A Case For Supportive Housing For Adults With Mental Illness
If you do a Google search for “supportive housing for adults with mental illness” you’ll find countless resources. To someone unfamiliar with the mental health care system, this makes it seem like there’s an array of options. In reality, finding and qualifying for the limited programs available is next to impossible.
The deinstitutionalism movement of the 50s and 60s, brought on by the flagrant corruption and abuse in psychiatric hospitals, was a positive change in many ways. However, it also left hundreds of thousands of adults living in the United States without the stable housing and support they need. As of 2014, only 35,000 people remain in hospitals, compared to the 356,000 individuals with severe mental illness in prisons.
In addition to a higher risk of incarceration, severe mental illness is the most prominent risk factor for suicide. It’s understandable then that the lack of support that comes with living on the streets or independent housing is far from ideal for most of this population.
So where does that leave the parents and caregivers of severely mentally ill adults? The safest options are allowing them to live in their family home or finding a privately-owned residential treatment center. But in many cases, neither of these options are practical.
Do We Have To Live Like This Forever?
Caring for adult children with any disability can be difficult. But severe mental illness presents some unique challenges.
For Lisa*, having her daughter, Julia*, living at home meant constant abuse and fear. Julia has been diagnosed with Borderline Personality Disorder. Lisa shared, “It felt like she was manipulating us. She’d scream and put holes in the walls during angry episodes. Neighbors hated us because she’d yell and curse at them through the window. We couldn’t have anyone over and we couldn’t go out much; when we did we’d come home to police at the door.”
Lisa says, “This is someone that we love and she was mistreating us. We really wanted to take care of her and help her, but it’s hard to do that when you feel abused.”
On top of that, Julia living at home meant there was little hope for treatment. She refused to leave the house for therapy. Every time she was released from a hospital stay, she would go to one or two sessions until she gave up. Her designated case workers would soon give up trying to force her.
Lisa and her husband were at their last straw. “I just kept thinking, ‘do we have to live like this forever?’”
Limited Housing Options
Lisa spent years researching, emailing state officials, joining support groups, and talking with social workers trying to find an answer. The grim truth was that there wasn’t a good solution.
Since psychiatric hospitals have such limited bed capacity, they typically can only hold patients for short periods from two days to two weeks. “They just stabilize them with medication and then release them,” says Lisa. They give patients plans for ongoing care, but there’s no one to ensure they follow that plan, so compliance is often low.
Unless the patient is homeless, hospitals don’t offer much support in terms of housing. One social worker actually suggested Lisa kick Julia out so she could take advantage of this extra support. “I couldn’t just throw her out! She doesn’t have any friends or means of supporting herself. Homeless shelters are only open at night, so what would she do on the streets all day? She’d kill herself.”
Apart from hospitals, there is very little government-funded supportive housing, unless patients have co-occurring substance abuse disorders. The other options that do exist have few openings and waitlists that span years.
The Cost of Decent Care
The only option left was private residential care, which can cost a small fortune and is rarely covered by health insurance.
Lisa remembers, “The cheapest we saw was $12,000 a month, and it was a pretty lousy place that didn’t have the right training for Borderline [Personality Disorder].”
Lisa’s family ended up borrowing money from friends and dipped into their retirement savings so they could send her to a more suitable place (an option most families don’t have). Julia spent a year at the residential facility, when the staff deemed her well enough to move to independent housing. Not long after, it was clear that she was worse than ever. But they couldn’t afford to send her back.
Currently, Julia is back living in Lisa’s home, and Lisa feels that her condition has further deteriorated since she’s been there.
A Call For Reform
Clearly, there’s a need for reform in the mental health system in the US, especially when it comes to housing services.
While some worry that increased spending on mental health will increase taxes, countless studies have shown that that’s not the case. In fact, it costs far more not to spend on preventing and treating mental illness. Untreated mental illness costs the government, taxpayers, and businesses more than $200 billion annually.
This cost can be reduced with proper prevention, treatment, and housing. Due to the higher prevalence of incarceration, homeless and untreated individuals with mental illness incur significantly higher criminal justice costs than those who receive more mental health services. Another study found that every $1 spent in prevention and early treatment saved $2-$10 in criminal justice and health care costs.
Finally, research has found that it costs 30% more per year in public spending to have people with severe mental illness living on the streets than it does to provide housing with onsite services.
Based on these studies, the most sensible next step would be to dedicate more government funding to quality supportive housing. In addition to increased funding, reallocating some of the existing funds currently spent on housing for substance abuse to mental illness would be beneficial. This could actually help to prevent more addictions in the first place by getting at one of the most common root causes.
You can help by writing to your local Senator, requesting more supportive housing services for those with mental illness, or advocating with your local NAMI chapter.
*Name has been changed
