As public mental health policy has moved away from reliance on institutions and toward community integration, policymakers, providers, and advocates have been forced to confront the many obstacles facing persons with mental illness who seek safe and affordable places to live.  While some of the difficulties encountered by this population are common to all who live on low or moderate incomes, other challenges are more directly related to the experience of mental illness. In any case, in order to consider steps a community might take to improve housing options, it is first necessary to understand the existing obstacles.

The price of housing stock, particularly in major cities, has risen well beyond the ability of people with low or moderate incomes to pay for it. Since people in the public mental health system are among the poorest in the nation, they are hard hit by this crisis in affordable housing. In 2000, there was no housing market in the country where a person with a disability receiving SSI benefits could afford to rent a one-bedroom or efficiency unit. ^[1]  

Federal housing subsidies for individuals with mental illness do not adequately compensate for the inflated private housing market.  In 1992 and 1996, Congress passed laws permitting public and assisted-housing providers to designate housing as "elderly only." This resulted in many "non-elderly" adults disabled by mental illness no longer having access to a major portion of the affordable rental units in this country. Unfortunately, U.S. Department of Housing and Urban Development (HUD) officials have also promoted policies in recent years that have failed to keep pace with the needs of low-income people with disabilities who wish to rent affordable apartments.  The Section 811 Supportive Housing for Persons with Disabilities Program has had its funding reduced from $346 million in 1991 to $217 million in the most recent budget. ^[2]    

Federal housing policy makes it especially difficult for ex-offenders with mental illness to secure public housing assistance.  At the most basic level, housing subsidies such as Section 8 are available only for the working poor - applicants must have federal income tax forms to be eligible.  Because the large majority of individuals with mental illness are unemployed (70 percent to 90 percent) most do not qualify for such programs. ^[3]       In addition, public housing authorities, Section 8 providers, and other federally assisted housing programs are permitted, and in some cases required, to deny housing to individuals with certain criminal histories. ^[4]   For example, if an individual is evicted from public housing for drug-related criminal activity, he or she is barred from reapplying to live there for three years. Because many people with mental illnesses have co-occurring substance use disorders, these restrictions affect this population disproportionately. People with mental illness who have histories of any kind of criminal justice involvement also frequently find themselves "jumped over" by others without such histories on waiting lists for assisted housing.

Even without the barriers to receiving federal assistance, the majority of individuals involved in the criminal justice system - regardless of whether they have a mental illness - have limited resources to secure adequate housing.  For example, most ex-offenders leave prison without enough money for a security deposit on an apartment. ^[5]      Furthermore, private landlords may require prospective tenants to disclose employment, financial, and criminal histories, as well as mental health information, and may exclude individuals based on these characteristics.   

Families and friends are an important housing resource for individuals with mental illness. When these individuals become involved in the criminal justice system their relationships with families and friends are often strained.  Families living in public housing may be concerned that allowing an ex-offender to resume residency there will compromise their own housing eligibility (see federal restrictions above).  More generally, family and friends may feel incapable of or uninterested in helping an individual who has decompensated sufficiently to become involved in the criminal justice system.   

Even if individuals with mental illness who have been involved in the criminal justice system are able to tap family or friends as a housing resource, their reintegration into the community can be problematic.  If an individual with mental illness is simply returning to the environment that fostered his or her involvement with the criminal justice system in the first place, there is a good chance that this reintroduction will result in a rapid return to the behavior that originally caused them to offend. 

Individuals with mental illness who are able to locate housing often have difficulty sustaining residency.  Sustained residency is usually predicated on the provision of support services (mental health, substance abuse, employment, etc.) in conjunction with housing. Housing and support services can be linked in a variety of ways.

Responses to the housing shortage for people with mental illness differ according to numerous variables: location (group vs. single-occupancy), level of supervision, funding source, intensity of integration with support services, intensity of case management, and others.  It is difficult to identify discrete housing "models"; each approach tends to be unique to the community where the housing is provided.  The recommendations below are an attempt to identify some of the common characteristics of successful efforts to develop housing options for individuals with mental illness.

Recommendations:

a.

Form community-based partnerships to develop comprehensive solutions to housing for persons with mental illness.

b.

Establish leadership and coordination at the state level to provide technical assistance and ensure access to resources.

c.

Institute linkages between housing options and service availability.

d.

Blend funding for development and operation of stable, affordable housing.

e.

Develop an array of housing to meet the varied needs of individuals with mental illness.