Permanent Supportive Housing MHSA Webcast Training Series

1. Permanent Supportive HousingMHSA Webcast Training Series Leslie Wise Program Manager Corporation for Supportive Housing October 13, 2005

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

3. What Is Supportive Housing?A cost-effective combination of permanent, affordable housing with services that helps people live more stable, productive lives.

4. Housing & Services • 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.

5. 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

6. 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

7. 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

8. 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

9. Scattered Site: One Example • 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

10. Direct Access to Housing in CA • 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).

11. Key Components of Master Leasing • 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

12. Strategies that Work Housing Tenants with Severe Psychiatric Disorders or Substance Use Problems • 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

13. Is Supportive Housing an Evidence-Based Practice? • 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

14. Consistent Findings Housing + Services Make a Difference • 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”

15. 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

16. 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

17. Supportive Housing Reduces Use of and Costs for: • 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

18. Supportive Housing May Increase 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

19. “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

20. To learn more about supportive housing visitwww.csh.org