Transcript Slide 1

Permanent Supportive Housing and
Mental Health System Transformation:
Key Elements in the Efforts to End and
Prevent Homelessness
Ending Homelessness: Plan, Act, Succeed
The National Alliance to End Homelessness
Annual Meeting
July 17, 2006
Marti Knisley and Steve Day
The Technical Assistance Collaborative
Today’s Discussion

What is MH Transformation?

Why MH Transformation?

Why are we talking about it today?

Why is permanent supportive housing (PSH) essential to
MH transformation?

What are the benefits of PSH + MH transformation?

What happens to people in systems that do not have PSH
+ a transformed MH system
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What is MH Transformation?
 Changing the way that states, local jurisdictions and even
the federal government do business, and
 Changing how business is done in a way that more people
get help and help that works
 Stems from President’s New Freedom Commission on
Mental Health: “To improve access to quality care and
services, the Commission recommends fundamentally
transforming how mental health care is delivered in
America”
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What is MH Transformation?
The New Freedom Commission and SAMHSA have
organized their agendas around five principles:
 Focusing on desired outcomes
 Focusing on community level models of care that
effectively coordinate MH treatment and delivery of other
services
 Focusing on policies that maximize the utility of existing
mainstream resources
 Using mental health research findings to influence the
delivery of services
 Ensuring that the President’s Commission
recommendations are used to promote innovation,
flexibility and accountability
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What is MH Transformation?
 The Institute of Medicine has identified the problem as
stemming from the complexity of health care and
recommends focusing energy on “levers” that can have
large scale effect with relatively small efforts in four areas:
 Finance
 Workforce
 Best practice
 Information technology
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Why MH Transformation?

Perception that the system is fragmented, has big gaps and
too many people fall through the cracks of the system

Financing does not reinforce provision of services proven to
be effective. Thus, many people don’t have access to
effective services

All the above problems have resulted in a lack of confidence
in the specialty mental health sector which in turn means
this sector is no longer the single payor or policy maker

This in turn requires collaboration beyond the boundaries of
traditional mental health systems
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Why MH Transformation
MH 4/06
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Why MH Transformation
MH 3/068
Why are we talking about it today?
 50-60% of single adults who are chronically homeless have
mental health problems
 Consensus that traditional mental health systems don’t have
services that are either desired by or work for people who are
homeless
 Demonstrations and specialty serves for people who are
homeless work well but don’t translate into changes in the
mainstream service delivery system or long term funding
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Why are we talking about it today?
 State and local MH systems are now or soon will be engaged
in transformational activities
 They will make choices about what activities they are engaged
in—and they have many choices
 Shifting mainstream resources to reimburse services that are
effective for people who are homeless requires a significant
shift in resource allocation
 MH systems need to have the tools and understand the need to
make services and supports for people who are homeless a
priority
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Why is housing essential to MH
transformation?
 Many people who could benefit from mental health
services could also benefit from stable affordable housing
 Having your own place to live promotes recovery
 The service strategy that helps people get and keep
housing—community support—is both clinically and cost
effective; if “housing first” is used, the system becomes
adept at engagement and relapse prevention
 Reduces the need for and likelihood of a costly, duplicative
system (homeless services system)
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What are the benefits of PSH + MH
transformation?
 Maximizes three sets of resources: housing capital,
housing subsidies/ operating funds and services funds--stretching existing resources and bringing new resources to
the table
 Provides useful, practical tasks for staff who have
responsibilities to help people become stable, contributing
community members engaged in their own recovery and
on their own terms
 Provides a platform for MH system to demonstrate value
to stakeholders, public officials and policymakers and most
of all to consumers and family members
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What are the benefits of PSH + MH
transformation?
 More people have access to PSH; PSH provides choice, rights
of tenancy and removes conditions for treatment
 Community Support Services are tailored to:
 Increase emphasis and resources directed toward people getting help to
get and keep jobs
 Assure integrated MH and SA services are the expectation
 Streamline and increase access to benefit programs/ with incentives for
going to work
 Value social and peer supports
 Housing support is a high priority of the Community Support
System
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What is community support in a
transformed MH system?
 Combined mental health and substance abuse and
rehabilitation services and complimentary supports
 Organized to resolve the interrelated clinical, social,
financial, and residential challenges encountered by
priority public mental health system constituents
 With services are delivered in natural community settings
such as homes, neighborhood venues, schools, homeless
shelters, drop-in centers, and on the streets – often
delivered by peers
 Overcomes barriers to engagement and service access,
develops coping skills, and promotes recovery in ways that
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traditional mental health service can not
What is housing support in a
transformed MH system?
 The system explicitly commits resources to one of two service
models: stand alone Housing Support Teams or integrated
housing support functions to Community Support/ ACT Teams
 Housing support functions include:
 outreach/ engagement,
 helping a person select housing, move in, access benefits, sign a lease
and meet all the required functions of tenancy and
 other supports so a person can “keep” their housing
 How to pay for it: Medicaid, state institution downsizing or
health care reinvestment, new state plan requirements, redirect current allocations
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What is housing support in a
transformed mental health system
 Access to continuous and sufficient bridge and long term
rental assistance and to contingency funds for deposits and
furnishings
 How to pay for it: HOME, state and local trust funds,
Medicaid or state institution downsizing reinvestment, SSI
Supplement, small grants
 Interagency agreements to meet service and housing policy
imperatives for affordable housing and MH reform – LIHTCs,
Trust Funds and other state and local capital or rental and
capital funds, private philanthropy
 A better trained and compensated workforce with more
opportunities for peers
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What happens to people in systems that do not
have PSH + a transformed MH system?
 Institutional care/ incarceration/residential treatment siphons
funds away from effective services,
 While at the same time costs for maintaining institutions will
continue to rise with little to show in return
 MH system blamed for homelessness which in turn reduces
credibility---ability to attract new resources
 People with mental illness even more likely to disengage from
the service system
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For discussion:
State Transformation Strategies
 Pennsylvania
 Is PSH a priority?
 North Carolina
 If not, why not; what can be
done to make it a priority
 New Mexico
 Connecticut
 Your state……
 If it is, what is working?
 What needs to be done?
 What are the challenges to
success?
 Is PSH linked specifically to
MH system transformation?
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