Housing Opportunities for Persons with Mental Illness Carol Wilkins Director of Intergovernmental...
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Transcript of Housing Opportunities for Persons with Mental Illness Carol Wilkins Director of Intergovernmental...
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