More than half the battle for parents is first to see the components and the phases of housing as a loved one with a psychiatric disability might experience it.
BY TOM PYLE, MBA, MS, CPRP
A great vexation of families navigating mental illness is housing. Once a loved one's psychiatric situations is sufficiently reliable, a family's thoughts inexorably turn to the quest for a suitable abode for the loved one. Because loved ones with mental illness tend to be both disabled and poor, their housing need is acute, but their financial capacity abject.
A Quagmire of Questions
Many loved ones with psychiatric disabilities continue to live with parents. This is usually a good thing; the family can give social, financial, and moral support – provided that the family and loved one can overcome the challenges a loved one's illness can pose. Assuming the best, then a gigantic worry eventually arises: what to do for the loved one's housing after the parents pass on? Assuming the worst, where loved ones abandon or are abandoned by their families, loved ones often must default to substandard boarding homes and shelters. This often leads parents to incessant worry or insufferable guilt. Worse still, not a few ill loved ones may live in their cars, if they have them, or in railway stations, under bridges, and on the streets, the nadir of all possible living situations, especially for one with a psychiatric disability.
The vexation for families comes when confronting the critical questions about housing for their disabled loved ones… Where to find it? How to afford it? What to expect of supports along with it? How long can one keep it? Who has priority for it? How to qualify for it? Who else is competing to get it? The ways and means to get appropriate housing are complex, confusing, and sometimes contradictory. Where do parents even begin?
Housing's Three Key Components
Perhaps the best start is to break down the housing conundrum into components.
There are three aspects of housing: stock, subsidies, and supports. Stock refers to the actual number of units in any particular market. Tragically, housing stock in many states is in short supply. Housing prices and rentals in many locations thus rise beyond reach even for the middle class, but especially for the poor. Programs to increase housing stock include special government grants and loans and tax credits for builders of new housing stock, especially when intended to provide for the poor of disabled. Second are subsidies that can reduce to cost of renting or buying an abode. Market rental rates often far exceed a poor person's ability to pay. A real estate rule-of-thumb says that a person's rent should total no more than 30% of one's disposable income.
Yet market rents even for modest one-bedrooms and efficiencies can eat up even 80% or more of one's disposable income. Programs providing rental subsidies include Federal and state programs. The best known Federal rental subsidy is the "Housing Choice Voucher" (formerly "Section 8 vouchers) provided by the U.S. Department of Housing and Urban Development and generally passed through state entities.
Third are supports, critical for many loved ones with psychiatric disabilities. These include intensive full live-in supervision and care staff among the residents in "group homes". They also include moderate supports like visits by a social worker, employment counselor, education consultant, direct support staff, psychologist, and even psychiatrist, all to assist the loved one manage daily life. They can also be only very light supports, perhaps only a weekly visit by a social worker, or a collective food shopping outing.
Housing's Seven Phases
Another way to think about housing is temporally, by the stage or phase in time of a loved one's potential housing odyssey. For a disabled loved one, there are seven (7) stages, ranging from most dependent to independent. The first phase might be considered the simplest and surest: familial housing. A loved one living with parents, at least theoretically, can enjoy housing that is lowest cost (e.g., free), supportive, and secure. While the true service level from the family is usually high, use of outside services in this phase is usually very low. Of course, familial housing presupposes an intact family that is financially capable. Often the opposite is true, if the mental illness breaks the family apart.
Family break-ups can lead to the second phase of a housing odyssey: emergency housing. When a mental illness skews symptoms and behaviors, bad things can quickly befall a loved one's health. Thus, the most emergent form of housing is a hospital emergency room. Another emergent form of housing are emergency shelters, where a loved one without a place to stay might find housing only a few nights.
But far too often, shelters are few and their beds scarce and hard to access, not to mention unsanitary and unsafe.
But far too often, shelters are few and their beds scarce and hard to access, not to mention unsanitary and unsafe. The third phase is usually transitional housing. Except for very severely psychotic loved ones unable to live in the community, hospital inpatient commitments can be considered transitional. Their ultimate goal is almost always community placement upon discharge after a shortest possible stay. Other transitional housing entities can house loved ones for only a limited period of time, such as six weeks, as a bridge from homeless or emergency housing to more permanent solutions. These assume that a loved one can find, or the market provide, such an abode in such time.
The fourth phase is supportive housing. "Supportive housing" is a term of art in professional communities that serve the disabled. It is a combination of housing and services intended as a cost-effective way to help those with the most complex challenges live more stable, productive, integrated lives. The level of supportive housing services ranges from high, as in group homes, to low, as in so-called scattered site housing. Families of loved ones with psychiatric disabilities often view supportive housing as an ultimate goal, anxious about a loved one's abilities to live truly independently. A goal of supportive housing is eventually for a loved one to recover sufficiently to be ultimately capable of independent living. An expensive kind of housing for governments, the availability of supportive housing is usually very constrained.
The fifth phase, subsidized housing, is housing generally offered at below market rates to for the indigent. Federally funded public housing authorities or projects can be considered as subsidized housing, receiving their subsidies for their buildings directly from the government. Private landlords participating in subsidized rental voucher programs such as "Housing Choice" (Section 8) vouchers are also part of this phase, although their subsidies are linked not to their buildings but to individual tenants who present rental subsidy vouchers.
The penultimate phase is "affordable" housing. The definition of affordable hous ing will vary from state to state. In New Jersey as one example, affordable housing is a kind of privately-developed housing derived in new building projects. Typically, developers must dedicate 20% of units in a new housing project to the affordable housing category. Renters or buyers of such units are typically designated by income category, such as "moderate", "low", and "very low". Each category is defined by a family income range set by the government and depending on family size. Typically, there are no subsidies in affordable housing. To bolster the lower revenue flows from affordable housing rentals, project developers adjust their market rates for the rest of their units accordingly. The economic benefit of an affordable housing unit to a loved one qualified as a very low income renter can be substantial. A very low income unit rental can be four or five times below the rental for a comparably sized unit on the regular market. A very low income purchase price for an affordable unit can be half the market price.
Finally, the seventh phase, with the most plentiful supply, but too often for those with disabilities with the least attainable prices, is of course regular market housing.
Understanding the First Step to Planning
For families navigating the maelstrom of mental illness, the housing challenge is vexing. More than half the battle for parents is first to see the components and the phases of housing as a loved one with a psychiatric disability might experience it. Understanding its three aspects (stock, subsidies, and supports) and its seven phases (familial, emergent, transitional, supportive, subsidized, affordable, and market) is half the battle. It can be a great help both to reduce undue parental anxiety and to begin charting a long-term strategy for navigating the treacherous shoals of housing for loved ones with psychiatric disabilities.
ABOUT THE AUTHOR:
Tom Pyle is father to a loved one with a psychiatric disability. Previously a banker and education foundation executive, Tom returned to school for a master's degree in psychiatric rehabilitation. A member of the New Jersey Behavioral Health Planning Council and board member of NAMI Mercer in Lawrenceville, NJ, Tom serves families and agencies navigating the maelstrom of mental illness. Contact him through: psychodyssey.net