Psychiatric News August 20, 2004
Volume 39 Number 16
© 2004 American Psychiatric Association
p. 9
Coordinated Services Key to Solving Chronic Homelessness
Kate Mulligan
A collaborative federal effort acknowledges the link between chronic
homelessness and serious mental illness.
Efforts to find solutions to homelessness increasingly are focusing on the
development of ways to help people with chronic mental illness and substance
abuse disorders stay housed and on increasing the stock of affordable
housing.
More than 1,000 homeless advocates and service providers gathered in
Washington, D.C., in late July at a conference sponsored by the National
Alliance to End Homelessness (NAEH) to discuss what works and how to create
the political will necessary to end homelessness.
One way of creating that political will, according to Philip Mangano,
executive director of the Interagency Council on Homelessness (ICH), is to
collect the data that will make a cost-effectiveness argument.
He told attendees, "Do your homework on the economic arguments to end
homelessness. Right now in difficult times at every level of government, no
argument—not moral, not spiritual, not even quality of life—is as
compelling as the economic arguments to end homelessness."
Two Homeless Populations Identified
In background material, the NAEH distinguished between two subgroups of
homeless people.
Eighty percent of those who experience homelessness each year enter the
homeless system and exit it again relatively quickly. They do not differ in
most characteristics from other people who are poor. They have similar rates
of mental disorders including substance abuse, physical ailments, and domestic
violence experience. They need housing that is affordable and can be assisted
with various kinds of housing subsidies.
"Housing First" is an approach that can be effective with this
group.
Tanya Tull, president of Beyond Shelter Inc., in Los Angeles, described the
goal as "to move homeless families, including those who are vulnerable
and at risk, into permanent, affordable, rental housing as quickly as
possible, followed by time-limited support services after they have been
relocated out of the homeless services system."
She wrote in a fact sheet, "The methodology is premised on the belief
that vulnerable and at-risk homeless families are more responsive to
interventions and social services support after they are in their own
housing, rather than while living in temporary/transitional facilities or
housing programs."
The model, as practiced by Beyond Shelter, requires six months to one year
of individualized, home-based case management after the move.
Beyond Shelter produced positive outcomes for homeless families on measures
such as reduction of domestic violence, participation in educational
activities, improvement in depression, and willingness to pay rent.
Affordable Housing Vanishing
The NAEH points out, however, that the availability of affordable housing
for this population is declining. The organization wrote in "Policy
Papers," prepared for the conference, that in 1970, there were 300,000
more affordable housing units available nationally than there were low-income
families that needed them. In 2001 there were 4.7 million more low-income
households in need of housing than there were affordable units.
The other subgroup, approximately 20 percent of the homeless population,
"differs quite significantly from the general population of poor people
in that they almost all have chronic disabilities, including mental illness,
chronic substance abuse disorders, physical disabilities, and
HIV/AIDS."
They need supported housing that is linked to services.
"Harm reduction" is a model being used with that group. With
that model, an individual who might otherwise be ineligible because of
criminal activity, substance abuse, or an unwillingness to accept treatment
can be placed in housing. The approach contrasts with one in which there is
zero tolerance for substance abuse or a refusal to serve people with mental
illness who will not take medication.
Service providers try to establish a trusting relationship with the person
so that he or she voluntarily accepts services.
Federal Agencies Collaborate
The Department of Housing and Urban Development (HUD), Department of
Veterans Affairs, and Department of Health and Human Services have
collaborated on a program that encourages cooperation among local service
providers and governmental entities to serve people with chronic
homelessness.
The program, which was developed by the ICH, restricts eligibility to
individuals with mental illness or a substance abuse disorder, as well as
specified experiences with homelessness.
In fact, ICH's executive director, Philip Mangano, testified before a
congressional committee, "Persons experiencing chronic homelessness
generally have a disability, [such as] mental health [problems], posttraumatic
stress disorder, substance abuse, [or] developmental or physical
disabilities."
Eleven communities, selected from 106 applicants, received a total of
nearly $35 million to provide housing and supportive services.
Mangano went on to urge passage of HR 4057, the Samaritan Initiative, which
would authorize $70 million to expand and improve on that collaborative effort
among the three federal agencies.
Within a week of the end of the conference, advocates had scored a
significant victory. Many of them headed to Capitol Hill at the close of the
meeting to lobby for restoration of money to fund Section 8 vouchers, which
are provided through HUD and enable people to secure housing in the private
market. Service providers frequently link their services to the housing
provided by the vouchers.
In Fiscal 2004, HUD changed the way money was distributed to housing
authorities in such a way that it reduced the number of vouchers. The Bush
administration's Fiscal 2005 budget proposed an "underfunding" of
the program by at least $1.6 billion, resulting in the loss of vouchers for
250,000 families.
On July 22, the House Appropriations Subcommittee on Veterans Affairs, HUD,
and Independent Agencies restored the funds to the Fiscal 2004 level.
Numerous publications about homelessness are posted online at
<www.naeh.org>.
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