No Place to Go. . . lack of housing for the mentally in our communities

Identification of the Problem: The care of the seriously mentally ill in the community had been a serious issue in our nation's mental health system for over 40 years since the initial deinstitutionalization movement in 1963 (Torrey, 2011). The lack of appropriate, supportive housing for the seriously mentally ill has resulted in this vulnerable population living in shelters or on the streets, often ending up in the prison system. Failure to survive in this minimally supportive setting often results in costly admissions to acute care inpatient units.

Background of the Problem: Multiple factors have contributed to homelessness among the mentally ill. Civil libertarians believed that mentally ill individuals had the right to live and receive treatment in the "least restrictive" environment (Krieg, 2001). Policy makers promised that the financial savings from the closing of state hospitals would be funneled to the care of the mentally ill in the community. The deinstitutionalization movement of the 1960s included opening federally funded community mental health centers to provide care to discharged patients in the community (Torrey, 2011). Unfortunately, the funds never reached the mentally ill in the communities as proposed. State hospital beds continue to close. In 2013, New York State Governor Cuomo closed 24 state psychiatric hospitals with expected savings of $20 million in the first year of the plan. (Hughes, 2013). However, reinvestment of the savings from closing hospital beds is not being used for the sickest in our communities. Instead the funds are being spent on educational programs focused on combating stigma , educating the public, and identifying asymptomatic individuals (CSEA,2016).

Background of the Problem: Unfortunately, the nature of their illness makes it difficult for the mentally ill to advocate for themselves. The National Alliance for the Mentally Ill (NAMI) is the most visible advocacy group for the mentally ill and their families. Unfortunately, their strength in lobbying for the rights for this population has been limited, but they are one of the few voices advocating for the mentally ill The limited political voice and minimal supports result in savings from cuts in mental health spending ending up in the pockets of other special interest groups with a louder voice and more lobbying power (Hughes, 2013).

There are multiple stakeholders involved in this issue:

• individuals with mental illness

• families of people with mental illness

• health care providers

• the legal system (police, jails)

• communities

• policy makers (governors, senators)

• governmental agencies (Medicaid, Medicare, Social Security)

• health care advocacy groups.

A potential option for addressing the lack of supportive community residences for the seriously mentally ill is the formation of partnerships between the public and private sector. Governmental agencies have consistently failed at providing for this population.The strength of the private sector in successfully managing health facilities will enable a public-private partnership able to provide desperately needed transitional residences for the mentally ill (Dominics, 2008). Through this partnership, private sector health systems will utilize the closed units in state hospitals to provide transitional residences for the seriously mentally ill. The partnership would include the state paying a management fee to the health system to administer the program. The program would be staffed by health system employees whose salary would be paid by the health system. Funding for the residential component would continue through SSI and SSD. Psychiatric treatment would be onsite, provided by health system clinicians and billed to Medicaid. The state would be responsible for building and structural expenses. The experience of the private sector in managing health facilities would lead to the success of such an initiative. The potential cost savings would be significant by decreasing rates of readmissions to inpatient units by maintaining mentally ill individuals in a secure, structured setting . When clinically appropriate, the patients would be stepped down to less structured residences in the community.

Resources needed:

Staff from private sector healthcare systems.

Funding agreements from Medicaid, and SSI/SSD.

At the state level it will be necessary to gain the support of the governor, state senators, representatives and ,congressmen to obtaining funding for the initiative.

At the federal level, support must be secured in both the House and the Senate in order for significant portions of payment for the plan to be approved.

An additional potential source of funding would be The Delivery System Reform Incentive Program (DISRIP) . The aim of this program, funded by New York State, is to improve health, and reduce costs in the provision of care to vulnerable populations including the mentally ill (

I will:

Educate private sector healthcare administrators about the potential option for addressing the serious issue of homelessness among the mentally ill in the community.

Advocate for the homeless mentally ill at both the state and federal level by contacting my senator, congressman, and assemblyman to reinforce the seriousness of this issues and the need for creative options in addressing it.

Educate patients and families about avenues for advocating for the needs of the mentally ill n the community.


Retrieved from:

Dominics, J. (2008, October 07). Private –public model can work in Georgia. The AtlantaJournal- Constitution, p. A10

Hughes, K. (2013, July 16). Governor Andrew Cuomo’s New York Mental Health Plan GainsSupport. Mental Health Association of New York State. Retrieved from

Krieg, R. G. (2001). An Interdisciplinary Look at the Deinstitutionalization of the Mentally Ill.The Social Sciences Journal, 38 (2001), 367-380.

Retrieved from:

Torrey, E. F. (2011, December) How-to-Bring-Sanity-to-Our-Mental-Health-System. Center for Policy Innovation. Retrieved from


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