Housing Opportunities for Persons with Mental Illness Carol Wilkins Director of Intergovernmental Policy Corporation for Supportive Housing

2 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

3 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

4 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

5 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

6 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

7 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

8 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

9 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

10 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

11 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

12 Supportive Housing Works as 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 – Shelter137$68$4,658 NYS OMH – Hospital57.3$437$12,520 NYC HHC – Hospital16.5$755$6,229 Medicaid – Hospital35.3$657$11,596 Medicaid – Outpatient62.2 (visits)$84$2,612 VA – Hospital7.8$467$1,821 NYS DCJS – Prison9.3$79$367 NYC DOC – Jail10$129$645 Total$40,449

Savings in Services Use Per NY/NY Placement ServicePer Diem Cost Reduction (days) Annualized Cost Reduction Municipal Shelter$6882.9$2,819 Psychiatric Hospital$ $6,162 Municipal Hospital$7553.5$1,321 Medicaid – Inpatient$6578.6$2,825 Medicaid - Outpatient$ (visits) ($1,982) Veterans Hospital$4671.9$444 NYS Prison$797.9$312 NYC Jail$1293.8$245 Total $12,145

NY/NY Housing - Costs and Savings

17 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 % 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

18 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

19 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

20 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

21 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

22 For More Information Corporation for Supportive Housing Technical Assistance Collaborative National Resource Center on Homelessness and Mental Illness National Alliance to End Homelessness AIDS Housing of Washington