Marie Williams, LCSW Assistant Commissioner, Division of Recovery Services & Planning 615-253-3049 Marie.Williams@s

1. T E N N E S S E E D E P A R T M E N T O F M E N T A L H E A L T H A N D D E V E L O P M E N T A L D I S A B I L I T I E S Tennessee Creating and Expanding Housing Options that Promote Recovery Opportunities Marie Williams, LCSW Assistant Commissioner, Division of Recovery Services & Planning 615-253-3049 Marie.Williams@state.tn.us

2. What is Recovery?When is a Person Recovered? • WHEN REVIEWING LITERATURE WRITTEN BY THE LEADERS IN THE FIELD OF RECOVERY: • DR. PAT DEEGAN • MARY ELLEN COPELAND • DR. BILL ANTHONY • AND OTHERS • IT IS CLEAR THAT RECOVERY IS A JOURNEY • WHOSE DESTINATION INCLUDES…..

3. ~ The process in which people are able to live, work, learn, and participate fully in their communities. Recovery is the ability to live a fulfilling and productive life despite a disability. ~ [President’s New Freedom Commission on Mental Health:Report to the President, 2003]

4. RECOVERY HAPPENS ecovery means that the mental illness is no longer the central focus of R a person’s life… …even when symptoms persist.

5. DEFINING TERMS • RECOVERY refers to the ways in which a person with a psychiatric disorder manages his or her disability in the process of reclaiming his or her life in the community. • RECOVERY-ORIENTED CARE refers to what psychiatric treatment and rehabilitation practitioners offer in support of a person’s recovery. —The Matrix Model @ Horizon House

6. THREE GOALS OF RECOVERY C onsumers engaged in the process of reintegration (recovery) strive to achieve three goals: • restoring relationships; • moving toward independent living; and • obtaining meaningful work. —Reintegration Today: Summer 2004

7. The Tennessee Department of Mental Health and Developmental Disabilities’ Response to Expand Community Recovery Options THE RESPONSE

8. THESETH CAMPAIGN The SETH Campaign is a strategic plan to partner with Tennessee community providers to increase the following community options for persons with mental illness and co-occurring disorders on the path to recovery: Housing - Phase 1 Employment/Education - Phase 2 Support Services - Phase 3 Transportation - Phase 4

9. Phase 1

10. CHI: CREATING HOMES INITIATIVE A strategic plan of the Department of Mental Health and Developmental Disabilities to partner with communities to create housing options for people with mental illness and co-occurring disorders effectively and strategically in Tennessee.

11. Recovery & Housing:Our Current Reality • Housing ranks as a priority concern of individuals with serious mental illness. Locating affordable, decent, safe and appropriate housing is often difficult, and out of financial reach. Stigma and discrimination also restrict consumer access to housing. MentalHealth: A Report of the Surgeon General, 1999

12. Recovery & Housing:Our Current Reality • Housing is, perhaps, the first line of treatment for people with serious mental illness. • The lack of decent, safe, affordable, and integrated housing is one of the most significant barriers to full participation in community life for people with mental illnesses. President’s New Freedom Commission on Mental Health: Report to the President, 2003

13. Americans with MentalIllness • Persons with mental illness and co-occurring disorders receiving SSI benefits average monthly income ($623) are among the lowest income households in the country. • There is not a single housing market in the U.S. where a person on SSI can afford to rent a modest efficiency apartment.

14. Tennesseans with Mental Illness • There are a total of 173,377 persons assessed with severe and persistent mental illness in Tennessee who have used some service covered by TennCare (Tennessee’s Medicaid waiver program). • Of those, approximately 2,000 individuals live in 212 licensed supportive facilities. • Approximately 20% of the criminal justice system and 25% of the homeless populations are diagnosed with mental illness and co-occurring disorders totaling 12,000. • Therefore, it is safe to conclude that approximately 187,377 persons in need of housing assistance.

15. Tennesseans with Mental Illness • For every 100 households at or below 30% of median income, there were only 36 units both affordableand available for rent. • The cost of a one-bedroom apartment is 80% of SSI monthly income • Current estimates show that over 180 persons in our regional mental health institutes could be discharged if appropriate housing, with the proper support services existed.

16. Creating Homes InitiativeThe Milestones • February 2000- Origins • Commissioner Elisabeth Rukeyser establishes Office of Housing Planning and Development (OHPD) with Marie Williams as Director • August 2000 - Kicks Off • Announces Creating Homes Initiative (CHI) at TN/KY Housing Institute • September 2000- $2.5 million for Phase One • Nashville • Jackson • Chattanooga • Memphis

17. Creating Homes InitiativeThe Milestones • $2 million from Tennessee Housing Development Authority • HUD Section 8 • Statewide group proposal review and rank • Funding announcements • Produces media events • Fights NIMBY/Legal issues • January - April 2001 - Moves forward A Place to Call Home • www.housingwithinreach.org • click on NIMBY (Not In My Backyard) • click on NIMBY literature

18. Creating Homes InitiativeThe Milestones • April 2001 - Hires Staff, Submits Grants • Hires Regional Housing Facilitators • Applies for new funding with CMS, THDA, HUD Continuum of Care, Section 8 and 811 • October. 2001 - Accepts Additional Project • Receives $1.8 million CMS Real Choice Systems Change Grant • October 2001 - Phase II Begins • Clarksville • Nashville • Johnson City • Knoxville • Jackson • Murfreesboro • Memphis • Chattanooga

19. Creating Homes InitiativeThe Milestones • December 2002 - Receives funding awards • $8 million from Federal Home Loan Bank Affordable Housing Program • $5 million from HUD Continuum of Care • Continues to work on HUD Collaborative Initiative to End Homelessness • October 2002 - Successes • Surpasses goal of 2005 • Announces new goal of 4010 by 2005

20. Creating Homes InitiativeThe Milestones • July 2004 – DMHDD Reorganization • Commissioner Virginia Trotter Betts forms the Division of Recovery Services to coordinate provision of services in areas of Support, Employment/Education, Transportation, and Housing/Homelessness (SETH). • Regional Housing Facilitators become Regional SETH Facilitators • Regional SETH Facilitators continue CHI activities • January 2007 – Regional Housing Facilitators reinstated and return to Housing as single focus • Initiative doesn’t miss a beat!

21. CHI: THE VISION T o create and expand affordable, safe, permanent and quality housing options for people with mental illness and co-occurring disorders in Tennessee CHI Packet on the Internet http://www.tennessee.gov/mental/publications/CHIpacket.pdf

22. CHI: THE MISSION T o partner with local communities, assertively and strategically, to educate, inform and expand affordable, safe, permanent and quality housing options for people with mental illness and co-occurring disorders.

23. CHI: THE GOAL Set in 2000: 2005 by 2005 Met in 2002, so reset to: 8009 by 2009

24. Creating Homes Initiative Current Outcomes • More than $200 million has been leveraged • More than 7,100 new or improved units have been developed • More than 1,155 individuals from local, regional and statewide organizations have participated in making CHI success • 95% statewide decrease in re-hospitalization

25. Creating Homes InitiativeRecognition and Replication • Eli Lilly National Housing Award • CMS Best Practices Award • HUD Best Practices in Fair Housing Award • NAMI - Phillip and Sarah Francoeur Award for Housing • The Commonwealth Fund State Behavioral Health Innovations: Best Practice • Many regional and local awards • CHI Model in Georgia • CHI Model in Kentucky

26. Jeanne Price Tameka Favors Rozann Downing Sandie Shaver Cheré Bradshaw Vonda Gray Susan Greene REGIONAL HOUSING FACILITATORS Seven Regional Housing Facilitators in Seven Mental Health Planning and Policy Council Regions

27. Louetta Hix Vacant Lawrence Wilson Gina Turley CONSUMER HOUSING SPECIALISTS

28. TOTAL CHIUNITS CREATED Supervised Group Housing 24-Hour On-Site Staff Ex: Multi-person Supportive Living Facility Partially Supervised Group Housing Staff On-Site as Needed Ex: Multi-person Group Homes & Residential Homes Independent Congregate Living No Staff On-Site Ex: Non-supervised Group Homes, Boarding Homes Rental Housing/ Voucher (Home or Apartment) Ex: Private Market, Public and Non-Profit Housing Home Ownership Ex: Permanent Homes or Condos 365 417 185 5,684 485 Total Units Created = 7, 136 Total Amount Leveraged = $200,722,055

29. CHI:THE FUNDING PARTNERS

30. CHI:THE FUNDING PARTNERS

31. CHI:THE FUNDING PARTNERS

32. CHI:THE FUNDING PARTNERS

33. CHI:THE FUNDING PARTNERS

34. CHI:THE FUNDING PARTNERS

35. CHI:THE FUNDING PARTNERS

36. FUNDING NEEDS • Capital • Acquisition • Rehab • New Construction • Operating • Recurring Housing Costs (utilities, maintenance, reserves, etc.) • Services

37. AFFORDABLE HOUSING CHALLENGE Assume homeless individual has or can get on SSI (SSI/SSDI Outreach, Access & Recovery) $623 per month income 30% to spend on housing (including utilities) = $187 per month for housing vs. Fair Market Rent for 1 Bedroom = $586 per month or $399 over affordability

38. FUNDING STRATEGY In order to keep housing affordable for very low income consumers, • Reduce or eliminate mortgage • Reduce or eliminate property taxes • Build or rehab for energy savings • Rental subsidies

39. CONDO OWNERSHIP, NASHVILLE TDMHDD $9,000 FHLB Am. Dream $13,300 FHLB Welcome Home $7,500 Owner deposit $500 Owner mortgage $32,100 Cost + Closing $62,400 Total monthly payments inc. PITI + Condo fee = $377 Two brothers with severe mental illness, both on SSI Cost savings to State in saved rental subsidy in 30 yr. = $180,000+

40. HOME OWNERSHIP,JACKSON, TENNESSEE • Habitat for Humanity new construction • 4-bedroom, 2-bath home valued at $80,000 • Total cost of Habitat Home $65,000 • THDA HOME grant -$14,999 • FHLB American Dream -$15,000 • FHLB Welcome Home -$ 7,500 • Owner mortgage with Habitat $27,501 • 30 yr. mortgage @ 0% • Monthly payments = $78 per month

41. ALPHA OMEGA VETERANS SERVICES, MEMPHIS THDA $238,362 Plough Foundation $245,000 HUD SHP $300,000 City of Memphis $500,000 FHLB AHP grant $575,140 Owner’s Contribution $337,627 TOTAL $2,296,129 Operations and Support • HUD SHP $190,000 • United Way • Permanent supportive housing for homeless veterans who are disabled by mental illness and/or substance abuse • New construction of two-story, 32 one-bedroom units plus common meeting and dining area • Support services on and off site

42. FREEDOM RECOVERY COMMUNITY, NASHVILLE • Permanent supportive housing for formerly homeless women with mental illness and/or substance abuse and returning to the community from prison • Twenty 2-bedroom apartments plus laundry, meeting room, office space • Support on and off site FHLB AHP grant $251,000 HUD SHP $135,000 Memorial Foundation $75,000 TDMHDD $100,000 THDA Trust Fund$500,000 TOTAL acq. & rehab $1,061,000 Operations and Services HUD SHP $241,551

43. BULLS GAP, TENNESSEE • Eight 2-bedroom apartments for homeless people who have mental illness • Bulls Gap Historical donated land and building • Clinch Powell Rural Dev. and First TN Dev. Dist. Applied for HOME THDA HOME $460,732 Bulls Gap Historical Railroad (land and building) $60,000 Operations: Kingsport Housing Authority 16 Section 8 vouchers annually $92,928 Frontier MHC /TN Care • Kingsport PHA supplies Section 8 vouchers • Frontier Health, using MCD, provides case management

44. Housing and Economic Recovery Act of 2008PL 110-289

45. Potential Opportunities Relative to Increasing Housing Opportunities For People Diagnosed with Mental Illness and Co-occurring Disorders

46. Establishes new, independent agency, Federal Housing Finance Agency, to regulate Federal Home Loan Banks (FHLB) (as well as Fannie Mae and Freddie Mac) with broader management and enforcement powers, including revision of goals of FHLB and expanding use of FHLB advances for use in community development projects and mortgage foreclosure avoidance. • Impact: Unknown at this time, but will likely modify FHLB focus and funding of Affordable Housing Program and American Dream Home Ownership Challenge Program which have been major sources of housing for CHI. Broader use of AHP funds will reduce funding available for new housing projects, at least for short-term future.

47. Creates National Housing Trust Fund. 65% of revenue from 4.2 basis points of Fannie and Freddie profits will create this fund to be distributed on formula basis to states, likely to supplement or create parallel THDA Housing Trust Fund in Tennessee. Very rough guess, depending on formula created, may provide $6 million - $10 million annually to be distributed through THDA. Minimum 90% to be spent on rental housing; minimum 75% on families at 30% or less AMI; remaining 25% for families at 50% or less AMI. • Impact: As early as 2010, this could be a major source of added funding for developing housing opportunities for those people with very low income that we serve, especially rental housing projects, but also including some home ownership options.

48. Creates Capital Magnet Fund. Designed to attract private investment into affordable housing. 35% of the revenue from 4.2 basis points of Fannie and Freddie profits (rough guess $200 million annually) goes to a competitive grant program operated by Secretary of Treasury and open to “community development financial institutions” and non-profit housing developers (e.g. CHDOs) for “affordable housing, economic, and community revitalization projects.” Aggregate cost of all projects funded must be at least 10 times grant amount. • Impact: Beginning 2010, potential new funding layer for affordable housing projects.

49. Creates fund to redevelop abandoned and foreclosed homes. Although it is currently not clear what locations in Tennessee might qualify, this provides nearly $4 billion nationally for states and local governments to purchase, rehab, resell, or tear down abandoned and foreclosed homes. Funds distributed like CDBG money, i.e. 70% to localities, 30% to state. At least 25% of these funds will be used to house individuals or families at 50% or less of AMI. Funds are to be used within 18 months. • Impact: May provide opportunities for low income rental housing development by agencies or even free acquisition of properties with rehab financed by local housing authority with restriction that low income families, such as our consumers, be housed there. We should talk soon with local housing authorities and THDA about the option of using these funds for our consumers’ housing and then carefully monitor what funds come to what places in Tennessee so we can act where funding is allocated.

50. HELPFUL WEBSITES • www.hud.gov • Extensive info on all HUD funding and Ohio HUD activities • www.csh.org • Corporation for Supportive Housing • Click on Resources; click on Financing guide • www.nlihc.org • National Low Income Housing Coalition • Current info on National Housing Trust Fund