The Evolution of Supported Housing
In New York City, Ellen Baxter, a founder of the Coalition for the Homeless, and Tony Hannigan, a developer of housing and services for the severely mentally ill, channeled their concern for the housing needs of the homeless mentally ill by spearheading the advance of the model of supportive housing developed by Frs. Felice and McVean. Advocating for a permanent supportive housing model that would provide services, allow the tenant to hold the lease, and have an integrated tenancy made up of formerly homeless people with mental illness and people from the local community, an initial effort reflecting this approach was the nonprofit Broadway Housing. This model has been widely replicated and is well represented in the 30,000 supportive housing units now available in New York City.
Capitation funding for supportive housing from state and local governments, such as New York/New York Housing, has fueled the expansion of new multi-unit buildings, but this type of support is relatively uncommon. The creation of new single-site supportive housing has required developers to piece together funding from foundations, private donations, interest- free loans, low-income housing tax credits, and various public agencies. The Corporation for Supportive Housing, founded by Julie Sandorf in 1991, has played an important role in enabling communities to invest in housing for homeless people with mental disabilities. A certified community- development financial institution, the Corporation for Supportive Housing offers loan products and technical assistance to developers to leverage financing and advise communities on the issues involved in implementing solutions to homelessness. Staff trainings on best practices are offered to providers to assist tenants to participate in mainstream society. Originating in New York City, the Corporation for Supportive Housing has expanded nationwide (www.csh.org).
Supportive housing has been widely implemented in homeless services and mental health service systems nationwide. Federal funding for housing assistance through the McKinney-Vento Homeless Assistance Act has facilitated the expansion and formalization of supportive housing. In the 1990s, the Department of Housing and Urban Development’s funding initiatives supported service-enriched transitional housing, including safe havens as places of respite, treatment engagement, and rehabilitation, to achieve readiness for more long-l asting housing placement. Safe havens were created for people who are chronically homeless and service-resistant. Often involving the collaboration of a mental health service agency, programs are limited to about 25 residents, and are typically guided by a housing-first or low-demand perspective. Behavioral health programs are offered, such as 12-Step meetings, training in daily living skills, medication maintenance, and case management, but residents are not required to participate. Safe havens are staffed around the clock (O’Hara & Housing and Urban Development, 1997). In the most recent Federal homelessness initiative, however, transitional housing has been eclipsed by the emphasis on permanent supportive housing and rapid rehousing (USICH, 2015).
The two most common models of supportive housing are the single-site model (also termed “purpose-built” or “site-based”) in which all or most of the units in a facility (apartment building or SRO hotel) are dedicated to formerly homeless people with mental illness, and treatment and support services are provided onsite; and the scatter-site model in which the target population is able to access rent-subsidized apartment units in the competitive housing market, with services provided by a mobile team or offsite case managers. Some apartment buildings have “unit set-asides” for a specified number of people with disabilities. There is a third, hybrid model in which a single site mixes supportive housing for formerly homeless people with mental illness with rental housing for people with HIV/ AIDS, substance use disorder, or low-wage workers from the community at large. The housing programs created by developers of integrated housing provide a relatively secure community to a diverse group of residents who have all met the required admission standards (Hopper & Barrow, 2003).
Because these program models serve a population suffering from severe mental illness or multiple comorbidities, a range of services is provided directly or by referral to meet a variety of needs (Caton et al., 2007). For example, services delivered onsite can include assistance in establishing a household, health and mental health treatment, substance abuse treatment, peer support, money management, and connections to educational and employment opportunities. State and local mental health authorities have often funded mental health and substance abuse treatment services, but in the Affordable Care Act’s Medicaid expansion, treatment costs in supportive housing will be a covered expense. Tenants typically pay 30 percent of their income in rent, with the remainder of rent funded with federal housing vouchers, state or local subsidies, or charitable contributions to housing nonprofits. Section 8 housing supports some scatter-site apartments, and multiple Section 8 vouchers are sometimes bundled and allocated to a single-site permanent supportive housing program. About one-fourth of permanent supportive housing units nationwide are funded through the Department of Housing and Urban Development’s Continuum of Care program.