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

 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

The Cost of Homelessness in NY

Service Provider

Mean Days Used (2-year pre-NY/NY)

Per Diem Cost

Annualized

Cost

NYC DHS – Shelter 137 $68 $4,658

NYS OMH – Hospital 57.3 $437 $12,520

NYC HHC – Hospital 16.5 $755 $6,229

Medicaid – Hospital 35.3 $657 $11,596

Medicaid – Outpatient 62.2 (visits) $84 $2,612

VA – Hospital 7.8 $467 $1,821

NYS DCJS – Prison 9.3 $79 $367

NYC DOC – Jail 10 $129 $645

Total $40,449

Savings in Services UsePer NY/NY Placement

Service Per Diem Cost

Reduction

(days)

Annualized Cost Reduction

Municipal Shelter $68 82.9 $2,819

Psychiatric Hospital $437 28.2 $6,162

Municipal Hospital $755 3.5 $1,321

Medicaid – Inpatient $657 8.6 $2,825

Medicaid - Outpatient $84 -47.2 (visits)

($1,982)

Veterans Hospital $467 1.9 $444

NYS Prison $79 7.9 $312

NYC Jail $129 3.8 $245

Total   $12,145

NY/NY Housing - Costs and Savings

$0$2,000$4,000$6,000$8,000

$10,000$12,000$14,000$16,000$18,000$20,000

Savings Per Unit fromReduction

Annual Per Unit Cost of Housing

Community Residence Supportive Housing Weighted Mean

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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 weren’t officially intended – making it difficult to replicate creative strategies

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Partnership Strategies to expand housing opportunitiesAt 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 HUD’s 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 President’s 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 Illnesswww.prainc.com

National Alliance to End Homelessness www.endhomelessness.org

AIDS Housing of Washington www.aidshousing.org