people with ongoing or relapsing
  substance use problems

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Supportive Housing Worksas documented by
researchers across the country

• 80 of tenants coming from streets and shelters
  achieve housing stability for at least a year
• Emergency room and hospital visits drop by more
  than 50
• Increase use of primary care and services to
  address substance abuse problems
• Increase participation in work and employment
  services

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 The Impact of Supportive Housing for Homeless
Persons with Severe Mental Illness on Use of
Public Services in New York City Dennis
Culhane, Ph.D., Stephen Metraux, M.A., and Trevor
Hadley, Ph.D. Center For Mental Health Policy
Services Research University of Pennsylvania

• Study analyzed patterns of service utilization in
  shelters, state mental health facilities,
  hospitals, VA, Medicaid, jails, and prison
  before and after housing placement for 4,679
  individuals
• The cost of homelessness for persons with serious
  mental illness was more than 40,000 per year
  with 86 of costs in health care and mental
  health systems
• Costs of creating and operating supportive
  housing are offset by savings in other public
  systems

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The Cost of Homelessness in NY
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Savings in Services UsePer NY/NY Placement
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NY/NY Housing - Costs and Savings
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Ending Long-Term Homelessness

• 250,000 individuals and 15,000 families have been
  homeless for more than a year
• Most face multiple barriers to housing stability
  including mental illness, addiction, and other
  chronic health conditions
• About 10 - 15 of those who become homeless
  remain in streets or shelters, or cycle between
  homelessness, hospitals, or jails for years
• The goal 150,000 units of permanent supportive
  housing within 10 years

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Creating and Sustaining 150,000 Units of
Supportive Housing - The Challenge

• Supportive housing is a product with proven
  results without a system to produce it
• Every project is a patchwork of authorizations
  and funding
• Often, success means using money for purposes
  that werent officially intended making it
  difficult to replicate creative strategies

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Partnership Strategies to expand housing
opportunities

• At federal, state, and local levels government
  and non-profit agencies and other stakeholders
  from Mental Health, Housing, and other service
  systems work together to
• Agree on priority needs, target population(s) and
  goals
• Coordinate and streamline funding decisions for
  housing and services
• Manage projects as they move through the
  pipeline
• Build community acceptance for housing for people
  with special needs

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Policy Implications

• Provide sustainable funding for rent subsidies
  operating costs of housing targeted to people who
  are homeless and disabled
• Strong and effective interagency partnerships
  involving HHS, HUD, and other federal agencies
  must provide resources and incentives to leverage
  state and local investments and systems change
• Streamline funding for approaches that integrate
  housing and services to support recovery in
  community settings

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Some specific policy recommendations

• Provide permanent solution to renewal funding for
  permanent housing funded through HUDs Homeless
  Assistance and 811 Programs
• Increase federal investment to produce rental
  housing for people with disabilities and with
  incomes below 30 of AMI (Area Median Income)
• Implement, expand, and learn from Presidents
  Interagency Council on Homelessness initiative on
  chronic homelessness and Policy Academies
• Authorize more flexible Medicaid benefits
  consistent with recovery principles, and
  encourage use of Medicaid for services in
  supportive housing
• Provide Medicaid eligibility for chronically
  homeless adults with co-occurring disorders who
  are not receiving SSI benefits

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For More Information

• Corporation for Supportive Housing www.csh.org
• Technical Assistance Collaborative www.tacinc.org
  
• National Resource Center on Homelessness and
  Mental Illness
• www.prainc.com
• National Alliance to End Homelessness
  www.endhomelessness.org
• AIDS Housing of Washington www.aidshousing.org