Permanent Supportive Housing

MHSA Webcast Training SeriesLeslie Wise

Program ManagerCorporation for Supportive Housing

October 13, 2005

Our Mission

CSH helps communities create permanent housing with services to prevent and end homelessness.

What Is Supportive Housing?

A cost-effective combination of permanent, affordable housing with services that helps people live more stable, productive lives.

HOUSING – PERMANENT: Not time limited, not

transitional;– AFFORDABLE: For people coming out of

homelessness; and– INDEPENDENT: Tenant holds lease with

normal rights and responsibilities. SERVICES

– FLEXIBLE: Designed to be responsive to tenants’ needs;

– VOLUNTARY: Participation is not a condition of tenancy; and

– INDEPENDENT: Focus of services is on maintaining housing stability.

Housing & Services

Supportive Housing is for People Who:

Are chronically homeless Cycle through institutional and emergency

systems and are at risk of long-term homelessness

Are being discharged from institutions and systems of care

Without housing, cannot access and make effective use of treatment and supportive services

Services Make the Difference

Flexible, voluntary Counseling Health and mental health services Alcohol and substance use services Independent living skills Money management / rep payee Community-building activities Vocational counseling and job placement

Models for Supportive Housing: Traditional Development

Creates a permanent asset to the community Involves acquisition and construction and the full

compliment of development activities, including finding capital funding.

Can take 2-3 years (or more) to develop Involves establishing on-going funding sources

and providers for operating and services

Models for Supportive Housing: Accessing Existing Housing

Sometimes referred to as “Housing First” Also might be referred to as Scattered Site

Housing Integrates residents into the community Can “retrofit” existing affordable housing and add

services in a single site Once secure rental subsidy secured, can move

very quickly Involves establishing ongoing funding sources

and providers for operating and services

Using existing apartments in the community Provider does not own units but might master

lease No rehabilitation or construction involved – take

apartments “as is” Owner of apartments typically private landlords

who own large and small apartment buildings or 2-4 family houses

Scattered Site: One Example

The city of SF acquires sites for the DAH program through “master leasing”

Most units have private baths and shared cooking facilities

DAH housing presently includes:– The Camelot Hotel (51)– Windsor Hotel (78 units)– Star Hotel (54 units)– Pacific Bay Inn (75 units)– Le Nain Hotel (86 units)– Broderick Street Adult Residential Care Facility

(34 units).   

Direct Access to Housing in CA

Identifying privately-owned buildings that are vacant or nearly vacant where the building’s owners are interested in entering into a long-term lease

Negotiating improvements to the residential and common areas of the building prior to executing the lease

SFDPH contracts with one or more organizations to provide on-site support services and property management

Most buildings include a collaborative of two or more entities

Key Components of Master Leasing

Dividing responsibilities – Property managers maintain health and quality of life in the

building as a whole– Support service providers work with individual tenants and

advocate on their behalf during periods of relapse Having mixed populations in buildings

– Ensures that not all tenants at a site require extensive support or have difficulties meeting terms of their leases

Offering alternative accommodations at other sites during relapse or crisis

Screening and structure can create supportive environments for those who agree to participation in treatment– This is minority of extremely long-term homeless

Strategies that Work

Housing Tenants with Severe Psychiatric Disorders or Substance Use Problems

Consensus among experts and policy-makers Responds to documented needs and

preferences of consumers Documentation of supportive housing model(s)

and agreement on (most) key principles A growing body of evidence from research

Is Supportive Housing an Evidence-Based Practice?

More than 80% of supportive housing tenants are able to maintain housing for at least 12 months

Most supportive housing tenants engage in services, even when participation is not a condition of tenancy

Use of the most costly (and restrictive) services in homeless, health care, and criminal justice systems declines

Nearly any combination of housing + services is more effective than services alone

“Housing First” models with adequate support services can be effective for people who don’t meet conventional criteria for “housing readiness”

Consistent Findings

Housing + Services Make a Difference

A Cost-Effective Solution

Providing a mentally ill person with permanent supportive housing costs only $995 per year more than allowing that person to remain homeless

Supportive Housing: It Works

summary of key findings from a range of studies

ER visits down 57% Emergency detox services down 85% Incarceration rate down 50% 50% increase in earned income 40% rise in rate of employment when employment

services are provided More than 80% stay housed for at least one year

Hospital inpatient care for medical and psychiatric conditions

Hospital emergency room visits – especially for the most frequent users of ER

Psychiatric emergency and institutional care Residential mental health & substance abuse

treatment – especially detox Jails and prisons Emergency shelters

Supportive Housing Reduces Use of and Costs for:

Outpatient primary and specialty medical care Some mental health services (e.g. case

management, pharmacy) Methadone (more consistent participation) Services to address substance-abuse problems,

including services delivered outside of traditional treatment programs

Vocational and employment services Probation

Supportive Housing May Increase Use of and Costs for:

“Getting mentally ill people off the streets and into

supportive housing costs taxpayers only slightly more than leaving them to fend for

themselves…”

The Wall Street JournalMay 2, 2001

To learn more about supportive housing

visit www.csh.org