Why Permanent Supportive Housing?
Because it works: It is effective therapy, it is cost effective, and there is a tremendous need.
1. Permanent Supportive Housing Is Effective Therapy
In permanent supportive housing (PSH) the supports are wrapped around each resident in the housing unit in an individual recovery action plan which provides the type and frequency of therapeutic services best suited to person’s illness and recovery.
The fact that a person has a roof over his head and his name on a lease, reduces stress, and stress reduction helps with recovery. A person in supportive housing generally finds a job and develops a network of friends, all of which are essential parts of the recovery process. Good PSH settings encourage family involvement, and that also helps on the road to recovery.
Research shows that individuals with mental illness who are in PSH settings have better rates of recovery than those in other settings. Thresholds, one of the nation’s leading mental health services providers reports that in a good permanent supportive housing situation between 70 and 80% of the residents will see their mental illness symptoms completely disappear.
Right now Illinois leads the nation in the numbers of people with mental illness living in nursing homes. This is most unfortunate because as a rule, nursing homes are ill equipped to effectively treat residents with mental illness. So, people in supportive housing generally recover while people in nursing homes generally remain static or even regress.
Recently, after a series of articles in the Chicago Tribune, the inappropriate housing of individuals with mental illness in nursing homes has become an issue of great concern in Illinois. The Illinois Nursing Home Safety Task Force was formed to address the problem. Testimony provided by Lore Baker of the Supportive Housing Providers Association supports the benefits of PSH as an alternative to nursing home placement.
2. Permanent Supportive Housing is Cost Effective
Many studies demonstrate this. It is generally accepted that it costs the State of Illinois between $40,000 and $70,000 a year to keep a person with mental illness in a nursing home, while the cost of high quality permanent supportive housing is about $20,000 per person.
And to make matters worse, Medicaid regards nursing home placements for younger people with mental illness as substandard care and so will not reimburse the State for its cost. Illinois, then, must bear those costs alone. But Medicaid will reimburse the state for the costs of PSH on the same bases as other medical treatments.
The Supportive Housing Providers Association recently found that it costs the State of Illinois $116 per day to keep a person with mental illness in a nursing home, while keeping the same person in permanent supportive housing costs only $27 per day. And we have 17,000 people with mental illness in nursing homes in Illinois. In addition, a recent study by the National Governors Association Center for Best Practices compares the cost of PSH to the costs of other typical types of housing for people with mental illness. PSH is better therapeutically and is also cheaper than the alternatives -- much, much cheaper in most cases. The report is entitled Supportive Housing for People with Mental Illness: Regaining a Life in the Community. We don't have enough space to include the report on this website, but it can be found on line at:
Supportive Housing for People with Mental Illness: Regaining Life In the Community a report prepared by The National Governor's Association Center for Best Practices
It is well worth reading.
Permanent supportive housing also results in cost savings for other public services. Recently the Heartland Alliance conducted a large study comparing permanent supportive housing to the typical disorganized mix of shelter and haphazard care. The study found that Illinois saw an overall 39 percent cost reduction in the use of public services, such as inpatient mental health care, nursing homes, and criminal justice, over a two-year period after a sample of 177 individuals were moved into supportive housing. The shrunken need for public services yielded a total overall cost savings of more than $850,000 – an average savings per resident of $2,400 per year.
Study Links Reduced Use of Public Services to “Smart Investments” in Supportive Housing
If you get out a calculator and try to get all these figures to add up to the same thing, you will most likely be quite frustrated. The reason is that each of the studies uses somewhat different costs and calculates expenditures somewhat differently. But the direction if quite clear: Permanent supportive housing saves money, lots of money.
3. There is a Tremendous Need for Permanent Supportive Housing
Mental illness is the leading cause of disability among people ages 18 to 44. Because of this disability, many people with mental illness in typical settings are unable to work and have to rely on Supplemental Security Income (SSI) a part of the Social Security system. But SSI isn’t enough to live on. In their biannual study of housing for people with disabilities, Priced Out in 2008, the Technical Assistance Collaborative found that in Illinois SSI monthly stipends were $637, while at the same time the typical one bedroom apartment in the Chicago metro area rented for $893 per month. So a person living on SSI must pay 140% of his or her income in rent – an obvious impossibility.
The Technical Assistance Collaborative puts it this way: “The general shortage of affordable rental housing hits with particular virulence at people with disabilities. Federal and state support for people with disabilities provides them with incomes far too low to access most decent market rate housing.”
Supportive housing is rent subsidized. The person in a permanent supportive housing apartment pays 30% of his or her monthly income in rent. So the person on SSI would pay only about $200 per month. The rest is subsidized by various units of government. Those rent subsidies are included in the cost savings mentioned in the previous section.
Unfortunately, there is almost no permanent supportive housing in the northwest suburbs of Chicago. What little there is in our area is concentrated in Chicago and near Lake Michigan. And even those places report waiting lists between three and five years long.
So what is the impact of this lack of permanent supportive housing?
One Task Force member put it this way:
Letter from a Task Force member:
So the answer is clear. Projects like the ones Task Force envisions work: Permanent supportive housing is effective therapy, it is more cost effective than other alternatives, and there is a tremendous need for it.