Olmstead and Homelessness Dr. Fran Randolph Chief, Homeless Programs Branch SAMHSA/CMHS DHHS
Olmstead and HomelessnessBackground • The Olmstead decision encourages use of least restrictive community setting • Implementation requires development of state plans to provide for housing with necessary support services • SAMHSA/CMHS has gained valuable knowledge about providing effective housing and supports in the effort to end homelessness for persons with mental illnesses
SAMHSA/CMHS GOALS The President’s New Freedom Commission Report Vision Statement: • We envision a future when everyone with a mental illness will recover, a future when mental illnesses can be prevented or cured, a future when mental illnesses are detected early, and a future when everyone with a mental illness at any stage of life has access to effective treatment and supports — essentials for living, working, learning, and participating fully in the community.
Common Vision Common goal of the President’s Commission and the Olmstead decision: • To support full participation in community life for persons living with mental Illness
Steps to Achieve the Vision Accessing affordable housing and necessary supports requires: • Recognize that obtaining housing is only part of the answer • Services and supports are needed to help persons maintain housing • Collaborations with other community organizations are needed to provide other essential services for effective community supports.
Challenges to Achieving the Vision:Lack of Affordable Housing • An estimated 637,000 adults in the United States are homeless in a given week • 2.1 million adults experience homelessness over the course of a year • An estimated 200,000 people experience chronic homelessness in a given year
Challenges, cont. • What is chronic homelessness: • Temporarily homeless-persons who experience only one spell of homelessness, usually short, and are not seen again by the homeless assistance system (80%) • Episodically homeless-those who use the system with intermittent frequency, but usually for short periods (10%)
Challenges, cont. • Chronically homeless-those with a protracted homeless experience, often a year or longer, or whose spells in the homeless assistance system are both frequent and long (10%) • Working definition=homeless for a period of a year or more OR has had at least 4 episodes of homelessness in the past 3 years
Challenges, cont’d Characteristics of persons who experience chronic homelessness: • Have disabling health and behavioral health problems • At least 40 percent have substance use disorders • 25 percent have some form of physical disability or disabling health condition, • 20 percent have serious mental illnesses
Challenges, cont. • Characteristics of persons who experience chronic homelessness • Heavy users of services. Although small in number, they use half of all emergency assistance for people who are homeless. • High involvement with the criminal justice system
Challenges, cont’d Persons who are homeless are only part of those in need of affordable housing • The lack of affordable housing and accompanying support services often causes people with serious mental illness to cycle between jails and other institutions: • Large segregated facilities, • Board and care homes, • Seriously substandard housing.
Challenges, cont’d A new study by the Technical Assistance Collaborative found that • People with serious mental illness and other disabilities relying solely on SSI benefits (currently $545 monthly) have incomes equal to only 18% of median income and cannot afford decent housing in any of the 2,703 HUD-defined housing market areas of the United States • People with serious mental illness receiving SSI would need to pay, as a national average, 105% of their monthly SSI benefit to rent a modest one-bedroom apartment
Solutions What have we learned about providing effective services in the community for persons with serious mental illness? • SAMHSA/CMHS has sponsored many demonstration grants which have contributed to our knowledge, including the ACCESS Program • While many of the programs focused on persons who are homeless, the findings apply to any program providing care so persons can fully participate in community life
SolutionCreate Coordinated System of Care COORDINATION Other Services Mental Health Services Housing
Solution: Mental Health Services To maintain persons with serious mental illness in the community, services must: • Be effective • Be moved out of the clinic and brought to the consumer where he or she lives • Outreach and engagement • Clinical case management (ACT) • Psychosocial Rehab programs
Solution: Other Services Coordination and integration of services must address needs outside the mental health system: • Substance abuse treatment • Health care • Income support and entitlements • Employment • Transportation • Comprehensive discharge planning
Solution: Housing • Affordable housing • A range of housing options
Solution Creating a coordinated and integrated system of care involves providing housing and effective community support : • The most effective way to coordinate/integrate community services and housing is to forge relationships with other service providers
Solution: Strategic Partnering What is it? • An approach that builds relationships with other organizations in order to gain access to their capabilities and resources • It integrates strategic planning with methods of building organizational partnerships • It works by assuring that each organization achieves its own goals through a joint planning process • It has been tested through research
Strategic Partnering: • Conduct a comprehensive scan of the organization and the environment • A. Review the organization’s internal readiness to engage in partnerships • What is the organization’s role in the service continuum? • Is the whole organization behind the idea of creating a coordinated system of care? • Are there key programs within the organization that have this interest? • Do you need to address internal change to move the agenda forward?
Strategic Partnering, cont’d • B. Scan the environment to draw a services profile • What kinds of organizations make important decisions concerning care for your population: • Political organizations: local councils, state legislature, etc • Mental Health and Substance Use System • Criminal Justice System • Housing Authority • Special Interest Groups • Business organizations • Law Enforcement Officials
Strategic Partnering, cont’d -Who is providing which services to your population • Mental health services • Substance abuse services • Housing • Entitlements • Healthcare • Institutions: Hospitals, crisis centers, jails
Strategic Partnering, cont’d • Identify and involve Partners • Identify key/ potential partners to provide the desired level of coordination • Look for partners in decision making roles
Strategic Partnering, cont’d • Create Shared Vision • What would a shared vision of a coordinated system of care look like? • How do you involve other organizations in crafting the vision? • Determine what level of partnering is needed and/or possible. • Develop a systematic approach to forming partnerships.
Strategic Partnering, cont’d • Establish Goals and Objectives • Identify short and long term goals of the partnership efforts • Insure that goals are consistent with partnership activities: • how do the partnering activities support achieving the goals • is there a clear understanding of how the benefits and contributions of each partner tie in with the goals • Monitor activities to insure that partnership and project goals are being met
Strategic Partnering, cont’d What is a true Partnership Its a special kind of relationship characterized by shared goals and mutual expectations which has some duration.
Strategic Partnering, cont. • How do you develop a successful partnership? • Enabling the partnership • Forming the partnership • Sustaining the partnership
Enabling the Partnership • Readiness • What each partner is prepared to do to participate in a relationship. • Identify levels of trust and willingness to relate with other organizations.
Enabling the Partnership • Familiarity: The knowledge partners have about each other’s culture, services provided and desired type of relationship • Determine how familiar your organization is with the special needs of the homeless and the kinds of services appropriate for them • Determine how familiar the different organizations responsible for homeless services are with each other
Forming the Partnership • Benefits • Create a clear statement of what each partner wants to get from participating in the partnership. • Contributions • Determine what resources and activities each partner must contribute to realize the desired benefits.
Sustaining the Partnerships • Linkages: Create structures between partners to accomplish desired interactions • Develop an interagency coordinating body • Look for opportunities to serve on the boards of organizations which make decisions important to achieving your overall goals. • Look for sponsorship from local businesses, foundations and other organizations not already funding services.
Sustaining the Partnerships • Agreements • Write simple agreements that capture the core of the partnership for each party • Build specific linkages among services providers that institutionalize coordination (cross-training, interagency case management teams, interagency MIS) • Put a face on the partnership for your organization (and other partners) by designating who will manage the relationships
Benefits of Strategic Partnering For State and Local Administrators, Partnerships: • Guide the development of a shared community vision • Lead to mutually beneficial and efficient means for managing dwindling resources • Provide opportunities to reduce system wide costs by re-deploying resources • Decrease use of inappropriate and expensive institutional settings such as hospitals and jails and move persons into community housing with supports, at less overall cost.
Benefits of Strategic Partnering For Community Service Providers: • Partnerships increase services to persons with mental illness who are potentially underserved • Partnerships clarify and make available effective referral destinations for persons with mental illness • Partnerships allow access to less restrictive, more appropriate and less costly alternatives • Partnerships work in coordinated fashion to access supportive services
Benefits of Strategic Partnering For Consumers: • Consumers are important participants in the partnership process, contributing to the coordination effort, the creation of more effective services, and ending chronic homelessness and long-term institutionalization
Conclusion Both the Olmstead decision and the President’s New Freedom Commission support the goal that every person with a mental illness at any stage of life has the right to effective treatment and supports — essentials for living, working, learning, and participating fully in the community