RD337 - Permanent Supportive Housing – Program and Participant Characteristics – October 1, 2016

Executive Summary:
Permanent supportive housing (PSH) is an evidence-based practice for adults with serious mental illness (SMI) that has been implemented, refined, and studied for more than 30 years. A notable subset of individuals with SMI are unstably housed or are homeless and, as a result, have poor behavioral health outcomes and are high utilizers of costly treatment and criminal justice resources. Multiple peer-reviewed research studies, including seven randomized controlled trials, have found that PSH is particularly effective in improving participants’ housing stability and reducing their emergency department and inpatient hospital utilization.(*1)

The two core components of the PSH model are (1) affordable rental housing and (2) housing-focused, community-based supportive services designed to support individuals in securing income, treatment, and rehabilitative services to improve their behavioral health conditions. PSH is widely endorsed as a critical resource to prevent unnecessary institutional stays and facilitate discharges from institutions for persons with disabilities as required by Title II of the Americans with Disabilities Act, and as interpreted by the U.S. Supreme Court in its Olmstead decision. While PSH is widely recognized as an essential community behavioral health support, its availability has been limited in Virginia by the absence of a targeted funding mechanism.

The 2015 Virginia General Assembly appropriated $2.1 million to DBHDS to “support rental subsidies and services to be administered by community services boards (CSBs) or private entities to provide stable, supportive housing for very low-income persons with serious mental illness.” DBHDS adopted the evidence-based practice standards for Permanent Supportive Housing from the federal Substance Abuse and Mental Health Services Administration (SAMHSA) to define the program model, target population, and operating standards for Virginia’s PSH program for adults with SMI. This report describes key characteristics of the program, how the funds are allocated by organization, average rental subsidies, and characteristics of the first cohort of 68 PSH participants who were housed between January 15, 2016 and July 15, 2016. By the end of the first year of operation, these programs will collectively serve at least 149 individuals in permanent supportive housing.

Findings in this report support the value of investment in PSH for this population:

• Eighty percent of the population served had at least one episode of homelessness (i.e. sleeping outdoors, in a place unfit for human habitation, or in emergency shelter), typically spending 111 of their 183 nights homeless before moving into PSH.

• Only 15 percent of the population reported one night in stable housing in the six months before PSH.

• Individuals in this population have extremely low incomes at the time of PSH admission and cannot secure rental housing without a subsidy.

• Individuals report significant behavioral health challenges coupled with cognitive impairment and psychological trauma.

• A subset of high utilizers of emergency and institutional services accessed emergency department (ED) or inpatient services 2.6 times in the 30-day period before PSH admission, spent 10.6 nights in inpatient care, and used ED services 4.9 times.
(*1) Center for Budget and Policy Priorities. (2016). Supportive Housing Helps Vulnerable People Live and Thrive in the Community. Retrieved from http://www.cbpp.org/research/housing/supportive-housing-helps-vulnerable-people-live-and-thrive-in-the-community#_ftn27