Admission to service-enriched housing programs is not available to everyone who is homeless and mentally ill. Importantly, there are strict eligibility criteria for access. An individual must have a DSM diagnosis (Diagnostic and Statistical Manual of Mental Disorders) determined by a psychiatrist that is consistent with severe mental illness (psychotic disorder, major depressive disorder, or obsessive compulsive disorder), rendering the individual eligible for Social Security disability benefits. Sometimes public or private funding sources target a subgroup of homeless people with specific characteristics. For example, housing programs in receipt of Housing and Urban Development (HUD) funding for chronic homelessness require that an individual meet the Federal definition of chronic homelessness: disabled, having been homeless continuously for one year, or has had four or more homeless episodes in three years (HUD, 2015). Other programs have looser restrictions on the duration of homelessness needed to qualify for supportive housing. Despite the substantial progress that has been made in providing housing for homeless people, some are left out. The underserved include newly homeless people with severe mental illness, homeless youth with new-onset psychiatric disorder, and homeless people with addictions who do not meet the eligibility criteria for severe mental illness.

Mental health providers typically introduce individuals to supportive housing opportunities, but a formal application is required that includes the documentation of a psychiatric disability and receipt of a disability income to cover a portion of the rent payment. Proprietors of nonprofit housing programs set terms and conditions for admission and tenure, and they are not required to accept everyone who applies. Some will accept only those who are “clean and sober” and connected to a mental health treatment program. In some cases, a proprietor will request to be made the applicant’s representative payee for receipt of disability benefits in order to guarantee rent payments.

In a tight low-cost housing environment, homeless people with severe mental illness must compete with other low-income groups in the search for a market-rate apartment. They rely on providers of the “housing as housing” and housing-first approaches to assist them in gaining access to entitlements and subsidies, in the search for an available apartment, in guaranteeing rent payments, and vouching for their ability to be good neighbors (Hopper & Barrow, 2003). Often providers have established relationships with landlords and are able to intervene in disputes or behavioral problems that could put the person at risk for eviction. There is very little information on the process of housing search for this population, how quickly apartments are obtained, whether they comply with the individual’s housing preferences, or the characteristics of the neighborhood.

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