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NAMI Convention Permanent Supportive Housing and Recovery Technical Assistance Collaborative Inc. Boston MA June 22, 2007.

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Presentation on theme: "NAMI Convention Permanent Supportive Housing and Recovery Technical Assistance Collaborative Inc. Boston MA June 22, 2007."— Presentation transcript:

1 NAMI Convention Permanent Supportive Housing and Recovery Technical Assistance Collaborative Inc. Boston MA June 22, 2007

2 2 TAC Boston-based non-profit organization founded in 1992 Assists NAMI and CCD Housing Task Force with housing policy issues Assists with mental health system development at the federal, state and local level TAC expertise includes affordable and permanent supportive housing policies, resources and practices

3 3 Mental Health System Transformation Achieving The Promise: The New Freedom Commission on Mental Health Report The lack of decent, safe, affordable and integrated housing is one of the most significant barriers to full participation in community life for people with severe mental illness Many mental health systems…do not see housing as their responsibility

4 4 Homelessness and Mental Illness Homelessness is the most visible manifestation of the housing and support services problems of people with mental illness A significant percentage of people who are chronically homeless report mental illness issues (self-reported 51% in Martha Burt study) Chronic homeless definition: An unaccompanied adult who has been continuously homeless for a year or more or has had at least four episodes of homelessness in the past three years Federal goal to end chronic homelessness by 2012 – includes prevention

5 5 Housing and Recovery Consumers believe and studies strongly support permanent housing as a basis for mental health recovery Consumers are much more responsive to accepting treatment after they have housing in place Housing choice and housing first approach preferred by consumers Flexible, mobile, individualized and voluntary support services are also necessary Too few mental health systems dedicate resources to ensuring that people with mental illness have adequate housing with supports (New Freedom Commission Report)

6 6 The Permanent Housing Approach: A Best Practice Consumers should have housing choices and – with appropriate supports – can successfully acquire and maintain permanent housing People deemed difficult to serve can be successful in permanent housing People do not have to pass through a linear set of preparatory residential services in order to be successful in permanent housing Housing should be decent, safe, and affordable and include rights of tenancy for consumers

7 7 Permanent Supportive Housing No official definition Decent, safe, and affordable community-based permanent housing providing consumers with rights of tenancy under applicable landlord/tenant laws and linked to voluntary and flexible supports and services designed to meet consumers needs and preferences Emphasis on: – Choice – Affordability and Quality – Tenancy rights/consumer control of housing – Normal and integrated housing settings (apartments) Linked with community models of service delivery – Voluntary services – Flexibility and mobility of services – Help with housing issues as well as mental health issues

8 8 Permanent Supportive Housing Emerged in the late 1980s – Robert Wood Johnson Foundation Demonstration Program – HUD McKinney-Vento Homeless Programs Prompted a paradigm shift in mental health housing practices Community integration mandates in U.S. Supreme Courts Olmstead decision An emerging evidence-based practice to prevent and end homelessness among people with serious mental illness – SAMHSA Supportive Housing Tool Kit Housing First models emerged in late 1990s Research/studies document PSH effectiveness

9 9 Recent Literature Permanent Supportive Housing – Increases residential stability and community tenure – Decreases use of in-patient settings – Decreases days in jail – Increases life satisfaction – May reduce psychiatric symptoms – May increase social functioning – Reduces costs in other systems

10 10 PSH Research Findings New York/New York Study – Center for Mental Health Policy and Services Research – PSH associated with a reduction in service use of $16,282 per person per year – Service use included public shelters, public hospitals, Medicaid funded services, veterans inpatient services, state psychiatric inpatient services, state prisons, and city jails Pathways to Housing Study – Psychiatric Services April 2000 – 88% of homeless consumers with mental illness who obtained PSH remained housed after 5 years compared to 47% placed in residential treatment models CT Corporation for Supportive Housing Study – – PSH created positive outcomes for tenants while decreasing their use of acute and expensive health services – Property values in neighborhoods with PSH have increased or remained steady San Franciscos Direct Access to Housing – Since 1998, 2/3 rd remained housed in PSH. – Of 1/3 rd who moved out, ½ moved to other permanent housing.

11 11 What Does Permanent Supportive Housing Look Like? Variety of housing models including: – Scattered-site apartments – Clustered apartments – Small scale single purpose buildings – Mixed population buildings (50-50 model) – Larger scale single population buildings – Single family homes

12 12 Successful PSH Initiatives North Carolina – Housing Finance Agency partnership with Department of Human Services – Mixed population model – Mandated set-asides in all affordable housing developments – 900+ units – Linked with local community based services Louisiana – Replicating NC model for up to 3,000 units of PSH Allegheny County PA – Reinvestment funds creating 300+ units – Both project-based and tenant-based models – Housing Support Team approach Arlington County, Virginia Other high performing states include Ohio, Connecticut and California

13 13 Permanent Supportive Housing Services Help people get and keep housing in the community Reflect needs and preferences of consumers Are flexible to respond to consumers changing needs Include frequent contacts In vivo learning Explicit goals to increase residential stability and improve quality of life 24/7 including access to crisis services

14 14 What is Housing First A housing model? Or a services model? Features of the model – Permanent housing first – No services required as a condition of obtaining the housing – Intensive services offered – continuously – to Housing First tenants Successful Housing First programs are challenging traditional mental health housing and services policies

15 15 Permanent Supportive Housing Depends on Best Practice Service Models Programs of Assertive Community Treatment (PACT) Integrated dual diagnosis treatment (IDDT) Community Support/intensive case management Medication management Supported Employment Illness self-management/recovery

16 16 System Transformation Towards Recovery and EBPs is Supported by Permanent Supportive Housing Requires multi-system coordination Requires flexibility, mobility and responsiveness of services Requires services that teach and support living skills and resiliency in typical environments Requires revision in funding criteria, service definitions and provider qualifications Foundation of PSH is individual choice, independence and integration in the community

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