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1. Housing
Opportunities for Persons with
Mental Illness
Carol Wilkins
Director of Intergovernmental Policy
Corporation for Supportive Housing
www.csh.org

2. 2
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 1-
bedroom 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

3. 3
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

4. 4
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

5. 5
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

6. 6
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

7. 7
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

8. 8
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

9. 9
“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

10. 10
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

11. 11
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

12. 12
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

13. 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

14. The Cost of Homelessness in NY
Service Provider
Mean Days
Used (2-year
pre-NY/NY)
Per
Diem
Cost
Annualized
Cost
NYC DHS – Shelter 137 $68 $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
Medicaid – Outpatient 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
Total $40,449

15. 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

16. NY/NY Housing - Costs and
Savings
$0
$2,000
$4,000
$6,000
$8,000
$10,000
$12,000
$14,000
$16,000
$18,000
$20,000
Savings Per Unit from
Reduction
Annual Per Unit Cost of
Housing
Community Residence Supportive Housing Weighted Mean

17. 17
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

18. 18
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 weren’t
officially intended – making it
difficult to replicate creative
strategies

19. 19
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

20. 20
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

21. 21
Some specific policy recommendations
 Provide permanent solution to renewal funding for
permanent housing funded through HUD’s 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 President’s
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

22. 22
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