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Recovery in the Community: Housing’s Role in Mental Healthcare

The Department of Mental Health (DMH) embraces a community-based approach to treatment and recovery from mental illness, which focuses on the question of how individuals can have more active control over their lives and thrive in their respective communities. DMH’s mission assures and provides access to services and supports to meet the mental health needs of individuals of all ages; enabling them to live, work and participate in their communities.”

It is nearly impossible to discuss access to mental health services without touching on the need for housing.  For a community-based mental health system to work effectively in promoting recovery, there must be an “exit” that supports community integration, health, wellness, and access to services.  The largest barrier to this “exit” is accessing affordable housing.  Without affordable housing, clients remain in programs for longer than necessary, which in turn creates access issues at the “front door” of the mental health system.

While housing has long been a crucial component of DMH’s service delivery system, it has recently become a Department priority. In 2016, Commissioner Joan Mikula established a Housing Plan with the explicit goal to “create movement through the DMH system by securing a predictable flow of State and Federal housing resources that enable individuals to move into safe, affordable community-based-housing.”

The Housing Plan lays out a series of objectives that include the expansion of the DMH Rental Subsidy Program (DMHRSP), along with greater utilization of capital investments.  The Facilities Consolidation Fund (FCF), which is managed by CEDAC on behalf of the Department of Housing and Community Development (DHCD),  allows DMH to obtain access to apartments exclusively set-aside for its clients (“integrated supportive housing”) in multi-family developments for 30 years.

The plan also touched on enhanced cooperation with the Department of Developmental Services (DDS) and the re-use of C689 Special Needs Housing owned by Local Housing Authorities and used as group living residences that are no longer appropriate for the DDS clients; it includes collaborating with the Massachusetts Rehabilitation Commission (MRC) and DHCD to access federal Section 811 rent subsidies tied to meeting the objectives articulated in the Olmstead Plan which seeks to move clients from institutional settings; and finally, expanding training opportunities to the field, and securing qualified outside expertise to advise the Department in its housing work.

In order to meet the goals of the Housing Plan, the Department has tapped into its extremely strong working relationships with CEDAC, as well as MassHousing, the Massachusetts Association of Community Development Corporations (MACDC), local housing authorities (LHAs), and contracted service providers.  In FY19, the DMHRSP Program expanded by $2 million, a 20 percent increase in funding that translates to about 160-170 units, bringing the overall program to over 1,500 clients, most of whom live in scattered site studios and 1-bedroom apartments.

On the capital side, the Baker-Polito Administration has made a tremendous investment in affordable housing.  In late July, Governor Baker announced awards from the 2018 Rental Housing funding competition, which will provide financing for some 1,300 affordable units, with over 200 targeted to extremely low-income residents.  FCF resources were awarded, and DMH will secure 20 units for long-term use.  FCF investments provide nearly 1,000 units of “integrated supportive housing” for DMH clients. FCF resources were reauthorized for $65 million through the passage of the $1.8 billion Housing Bond Bill, signed by Governor Baker in June. The Administration issued a five year capital budget that represents an 18% increase over prior capital plans, with an emphasis on supportive housing for disabled persons.

Through collaborative efforts on the Federal, State, and local levels, DMH has been able to drastically improve access to safe, affordable community-based housing for clients; and these relationships will be vital in order to continue to create housing opportunities for all individuals in the Commonwealth.

In the rebidding of the DMH adult services system, the following provisions describe the Department’s approach to ending and preventing homelessness, which promotes the core principles of the “Housing First” model:

  • All individuals can achieve housing stability in permanent housing that is safe and affordable.
  • Housing support services are flexible, individualized, developmentally and culturally appropriate, including those of young adults, elders, and families.
  • A Person-Centered approach that emphasizes the right to determination, dignity, and respect.
  • Recovery and stability, including improved quality of life, health, mental health, and employment, are linked to having a safe, affordable place to live, and success is measured through housing tenure.
  • “Integrated supportive housing” (e.g., scattered site units) provides opportunities for social connections and community inclusion.

None of this is possible without the strategic partnerships DMH has at all levels in order to provide the necessary housing for clients.

Specific programs include:

  • Special Needs Housing (Chapter 689/167): Administered by DCHD and designed to provide housing with specialized services for person with mental illness, cognitive impairment, or physical disabilities. The purpose of these programs is to provide onsite services so tenants can maintain a maximum level of independence.
  • Elderly Housing (In conjunction with DCHD) (chapter 667): State funding for housing specifically designated for Elder (60+) and disabled low-income
  • Metropolitan State Hospital Housing Trust Fund: Money granted to the state from the sale of the Metropolitan State Hospital, to be used for the purchase of condominiums across Metro West under agreement with CASCAP. Based on many years of successful collaboration on the FCF program, DMH selected CEDAC to manage the process of selecting the private non-profit developer, finalizing the acquisition and rehab plan, and implementing the strategy.
  • Danvers State Hospital Housing Trust Fund: A Loan fund created from sale of Danvers Hospital to be used in the communities within the DMH Northeast Area.
  • MassHousing Set-Aside (DMH/DDS): Memorandum of understanding (MOU) with MassHousing, DMH, DDS since 1978, which sets aside 3% of all affordable units for DMH/DDS clients.
  • Facilities Consolidation Fund (FCF) (DMH/DDS): State bonded-financed loan program developed in 1993 to build community-based housing for clients of DMH and DDS. FCF loans can finance up to 50% of the total development costs of each project, with payments deferred for 30 years. Land-use restrictions require that the land be used to provide community based housing for DMH/DDS clients only. Available to non-profit and for-profit developers, builds integrated units or GLE settings, must be affordable, enforced by underwriter CEDAC. HUD- Project-Based Vouchers (PBV) secured to support operating costs in most developments. Through FCF, DMH works with CEDAC to ensure that clients have access to quality affordable housing throughout the Commonwealth.
  • CHOICE – DMH: DMH owned housing, a state initiative in which specific properties were purchased specifically to provide client housing in mainstream neighborhoods. Client rent (25% of income, max $100/month) goes into a reserve fund for repairs and renovations. Program supports multi-bedroom residential buildings; DMH owned, assigns provider, tenants selected by DMH.
  • DMH Rental Subsidy Program: Subsidy program specific to DMH clients. Administered by DHCD in cooperation with DMH, LHAs administer at local level. Uses closed referral process, client rent is calculated at 30-35% of the client’s adjusted household income, depending on utility inclusion.

On Tuesday, September 25, 2018, the Housing Subcommittee of the Massachusetts State Mental Health Planning Council is hosting “Housing and People with Serious Mental Illness: Taking Actions to Implement Solutions at Scale.” The conference will highlight best practices in developing and subsidizing a housing stock that fits the needs and scale of people with mental illness statewide. Learn more here.

Categories: CEDAC, Housing

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