Mental
Health Association in New York State, Inc. |
Community Connections, Spring 2003Housing:
A Keystone Mental Health Service As mental health consumers, family members and advocates reel under the latest exposés regarding the deplorable conditions in adult homes, locked wards for persons with mental illness in nursing homes, and, perhaps the most shocking of all, the exportation of some persons with mental illness out of the state, our anger and frustration mount, along with our determination to see to it that the governor and state legislature respond with meaningful corrective actions. It was only relatively recently that the mental health system came to the issue of housing. Even during the era of community mental health that began in the mid-1950s, most mental health professionals and policy-makers viewed the mental health system as only responsible for medical treatment. It was not until the mid-1970s, when thousands of men and women with serious mental illness were discharged from the state psychiatric hospitals, that it became obvious that basic human needs, such as housing, would have to be addressed. New York State responded in the early 1980s by creating a program to fund housing for persons with serious mental illness. Over the past 20 years, it has created 20,480 community beds state-wide, 9,374 or 47% of which are in New York City. The vast majority of these beds are operated by non-profit community-based agencies. All of these beds are either licensed directly by the state Office of Mental Health (OMH) or are in contract with OMH or the local governmental department of mental health. In New York City, this is the Department of Health and Mental Hygiene (DHMH). In addition, the City of New York has created 1,415 beds for homeless persons with mental illness under the NY/NY agreements. In developing a network of quality housing, mental health recipients and their families, agencies and advocates have recognized how essential housing is in the rehabilitation and recovery of persons with serious mental illness. Despite the development of a high-quality housing network for persons with serious mental illness, the remaining need in the community far exceeds the resources available. Although 20,000 beds have been developed, we know that many more of the State's estimated 125,000 adults living with serious mental illness need this kind of quality housing. Clearly, cost is an issue. To date, residential development and ongoing services have been funded largely by the state (OMH and the Office of Temporary and Disability Assistance), with the federal Department of Housing and Urban Development funding some of the development. If a significant new housing development initiative is to be launched, funding will be a major challenge. Secondly, much of the housing that has been developed has been set aside for specific sub-populations. For example in the congregate care or community residence arena, 50% of the beds are designated for persons being discharged from state psychiatric centers, leaving only half the beds for "community" referrals. Similarly, much of the housing already developed is set aside for persons who have histories of homelessness (the so-called "New York/New York" housing). These set-asides have been a source of frustration for families and providers alike. Another important issue has to do with the number of beds designated in each of the three major categories. In recent years, the lion's share of new development has been in Supported Housing, which provides the least supervision and support. And, although many clients have been able to make the transition from Congregate Care to Apartment Treatment to Supported Housing programs, the need for additional long-term housing with greater supervision has been well established by family members who often face great frustration in trying to access programs. Since these kinds of programs are more costly, funding issues will again be paramount. The scandals of recent months have cast the housing debate in a new light. The need to quickly develop new residential programs is clear. The fact that there is an experienced network of providers, and that OMH has developed a regulatory structure to competently oversee it, are advantages. What is needed first and foremost is the political will to act. The governor and legislature must feel our outrage and join with us in developing the creative strategies that are needed for a meaningful response. Dr. Beitchman is a member of the Board of Directors at NAMINYC-Metro and is the Executive Director of The Bridge, Inc. posted 6/13/03 |