Supportive housing is essential for homeless with serious mental illness

New York Mayor Bill de Blasio’s plan for building new housing should target those most in need.

By Stephen Eide

While opinions of Mayor de Blasio’s approach to homelessness are mixed, he has enjoyed broad support for his commitment to build 15,000 new units of supportive housing. For decades, supportive housing — which places people in apartments with a network of support services — has been considered essential to addressing homelessness, particularly among the single adult population.

The success, however, has led to overuse. The city’s first broad effort to build supportive housing in the 1990s focused on those homeless people with severe mental illness. Since then, policymakers have added more populations, a trend the mayor continues by promising more units to former substance abusers, those suffering from a “disabling medical condition,” and youths aging out of foster care.

The city’s job is to connect vulnerable populations with the programs that serve them best, and supportive housing has proven to be most valuable in benefiting homeless people suffering from serious mental illness.

Continuing along this path would be a mistake. The city’s job is to connect vulnerable populations with the programs that serve them best, and supportive housing has proven to be most valuable in benefiting homeless people suffering from serious mental illness. The mission creep of recent years has siphoned resources away from people with both the deepest need and most to gain.

Mayor de Blasio could make this point strongly by pledging 10,000, or two-thirds, of the new units in service of the seriously mentally ill.

Placing someone in a supportive housing unit provides them with a permanent rental subsidy and access to social services beyond those provided to other poor New Yorkers. The goal is not only to house the homeless, but to facilitate independent living for those who could not otherwise function in normal society.

The city and state first got into the supportive housing business in a major way through a 1990 agreement called “The New York/New York Agreement to House Homeless Mentally Ill Individuals.” As its name implies, this 3,615-unit program focused resources exclusively on the intersection of homelessness and mental illness. The same went for a 1,500-unit successor agreement signed by the Giuliani and Pataki administrations in the late 1990s.

Buoyed by the success of these efforts, during the Bloomberg years, supportive housing’s focus was broadened. Suffering from some variety of mental illness could make someone eligible most of the 2005 New York/New York III agreement’s 9,000 units. But it was not made a necessary prerequisite for thousands of units, as access was also granted to those with a history of substance abuse and/or a medical disability, even when not found in conjunction with serious mental illness.

According to the Supportive Housing Network of New York, over 32,000 units exist citywide. The de Blasio plan will thus increase the total stock by close to 50%. But the historic magnitude of the mayor’s efforts should not cause us to overlook what a scarce resource supportive housing truly is. The mayor’s 15,000 units will take at least 15 years to bring online, and there are currently six eligible applicants for each new unit being built-all while single adult homelessness continues to grow.

In January, the mayor appointed a task force to decide how to allocate the 15,000 units he has proposed to build. Their recommendations have not come out. As was the case with New York/New York III, serious mental illness can qualify someone for a unit, but none of the 10 subgroups listed in the mayor’s plan provide exclusive access for the seriously mentally ill.

The inadequate treatment of serious mental illness over the last half century has been one of the most disgraceful episodes in the history of American social policy. A well designed supportive housing program would help reverse this injustice.

This is troubling news for three reasons. First, as advocates often emphasize, placing someone in supportive housing reduces expenses on other public services such as shelter, jail and psychiatric hospitals. But these savings are by far the greatest for the seriously mentally ill. A 2013 study of New York/New York III found that, while providing supportive housing to youths aging out of foster care and substance abusers led to a net increase in government spending, providing a unit to a single adult exiting psychiatric institutions saved almost $80,000 a year.

Second, untreated mental illness poses a serious threat to public order. To the ordinary New Yorker, there’s no more damning indictment of city government’s incompetence on homelessness than the presence of obviously disturbed individuals occupying libraries, parks, streets and subway and train stations. This situation is neither good for the public nor the homeless and supportive housing is one of our most effective tools for addressing it. HUD data from February 2015 peg the number of “seriously mentally ill” homeless in the city at about 10,000.

Third, other options exist for homeless sub-populations whose service needs are less intense, such as transitional housing or carve-outs from the mayor’s 200,000-unit affordable housing plan.

The vast majority of New York’s near 240,000 seriously mentally ill are not homeless. But the small portion who are should enjoy a special claim on public resources. In a recent report, I argue that dedicating two-thirds of the mayor’s 15,000 units for the seriously mentally ill would be a reasonable compromise.

The inadequate treatment of serious mental illness over the last half century has been one of the most disgraceful episodes in the history of American social policy. A well designed supportive housing program would help reverse this injustice. Given that there’s no end in sight to New York’s struggles with homelessness and serious mental illness, failing to dedicate maximum resources to the intersection of these two challenges would be a tragically missed opportunity.

Stephen Eide is a senior fellow at the Manhattan Institute and author of the new report “Supportive Housing and the Mentally Ill Homeless.” This piece originally appeared in the New York Daily News.