Table Of ContentIssue 12: September 2017
PRACTICING RECOVERY:
Recovery-oriented Approaches to Housing Instability
Supports for Individuals with Serious Mental Illness Experiencing
Housing Instability
A stable and safe place to live is a critical element to HUD Continuum of Care Program
recovery for individuals diagnosed with serious mental The Continuum of Care (CoC) program funds local
illness (SMI). In fact, “Home” is one of the four major nonprofit and government programs and supports
dimensions identified by SAMHSA that support a life in them in their efforts to re-house individuals and families
recovery. In addition, safe and affordable housing is a experiencing homelessness in a timely way. The
social determinant of health highlighted in the Office of CoC does this by helping to cohesively coordinate
Disease Prevention and Health Promotion’s (ODPHP) services and programs at the local level, helping local
Healthy People 2020 program. organizations work together, and promoting access to
other programs within the community. The CoC is often
As such, providers want to pay as much attention to the
the first resource for providers or practitioners looking to
housing situations of the people they serve as they pay
help the people they serve access housing.
to health, community supports, and other holistic factors.
This issue of Practicing Recovery explores the clinical United States Interagency Council on Homelessness
importance of safe and secure housing for individuals
The USICH is a partnership between 19 federal agencies
with mental health conditions and how you can
and offices that lead the national effort to prevent
understand, screen for, and assist those experiencing
and end homelessness in the U.S. USICH developed
housing instability or homelessness. The following
Opening Doors, the nation’s first comprehensive federal
resources are a great starting point to help you learn
strategy to prevent and end homelessness.
more about how housing affects the people you serve
and what you can do about it. SAMHSA Homeless Programs and Resources
HUD Exchange SAMHSA offers a number of homelessness prevention
and support programs, including grant-funded programs
The U.S. Department of Housing and Urban
for people experiencing homelessness and cooperative
Development’s (HUD) HUD Exchange is an interactive
grant programs jointly funded by the SAMHSA Center
website with resources and tools for understanding
for Mental Health Services (CMHS) and Center for
and applying for the many federal housing assistance
Substance Abuse Treatment (CSAT) for people with
programs, including public housing and voucher
behavioral health conditions who need permanent
programs. In addition, the site offers information on
supportive housing.
housing grants and education and training to learn more
about HUD’s services.
Recovery to Practice
Resources for Behavioral Health Professionals
PROGRAM SPOTLIGHT
Mental Health America of Los Angeles (MHA) Village Homeless
Assistance Program (HAP)
One of the keys to effectively providing services to
individuals with behavioral health conditions is to “meet MEETING PEOPLE WHERE THEY ARE
them where they are”—that is, to both physically and
MHA Village’s HAP team is focused on connecting
emotionally address what individuals want and need in that
with people with mental health conditions who are
moment and help them move forward toward their goals,
experiencing homelessness and helping them address
big or small. This is the proven approach the MHA Village
their immediate and long-term goals. Assisting
Homeless Assistance Program (HAP), in Long Beach,
someone with feeling productive and recognizing
California, takes to addressing housing instability among
that they have potential can be a starting point for
individuals with mental health conditions.
developing a long-term relationship. HAP does this
MHA Village’s HAP operates a drop-in center that serves through three key areas:
as a starting point for developing relationships between
Outreach and engagement. HAP teams visit
staff and individuals with mental health conditions who
homeless encampments, shelters, and other areas
are experiencing homelessness. The drop-in center
frequented by people with unstable housing to
allows the agency to help people determine what types
reach out and offer assistance ranging from clean
of services or resources they want, both short-term and
blankets to referrals. HAP can connect individuals
long-term. For example, today a person may only need a
experiencing mental health crises with a crisis
shower and a clean pair of socks, but tomorrow he may
intervention team, if needed.
want to talk to someone about his mental health issues
or finding an apartment. MHA of Los Angeles’ staff deftly Drop-in center. HAP’s drop-in center is the
addresses whatever a person needs in that moment while umbrella under which all other services are offered.
also providing linkages to mental health services, housing People can take a shower and get out of the
services, or other supports a person may want later. elements, receive personal mail, and do laundry
at the drop-in center. But they can also talk to staff
HAP follows a Housing First model for getting individuals
about applying for federal or state benefits, finding
who want a place to live into safe and secure housing
housing, or getting mental health services.
as a first priority. In addition, they use Whole Person
Care (WPC) to provide individualized, coordinated Case management. Through the drop-in center,
services to people who are experiencing homeless HAP offers short-term case management to
through approaches such as harm reduction, motivational help people on their paths to recovery. The case
interviewing, and outreach. management team connects individuals with more
permanent mental health services, if desired, and
HAP is not a residential program; rather, it serves as
with housing services.
an umbrella under which people who do not have
access to other services can find long-term housing and
connections with comprehensive care. The program has Special thanks to MHA Los Angeles Programs Manager
a variety of housing options and wraparound services Marjorie Solorzano for contributing information to this
available to those who want them. Community integration, article. For more information about MHA Village’s
empowerment, and recovery are woven into HAP’s service services, visit http://mhavillage.squarespace.com.
mix. HAP staff work with people who may not qualify for
traditional supports—such as individuals with criminal
records, no credit, or who have been homeless for a long
time. The program can help people connect with vital
resources such as legal services and obtaining or replacing
IDs and Social Security cards.
2
THOUGHT LEADER
Ann Denton, M.Ed., Senior Fellow, Center for Technical Assistance,
Advocates for Human Potential, Inc.
Ann Denton has spent more than 30 years working to stays, and reduced healthcare costs. Addressing unstable
advance systems change, provide training, and advocate housing as a barrier to recovery is person-centered,
for the needs of individuals experiencing homelessness. improves treatment engagement, and can be a powerful
She has served as the director of SAMHSA’s Homeless tool for instilling hope for the future.
and Housing Resource Network (HHRN) and provides
leadership, training, and support to other federal Understanding Housing Options
homelessness programs.
Ms. Denton recommends that behavioral health providers
and others who work with individuals with behavioral
People with mental illness are more likely than the
health conditions become adept at how and where to
general population to experience homelessness or
access housing services and supports. The links in the
housing instability. In fact, in 2016, one in five people
table below provide the basics on selected housing
experiencing homelessness had SMI. There are many
programs and other supports.
factors that contribute to this, but one stands out more
than any others, according to Ann Denton. If there is
Housing and services delivered with fidelity to the
a single fact that behavioral health providers should
Permanent Supportive Housing (PSH) model offer high
know about housing instability, it is that anyone living on
housing retention rates and reduced substance abuse
Supplemental Security Income (SSI)—the income that
over time, supporting long-term recovery. Housing First,
many people with SMI depend on—is at serious risk of
a high-fidelity form of PSH, has proven successful for
homelessness. “This is just a grim economic reality,” says
people with many barriers to housing.
Denton. “Regardless of where an individual is in their
recovery journey, unstable housing is a poverty issue
above all else.”
Housing for People Experiencing Homelessness
According to the report Priced Out in 2014, in 17 states
Continuum of Care Resources
and the District of Columbia the statewide average
one-bedroom rents were higher than an individual’s entire CoC Homelessness Assistance
monthly SSI payment. According to federal standards,
Rapid Rehousing (RRH)
housing that costs more than 30 percent of one’s income
is considered a cost burden; more than 50 percent is
Other HUD Housing Assistance
considered a severe cost burden. When SSI is a person’s
Public housing agencies provide Housing Choice
only source of income it becomes clear that, without a
Vouchers (formerly Section 8)
housing voucher or other supportive programs, accessing
and sustaining housing is exceptionally difficult. Similarly,
Other subsidized housing includes units with built-in
people who are not on SSI but earn a low wage are also
subsidies or other types of rental assistance. (See
at high risk of housing instability and homelessness.
HUD’s Multifamily Inventory.)
Why Stable Housing Matters to Recovery Cities and larger counties receive HUD resources for
Helping the people you serve with housing issues is affordable housing through the HUD Consolidated
part of providing comprehensive behavioral health care, Plan
says Denton. Furthermore, stable housing is critical to
United States Department of Agriculture (USDA)
recovery, she notes, because without a secure place to
live, people are unable to focus on improving any other Provides multiple forms of financial assistance
part of their lives.
Maintains an online inventory of assisted and
Safe, stable, community-based housing is a social subsidized housing (see USDA Multifamily
determinant of health and key contributor to health Inventory)
inequality among individuals with disabilities. Research
finds that people in stable housing show consistent
improvement in areas such as health, reduced hospital
3
WHAT YOU CAN DO
How to Screen for Housing Instability
Asking “are you homeless” is not useful for learning if a
person you serve is experiencing homeless or at risk, UNDERSTAND INDIVIDUALS’ HOUSING
according to the National Health Care for the Homeless AND FINANCIAL SITUATIONS
Council. People are often fearful of the negative
The best way to find out about the housing status of
association with homelessness or they feel that their living
the people you serve is to ask them! Become aware
situations—couch surfing, staying in settings not suitable
of people’s financial stability (to the extent that
for occupation (e.g., no running water or heat)—do not
they want to share), and learn what, if any, housing
qualify as homelessness. So how can you effectively ask
supports they may currently receive. Housing
about homelessness?
vouchers can be time-limited, so stay on top of their
The National Association for Community Health Centers status and help where and when you can. Talk to
has a simple screening for homelessness as part of the people you serve about ways to establish and
its Protocol for Responding to and Assessing Patients’ sustain financial stability and wellness.
Assets, Risks, and Experiences (PRAPARE) tool—a
INCLUDE HOUSING IN YOUR
national effort to help providers collect and act on data
TREATMENT PLANS
on social determinants of health. PRAPARE has just two
Safe and stable housing is a crucial piece of a
basic questions for effectively screening
person’s whole health and should be included in
for housing instability and homelessness:
a treatment plan whenever possible. This makes
What is your housing situation today? (Options housing a priority for everyone involved on the
include: I have housing today or I do not have
care team.
housing today, e.g., I am staying with friends or
staying in a car.) ASK PEOPLE WHAT THEY WANT
Are you worried about your housing? Research shows that when people are in the
housing they want, they are happier and healthier.
In addition, several comprehensive screening tools are Ask the people you serve if they have secure
available online. housing, and if they don’t, ask what that would look
like to them in terms of location, amenities, and
The VA Supportive Services for Veteran Families
support services, for example.
(SSVF) Homelessness Prevention (HP) Screening Toolkit
The Minnesota Family Homeless Prevention and PROVIDE ONGOING SUPPORT
Assistance Program (FHPAP) screening tool A big misconception about securing housing is that
the work ends when an individual moves in. Many
The Barriers to Housing Stability Assessment
people need ongoing support to be a good tenant
and neighbor.
UNDERSTAND THAT LANGUAGE
CONFERENCES & EVENTS MATTERS
Speaking to and about individuals experiencing
homelessness in a respectful and person-first way
is important for people who may feel that they are
September is National Recovery Month
not seen or understood. Likewise, MHA Village
This year’s theme is Join the Voices for Recovery: endorses open communication and strengths-based
Strengthen Families and Communities. To plan and language within their care teams and in working
promote your own Recovery Month with others who may encounter people experiencing
event, take advantage of the homelessness.
resources packaged in the
GET TO KNOW THE RESOURCES
Recovery Month Toolkit.
IN YOUR AREA
HAP doesn’t offer every service anyone could
International Association of Peer
ever need, but they have created a diverse network
Supporters National Conference
of connections and referral sources to assist the
October 16–18, Phoenix, Arizona OCT
people they serve as completely as possible. One
Learn more or register to attend 16-18 Degree is an online directory of support services
in the California area; the National Coalition for
American Public Health the Homeless offers a national directory. Local
emergency departments and large social services
Association Annual Meeting
agencies are great places to ask for resource
and Expo NOV
directories you could share with the people
Nov 4–8, Atlanta, Georgia 4-8
you serve.
Learn more or register to attend
