Over 20 years ago the Office of Mental Health awarded several agencies a contract to provide Supported Housing. Supported Housing created a housing program that provided permanent housing to individuals with a severe and persistent mental illness who could live independently in the community. That level of independence would be determined when the individual could make and keep appointments, maintain their medication regime, pay their rent, maintain their recovery and maintain their home, etc. The provision of case management was optional and there were no conditions of program attendance attached to the housing.
This housing was a tremendous opportunity to individuals who were living independently in the community in sub-standard housing. For most, unsanitary, unsafe and undesirable apartments were all they could afford on a fixed income. Due to their budget, many could not afford furniture or appliances in their homes. Supported Housing offered safe, clean, accessible apartments for 30% of an individuals’ income. The program also provided furniture and appliance to set up an apartment; furniture that the individual now owned and if they moved out of the program they could take the furniture with them. People applied in droves, were housed and remained in their housing until they required a higher level of care, usually, for physical illness. Today, over 25% of HALI’s tenants have been in our housing for over 10 years, 50% over 5 years.
There have been two distinct issues that have resulted in major changes in Supported Housing.
First, the budget to operate the program failed to increase as rents increased annually. This forced the agencies to, among other things, discontinue furniture start-up and recycle the furniture. The tenant was only able to take their mattress with them. Fiscal concerns also moved providers to create two or more bedroom apartments. To plan for that glass ceiling, where the budget will no longer be enough to house the contracted number of individuals, agencies began to purchase houses, apartment buildings and condos. The purchase of homes limited the geographical choice of potential tenants but created a fixed housing payment.
The second issue was created with the closing of hospitals and cuts in the amount of psychiatric long-term hospital beds. Due to the decrease, more people needed placement in Community Residences, which created waiting lists in step down beds and eventually huge waiting lists for Supported Housing. The problem is that the people applying for Supported Housing beds do not have the skills needed to live independently. Add to that the rising numbers of individuals (over 90%) that also struggle with addictions and relapse often.
The housing department at HALI provides an average of 3-4 visits each month (contracted to provide 1 visit per month) to individuals who are not able to maintain drug and alcohol-free living. Even at that intense level of case management, HALI needs to respond to public officials receiving complaints, house mates that are at risk for relapse, damages to the home from active users and the loss of rental income from non-payers. HALI prided itself on not having to evict anyone since we began this program over 20 years ago. Sadly, that is no longer the case. Now, providers need to determine on a daily basis whether they are landlords of service providers.
To resolve some of these issues, OMH has to commit to be fiscally responsive to the rising costs of housing, especially in high rental geographic areas. Agencies need to work closely with each other, especially housing agencies and case management agencies. Too often, case managers and housing providers become adversaries when it’s in the best interest of the tenant to be allies. HALI has seen that the tenant, who has HALI and outside case management that work together, is the most successful in their recovery, their housing and in their life. Isn’t that what we ought to be about?