The Redesign of Housing

In the Spring of 2007, the NYS Office of Mental Health, reached out to the residential providers in New York State asking them to review and provide feedback to the Guiding Principles for the Re-design of the (OMH) Housing and Community Support Policies.

The message from the OMH was that safe, decent and affordable housing is a cornerstone of recovery from mental illness. Stable access to good housing was a fundamental problem for many people with mental illness because of poverty, the limited supply of very low-income housing, the rising cost of rental market, and discrimination.

The fundamental problems listed previously, continue to exist today and there needs to be a change. Change must include an expansion of low-income housing for people with mental illness and flexible supports that do not condition housing or services. Housing is a basic need and necessary for recovery. Most people want permanent integrated housing. We must move forward with local systems of care that can provide housing and support needs in the housing preference at any level of recovery.

In 2007, the OMH revisited the structures that govern the mental health housing assets in New York. Many of these units were developed using approaches established in the 1980’s and 1990’s. This period of time emphasized residential treatment strategies, services and supports as a condition of living in the program. Within an accountable system of care there is a finite need for staffed specialty treatment programs.

Reform of housing is intended to balance access to housing for all individuals with the need to reform older models of residential care. Person centered principles of recovery guide the redesign efforts. Additional OMH goals include: expanding access to supported housing, re-evaluating existing staffed single site housing programs, developing permanent integrated housing, and reducing acute care stays. Flexibility is necessary for housing reform to be responsive to individual recipient wishes, needs, and system goals, and to work effectively as a tool in creating local systems that avoid institutionalization and homelessness.

The OMH has worked with stakeholders such as local government, consumers, family advocates and providers to incorporate flexibility, choice, want and need into projects on a local level of change. Since 2007, the OMH has worked with over 30 agencies to redesign housing programs in their community, reducing the number of congregate staffed housing, expanding apartment treatment and supported housing capacity and embracing the desire to change for the future. One such agency is DePaul.

DePaul, a progressive Western New York not-for-profit organization founded in 1958, is committed to providing quality residential, rehabilitation and treatment services to the elderly, persons with mental illness in recovery, persons with a developmental disability, and those with a history of homelessness as well as, addiction, prevention and support programs. Over the past seven years, DePaul has embraced the housing redesign model.

According to Mr. Mark Fuller, President of DePaul, “We’ve worked hard to convert many of our community residences into apartments. Our consumers have truly benefitted as the approach to treatment has evolved from a one-size-fits-all approach to a more personalized venue that fits individualized needs.

Supported housing – independent apartments with financial stipends and case management – clearly remains a therapeutic option for consumers but it is not necessarily for everyone, at least not immediately. The meteoric increase in home ownership has resulted in a negatively impacted renter’s market, with riskier, less stable neighbors and neighborhood relationships for consumers in individual apartment settings. This situation is most keenly felt by those moving directly into supported housing with few skills.

Consumers living in single-site, one-bedroom supervised apartments and consumers living in service-enriched SROs stated they have the best of both worlds including the availability of staff supports tailored to their individual wants and needs (ie. medication supervision, symptom management, socialization, support and advocacy, etc.), as well as the ability to retreat to their own apartment when they preferred to be alone. Residential staff assist consumers as they practice skills learned in treatment or skill-building programs, while residing in a safe environment. Consumer satisfaction surveys indicate many consumers in treatment apartments and SROs advocate for and support each other while residing in these programs, creating a peers-helping-peers mentality and environment.

Another major benefit to single-site treatment apartment programs and service-enriched SROs is the opportunity to socialize with others in the program. These programs encourage consumer interaction and socialization through in-house activities, community-based activities, or simply befriending other program residents. Surveys confirm concerns in this area, as consumers don’t often have the opportunity or motivation to go into the community and meet new friends when living independently.

It is important to remember that treatment apartments and service-enriched SROs are transitional in nature. People will likely leave the program in two years or less. These programs heavily emphasize recovery and self-sufficiency. After operating residential programs for many years, DePaul has learned that consumers are better prepared to live independently once they graduate from one or both of these two programs.

In conclusion, DePaul believes that single-site treatment apartment programs, service-enriched SROs, and supported housing are cutting-edge housing programs. Our experience demonstrates that they are more therapeutic than community residences and scattered-site, licensed apartments. Community residences still serve a legitimate role in housing for adults with psychiatric disabilities, yet have experienced a decreased demand over time. This may be due to the fact that individuals only rarely spend the amount of time in institutions as prior generations once did. Therefore, congregate living in a close-knit group home, without much privacy, may appear institutional for many of the younger people in the mental health residential system. The proof is waiting lists for apartments, while we have vacancies in community residences!”

Mark H. Fuller is the President of DePaul. DePaul, a progressive, private not-for-profit organization founded in 1958, is committed to providing quality services including assisted living programs for seniors; residential, rehabilitation and treatment services for persons with mental illness in recovery, some of whom have a history of homelessness; addiction prevention and support programs, and residential and support services for persons with developmental disabilities. DePaul is located in Rochester, New York and provides services in eight counties in Western New York and ten counties in North Carolina.

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