A recent ruling handed down by federal court is a reminder to all states and municipalities that individuals with mental illness should have access to housing and services that enable them to thrive in the communities where they live.
Disability Advocates Inc. v. New York State provides opportune time to fully realize the potential of supportive housing in New York and nationwide.
In this case, Judge Nicholas Garaufis issued an opinion that effectively mandates the State to find alternatives to warehousing mentally ill people in state-licensed adult homes, which he accurately equated with the outdated policy and failed institutionalizations of days gone by. He upheld that fundamental rights of decency should guide government as they craft options for addressing the needs of the mentally ill.
First, individuals who are grappling with mental illness should be in the community, not crowded in a state operated or funded facility hidden out of sight and mind. Millions of Americans are diagnosed with various forms and degrees of mental illness. There is absolutely no reason to exclude or quarantine - either directly or indirectly - those who pose no threat to themselves or the rest of society.
Second, we already know better ways to "support" individuals in our communities coping with mental illness. It is simply a question of our will and commitment to implement the solutions.
Adult homes are a relic of the deinstitutionalization of the 1980s, when institutions were closed with the intention of creating a community health care model to provide care in a more integrated setting. However, the resources for community health care never materialized and this resulted in a large number of people being placed into proprietary adult homes that share many of the characteristics of the asylums they replaced. Judge Garaufis went beyond condemnation of this practice and identified a solution: Supportive housing.
Supportive housing, defined as integrated housing and services, is one of the most significant public policy developments of the last three decades. It represents a shift in public health and housing that changes the focus from maintaining systems that provide temporary crisis services to one that seeks to permanently end homelessness, successfully serve vulnerable people and promote healthy communities. Supportive housing improves outcomes for individuals and communities and does it in a manner that reduces strain on overburdened emergency systems and reduces public costs. This recent court ruling found that supported housing is roughly $7,500 less expensive than adult homes per unit when all costs, including Medicaid, are factored in.
While supportive housing was originally conceived as a model to end homelessness, especially chronic homelessness, its benefits extend far beyond its original applications and it is becoming a leading model for integrating services with independent housing. Once a person or family has the stability of housing, a plan for supportive services that meet their needs can be created so that appropriate, effective treatment is received.
The Judge's ruling provides the opportunity to fully realize the potential of supportive housing in New York and around the country. Several other states have been forced to abandon antiquated methods that relied on grouping mentally ill individuals in homes or institutions where care and attention were often lacking.
Since the Olmstead v. L.C. decision in 1999, when the United States Supreme Court held that the unnecessary segregation of individuals with disabilities in institutions may constitute discrimination based on disability, several states - Georgia, New Jersey, Texas, California, New Mexico, Kentucky, Nebraska - have had to modify their approaches and develop more humane ways to assist those with mental illness. The Court ruled that the Americans with Disabilities Act may require states to provide community-based services, rather than institutional placements for individuals with disabilities.
Judge Garaufis has again underlined this vital right and the community-based foundation on which supportive housing rests. The decision allows the state of New York three months to prepare a plan to transition 4,300 individuals from adult homes to community-based housing and services. This is a daunting task, and New York is now in the process of deciding whether it will appeal the Judge's well-reasoned ruling.
New York has led the nation in the adoption of integrated funding systems that support comprehensive plans to house people experiencing long-term homelessness, institutionalization, and suffering from chronic health issues. Adult homes have been the exception to an illustrative record of systematic reform that has created affordable community-based housing options for thousands of New Yorkers with serious mental illness. In light of its success in developing the supportive housing industry, New York has proven it has the capacity, leadership and skills necessary to implement large-scale reform.
We at CSH are prepared to help New York and other states and cities develop supportive housing to its fullest potential so that everyone, regardless of the challenges they face, can be a welcomed and contributing member of our communities.