1. NAMI Convention Permanent Supportive Housing and Recovery
Technical Assistance Collaborative Inc.
Boston MA
June 22, 2007

2. TAC Boston-based non-profit organization founded in 1992
Assists NAMI and CCD Housing Task Force with housing policy issues
Assists with mental health system development at the federal, state and local level
TAC expertise includes affordable and permanent supportive housing policies, resources and practices

3. Mental Health System Transformation
Achieving The Promise: The New Freedom Commission on Mental Health Report
“The lack of decent, safe, affordable and integrated housing is one of the most significant barriers to full participation in community life for people with severe mental illness”
“Many mental health systems…do not see housing as their responsibility”

4. Homelessness and Mental Illness
“Homelessness is the most visible manifestation of the housing and support services problems of people with mental illness”
A significant percentage of people who are chronically homeless report mental illness issues (self-reported 51% in Martha Burt study)
Chronic homeless definition: “An unaccompanied adult who has been continuously homeless for a year or more or has had at least four episodes of homelessness in the past three years”
Federal goal to end chronic homelessness by 2012 – includes prevention

5. Housing and Recovery
Consumers believe and studies strongly support permanent housing as a basis for mental health recovery
Consumers are much more responsive to accepting treatment after they have housing in place
Housing choice and “housing first” approach preferred by consumers
Flexible, mobile, individualized and voluntary support services are also necessary
“Too few mental health systems dedicate resources to ensuring that people with mental illness have adequate housing with supports” (New Freedom Commission Report)

6. The Permanent Housing Approach: A Best Practice
Consumers should have housing choices and – with appropriate supports – can successfully acquire and maintain permanent housing
People deemed “difficult to serve” can be successful in permanent housing
People do not have to pass through a linear set of preparatory residential services in order to be successful in permanent housing
Housing should be decent, safe, and affordable and include rights of tenancy for consumers

7. Permanent Supportive Housing
No “official” definition
“Decent, safe, and affordable community-based permanent housing providing consumers with rights of tenancy under applicable landlord/tenant laws and linked to voluntary and flexible supports and services designed to meet consumers needs and preferences”
Emphasis on:
Choice
Affordability and Quality
Tenancy rights/consumer control of housing
Normal and integrated housing settings (apartments)
Linked with community models of service delivery
Voluntary services
Flexibility and mobility of services
Help with housing issues as well as mental health issues

8. Permanent Supportive Housing
Emerged in the late 1980s
Robert Wood Johnson Foundation Demonstration Program
HUD McKinney-Vento Homeless Programs
Prompted a “paradigm shift” in mental health housing practices
Community integration mandates in U.S. Supreme Court’s Olmstead decision
An emerging “evidence-based” practice to prevent and end homelessness among people with serious mental illness
SAMHSA Supportive Housing Tool Kit
“Housing First” models emerged in late 1990s
Research/studies document PSH effectiveness

9. Recent Literature Permanent Supportive Housing
Increases residential stability and community tenure
Decreases use of in-patient settings
Decreases days in jail
Increases life satisfaction
May reduce psychiatric symptoms
May increase social functioning
Reduces costs in other systems

10. PSH Research Findings
New York/New York Study – Center for Mental Health Policy and Services Research
PSH associated with a reduction in service use of $16,282 per person per year
Service use included public shelters, public hospitals, Medicaid funded services, veterans’ inpatient services, state psychiatric inpatient services, state prisons, and city jails
Pathways to Housing Study – Psychiatric Services April 2000
88% of homeless consumers with mental illness who obtained PSH remained housed after 5 years compared to 47% placed in residential treatment models
CT Corporation for Supportive Housing Study –
PSH created positive outcomes for tenants while decreasing their use of acute and expensive health services
Property values in neighborhoods with PSH have increased or remained steady
San Francisco’s Direct Access to Housing
Since 1998, 2/3rd remained housed in PSH.
Of 1/3rd who moved out, ½ moved to other permanent housing.

11. What Does Permanent Supportive Housing Look Like?
Variety of housing models including:
Scattered-site apartments
“Clustered” apartments
Small scale single purpose buildings
Mixed population buildings (50-50 model)
Larger scale single population buildings
Single family homes

12. Successful PSH Initiatives
North Carolina – Housing Finance Agency partnership with Department of Human Services
Mixed population model
Mandated set-asides in all affordable housing developments – 900+ units
Linked with local community based services
Louisiana – Replicating NC model for up to 3,000 units of PSH
Allegheny County PA
“Reinvestment” funds creating 300+ units
Both project-based and tenant-based models
Housing Support Team approach
Arlington County, Virginia
Other high performing states include Ohio, Connecticut and California

13. Permanent Supportive Housing Services
Help people “get and keep” housing in the community
Reflect needs and preferences of consumers
Are flexible to respond to consumer’s changing needs
Include frequent contacts
“In vivo” learning
Explicit goals to increase residential stability and improve quality of life
24/7 including access to crisis services

14. What is “Housing First”
A housing model? Or a services model?
Features of the model
Permanent housing first
No services required as a condition of obtaining the housing
Intensive services offered – continuously – to Housing First tenants
Successful Housing First programs are challenging traditional mental health housing and services policies

15. Permanent Supportive Housing Depends on Best Practice Service Models
Programs of Assertive Community Treatment (PACT)
Integrated dual diagnosis treatment (IDDT)
Community Support/intensive case management
Medication management
Supported Employment
Illness self-management/recovery

16. System Transformation Towards Recovery and EBPs is Supported by Permanent Supportive Housing
Requires multi-system coordination
Requires flexibility, mobility and responsiveness of services
Requires services that teach and support living skills and resiliency in typical environments
Requires revision in funding criteria, service definitions and provider qualifications
Foundation of PSH is individual choice, independence and integration in the community