Housing for People with Severe and Persistent Mental Illness

Common housing options for people with serious mental illness

Rest Homes

This custodial housing option is for people (usually aged) whose symptoms prevent them from living independently. Typically, rest homes are in large, institutionalized settings. They do not have staff trained to offer specialized mental health support.

Family Care Homes

Usually located in houses, this custodial housing option carries a warmer, more family-like feeling for its several residents. For example, meals are often prepared in the kitchen, and residents eat together in a dining room or kitchen. They do not have staff trained to offer specialized mental health support.

Mental Health Group Homes

Mental health group homes house just a few people and work with other service providers to maximize care. The home's structured daytime schedule and its staffing levels of trained service providers improve functioning, reduce anxiety, and maximize quality of life. Residents use group homes as a step towards independent living, or as a permanent home.

Supported Apartments

These full apartments have kitchens, living rooms, and bedrooms, and they offer support from an on-site apartment manager. The manager is trained to address mental health concerns and provide crisis intervention, and is also responsible for helping to coordinate care for residents.

Subsidized Apartments

These full apartments have amenities provided by the apartment complex, but they do not offer the specialized support of trained staff on site.

Single-Room Occupancies (SRO) and Boarding Houses

These inexpensive housing options may be attractive to people with SPMI, but they tend to draw people with substance abuse issues or legal problems. The chaotic nature of SROs and boarding houses increases stress for people with SPMI. And because SROs don't have kitchens, residents can't cook for themselves and take full advantage of resources like food stamps. They do not have staff trained to offer specialized mental health support.

Homeless Shelters

Homeless shelters are considered housing of last resort for people with mental illness, yet national statistics show that 39% of homeless people report some form of mental illness - and between 25 and 30% of them have a serious mental illness. A landmark study conducted by the University of Pennsylvania in 2001 found that the homeless mentally ill use $40,500 a year in public funds for shelter and hospital services - not including costs incurred through the criminal justice system or the effects this population can have on commerce and tourism. Providing homeless mentally ill individuals with "supported" housing would cost about the same (est. $41,000 per year), but would also cover comprehensive health and other life supports.

Creating safe housing options for people with severe and persistent mental illness (SPMI) can be a daunting project within any community and there are many challenges, including:

  • Community beliefs - Many people worry that providing housing for those with mental illness will decrease property values, create a bad reputation, and draw more "undesirables" to the area.
  • Limited local community budgets - There are many competing needs facing local communities and only so much money to address them.
  • Nature of the illness - Because relapse is common, many people with SPMI have inconsistent work histories and varying levels of need for services over time.

Ideally, a community would be able to offer a range of housing options for people living with SPMI. Reality dictates that most communities focus their efforts on what they can afford. However, even with budget limitations, building a successful program is possible.

 

Research Shows Some Housing Models Are Better Than Others

Seminal research by Trainor et. al. (1993) proves that structured day program models lead to better outcomes for people with SPMI than custodial models. Without doubt, rest homes and family care homes offer shelter and have been accommodating about accepting residents, but they are not designed to improve functioning or maximize independence of those living there.

 

For a housing program to address the needs of people living with SPMI, they need to:

  • Ensure residents participate in services and program operations
  • Offer a small, homelike setting
  • Adapt services to address an individual's fluctuating symptoms
  • Have flexible admission criteria
  • Evaluate their program and services and modify those based on the individual's needs
  • Provide case management

 

Considerations for Local Communities

To address the housing needs for individuals living with SPMI, local communities must understand that this type of housing is not likely to be self-supporting. Rather it is an investment in its quality of life for the entire community.

 

Stakeholders also need to understand that:

  • The primary need is among people without rental subsidies or eligibility to participate in other housing programs.
  • Those who lack housing assistance also lack sufficient income to pay fair market rates for housing.
  • Residents will need varying levels of support throughout their lives.
  • Like housing for other special populations, it needs to be centrally located with access to public transportation.
  • It is more cost-effective to purchase existing, affordable properties in decent shape than to build new.
  • Greater success will follow if clients and local service providers are involved in the planning process.
  • Community education and engagement before, during, and after the project will help to address concerns of potential neighbors and to maintain community support.