Housing Opportunities For Persons With Mental Illness: Carol Wilkins Director of Intergovernmental Policy

Housing
Opportunities for Persons with

Mental Illness
Carol Wilkins
Director of Intergovernmental Policy
Corporation for Supportive Housing
www.csh.org
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 1bedroom 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
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
3
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
4
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
5
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
6
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
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
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
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
10
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
11
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
12
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

Mean Days
Used (2-year
pre-NY/NY)
137
Per
Diem
Cost
$68
Annualized
Cost
$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
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
Service Provider
NYC DHS Shelter
Medicaid Outpatient
Total
$40,449
Savings in Services Use

Per 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
$20,000
$18,000
$16,000
$14,000
$12,000
$10,000
$8,000
$6,000
$4,000
$2,000
$0
Savings Per Unit from

Reduction
Community Residence
Annual Per Unit Cost of

Housing
Supportive Housing
Weighted Mean
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
17
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
18
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
19
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
20
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
21
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
22

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Housing

Opportunities for Persons with

People Disabled by Mental Illness Are

In 2000, people with disabilities receiving SSI needed to pay

In 2000, there was not one single housing market in the

Because of their extreme poverty, the 3.5 million non-elderly

Improve access to housing created or subsidized

Services + Property Management + Tenants =

for housing cannot access

for supportive services

Individuals and families who:

A Range of Models & Strategies

Apartment or SRO buildings developed

A broad array of services available

Services are voluntary for the tenants

Tenants choose as much or as little services as they desire without

Engagement is an ongoing activity to establish and sustain

Service strategies anticipate and help to manage the risks and

Building a strong and safe community to reinforce norms of behavior

Supportive housing provides opportunities

Access appropriate care for and

Expanding housing opportunities

Eligibility criteria for the housing (or subsidies)

Supportive Housing Works

80% of tenants coming from streets and

Emergency room and hospital visits drop

Increase use of primary care and services

Increase participation in work and

The Impact of Supportive Housing for Homeless

mental health facilities, hospitals, VA, Medicaid, jails, and prison

cost of homelessness for persons with serious mental

of creating and operating supportive housing are offset

The Cost of Homelessness in NY

NYS OMH Hospital

NYC HHC Hospital

NYS DCJS Prison

NYC DOC Jail

Savings in Services Use

NY/NY Housing - Costs and

Savings Per Unit from

Annual Per Unit Cost of

Ending Long-Term Homelessness

250,000 individuals and 15,000 families have been

Most face multiple barriers to housing stability including

About 10 - 15% of those who become homeless remain

The goal = 150,000 units of permanent supportive

Creating and Sustaining 150,000 Units of

Supportive housing is a product

Every project is a patchwork of

Often, success means using

Provide sustainable funding for rent subsidies &

Some specific policy recommendations

Provide permanent solution to renewal funding for permanent

For More Information

Corporation for Supportive Housing www.csh.org

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