Supportive Housing: A Cornerstone to Recovery in a Changing World

Advocates, providers, recipients, and policymakers are adjusting to the rapid pace of change in the mental health care system including behavioral health organizations, Health Homes, Medicaid reform, and many others. These changes, while challenging, present opportunities to improve efficiency, health integration, and consumer driven health care, reducing disparities and improving access. The Bureau of Mental Health within the New York City Department of Health and Mental Hygiene is responsible for improving the mental health of all New Yorkers and supportive housing is an essential part of the continuum of mental health services, promoting community integration and recovery. Toward that end, supportive housing is a top priority for our Bureau, comprising approximately $75 million or 40% of our overall funding to community-based providers throughout the City. The Bureau provides oversight, training and technical assistance to supportive housing providers to improve the quality of supports for tenants who reside in these programs as well as leadership on policy and planning activities within New York City on major mental health issues including supportive housing.

We at the Department are working with consumers and providers to continuously improve services to individuals living with mental illness who are homeless especially those with co-occurring substance use problems. Over the past year, the Department of Health and Mental Hygiene has articulated several priorities for community-based supportive housing providers:

  • Recovery
  • Improved care for individuals with co-occurring disorders
  • Harm Reduction
  • Health integration including smoking cessation
  • Employment
  • Engagement
  • Access for individuals exiting the criminal justice system; and
  • Consumer choice

Based on a random sample of 20 housing programs conducted in 2010, it was reported that more than 30% of individuals currently living in supportive housing were actively using illegal drugs or alcohol and more than 40% were smokers. We have come a long way from the paradigms of the past which required abstinence and periods of sobriety prior to acceptance into supportive housing. We still have a long way to go. To further improve service delivery, we provided harm reduction training to 85 supportive housing providers throughout New York City. Harm reduction promotes tolerance and engagement and acknowledges the challenges faced in changing addictive behaviors especially in the context of recovery from a mental illness. It enables tenants with the support of program staff to set clear goals and objectives and work toward achieving them in a measurable way.

Additionally, the Department supported an extensive series of trainings on “Integrating Tobacco Dependence Treatment Services.” More than 200 housing programs received extensive training on integrating tobacco cessation into their programs. This has helped shift many housing programs from inadvertent, tacit acceptance of smoking to supporting people in quitting. While the training specifically addressed nicotine dependence, it was built on a broader framework of Motivational Interviewing. Motivational Interviewing is strength-based and focuses on the individual’s own motivations to change rather than attempting to impose change externally. While smoking is damaging to an individual’s health it is also damaging to a supportive housing program and community, causing indirect risks to others through secondhand smoke, chance of fire and damage to apartments and belongings. Smoking cessation is just one important way to integrate healthcare into a supportive housing setting. Many community-based providers are doing so in creative innovative ways including creating gyms in lounge spaces, partnering with local health organizations, holding on site cooking and nutrition classes and many more. Integrating health care is no longer an optional enhancement for the behavioral health system. Improving physical health is a part of recovery and necessary for better mental health and a top priority for us at the Department.

Employment is a vital component to recovery from mental illness. Employment facilitates social inclusion promoting economic empowerment and self-sufficiency. The employment rates for individuals with serious mental illness are abysmally low. Increasing the number of individuals with serious mental illness who are competitively employed has become a top priority for our Department. Toward this end, we have been working with providers to implement vocational assessments within their standard operations in supportive housing. Throughout FY11, employment rates for adults with serious mental illness under the age of 62 living in DOHMH-funded supportive housing units hovered around 11% down slightly from previous years. Some of the drop-in employment rates can be attributed to the economy. People with mental illness are being affected just as the rest of the country is. When the rates are already so low, however, the slightest loss is disheartening.

An additional 9% of individuals in our supportive housing are in job training or supported employment while 80% remain neither in jobs nor job training. The barriers include stigma, real conflicts with benefits and the need for training on available incentives and programs to help individuals on disability maintain benefits while returning to work. Toward that end, the Department hosted two major forums on economic self-sufficiency for people with serious mental illness in January and June of this year. The forums included national and local speakers who informed the people we serve, providers, advocates and other policymakers about tools to help people achieve self-sufficiency. Presenters discussed Individual Disability Asset Accounts (IDA), earned income tax credits, personal banking and saving, and the Medicaid Buy-In among others. Hundreds of individuals we serve flocked to these forums to learn more. Subsequently, the Department co-hosted with the New York State Office of Mental Health a five-day intensive training for mental health providers on a range of benefits issues. More than half of those that attended were supportive housing providers.

We hear from every corner of our community how important housing is. In May of this year at our planning forum, the demand for greater access to affordable housing for individuals recovering from serious mental illnesses was a common chorus. The Bureau of Mental Health within the Department has also recently constituted a Consumer Advisory Board for mental health and held our kickoff meeting on October 4th. Over 100 consumers applied to sit on the board and 23 were selected for the inaugural class. In the very first meeting, board members identified housing as one of the biggest priorities.

Reflecting the prioritization of our community, The Department has worked hard to protect housing programs from the barrage of budget cuts over the past several years. Our current portfolio of over $75 million of supportive housing includes both congregate and scatter-site programs serving more than 5,000 people and continues to grow as we work to bring thousands of NYNYIII units online. Currently, the Department funds more than 70 providers to provide supportive services to help people recover from serious mental illnesses while maintaining a home – an integral part of recovery. While we have come a long way; we still have a long way to go. We will continue to support our community-based partners and to learn from our consumer advisors to improve the quality of care, help people with mental illness realize greater economic self-sufficiency, receive integrated care for their health, mental health and alcohol or drug use needs and to participate more fully in their communities, their families, and to fully realize their dreams. While we continue to fund the building of new supportive housing every day, we also recognize that simply building more housing is not enough. There will never be enough to meet the demand. We will have to work with all of our partners to improve access to affordable housing for people with serious mental illness, reducing barriers, removing stigma and promoting recovery in all we do.

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