ending homelessness: plan, act, succeed the national alliance to end homelessness annual meeting
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Permanent Supportive Housing and Mental Health System Transformation: Key Elements in the Efforts to End and Prevent Homelessness. Ending Homelessness: Plan, Act, Succeed The National Alliance to End Homelessness Annual Meeting July 17, 2006 Marti Knisley and Steve Day - PowerPoint PPT PresentationTRANSCRIPT
Permanent Supportive Housing and Permanent Supportive Housing and Mental Health System Transformation: Mental Health System Transformation: Key Elements in the Efforts to End and Key Elements in the Efforts to End and
Prevent HomelessnessPrevent Homelessness
Permanent Supportive Housing and Permanent Supportive Housing and Mental Health System Transformation: Mental Health System Transformation: Key Elements in the Efforts to End and Key Elements in the Efforts to End and
Prevent HomelessnessPrevent Homelessness
Ending Homelessness: Plan, Act, SucceedThe National Alliance to End Homelessness
Annual MeetingJuly 17, 2006
Marti Knisley and Steve DayThe Technical Assistance Collaborative
Ending Homelessness: Plan, Act, SucceedThe National Alliance to End Homelessness
Annual MeetingJuly 17, 2006
Marti Knisley and Steve DayThe Technical Assistance Collaborative
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Today’s DiscussionToday’s DiscussionToday’s DiscussionToday’s Discussion
What is MH Transformation?
Why MH Transformation?
Why are we talking about it today?
Why is permanent supportive housing (PSH) essential to MH transformation?
What are the benefits of PSH + MH transformation?
What happens to people in systems that do not have PSH + a transformed MH system
What is MH Transformation?
Why MH Transformation?
Why are we talking about it today?
Why is permanent supportive housing (PSH) essential to MH transformation?
What are the benefits of PSH + MH transformation?
What happens to people in systems that do not have PSH + a transformed MH system
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What is MH Transformation?What is MH Transformation?What is MH Transformation?What is MH Transformation?
Changing the way that states, local jurisdictions and even the federal government do business, and
Changing how business is done in a way that more people get help and help that works
Stems from President’s New Freedom Commission on Mental Health: “To improve access to quality care and services, the Commission recommends fundamentally transforming how mental health care is delivered in America”
Changing the way that states, local jurisdictions and even the federal government do business, and
Changing how business is done in a way that more people get help and help that works
Stems from President’s New Freedom Commission on Mental Health: “To improve access to quality care and services, the Commission recommends fundamentally transforming how mental health care is delivered in America”
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What is MH Transformation?What is MH Transformation?What is MH Transformation?What is MH Transformation?The New Freedom Commission and SAMHSA haveorganized their agendas around five principles:
Focusing on desired outcomes Focusing on community level models of care that
effectively coordinate MH treatment and delivery of other services
Focusing on policies that maximize the utility of existing mainstream resources
Using mental health research findings to influence the delivery of services
Ensuring that the President’s Commission recommendations are used to promote innovation, flexibility and accountability
The New Freedom Commission and SAMHSA haveorganized their agendas around five principles:
Focusing on desired outcomes Focusing on community level models of care that
effectively coordinate MH treatment and delivery of other services
Focusing on policies that maximize the utility of existing mainstream resources
Using mental health research findings to influence the delivery of services
Ensuring that the President’s Commission recommendations are used to promote innovation, flexibility and accountability
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What is MH Transformation?What is MH Transformation?What is MH Transformation?What is MH Transformation?
The Institute of Medicine has identified the problem as stemming from the complexity of health care and recommends focusing energy on “levers” that can have large scale effect with relatively small efforts in four areas:
Finance Workforce Best practice Information technology
The Institute of Medicine has identified the problem as stemming from the complexity of health care and recommends focusing energy on “levers” that can have large scale effect with relatively small efforts in four areas:
Finance Workforce Best practice Information technology
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Why MH Transformation?Why MH Transformation?Why MH Transformation?Why MH Transformation? Perception that the system is fragmented, has big gaps and
too many people fall through the cracks of the system
Financing does not reinforce provision of services proven to be effective. Thus, many people don’t have access to effective services
All the above problems have resulted in a lack of confidence in the specialty mental health sector which in turn means this sector is no longer the single payor or policy maker
This in turn requires collaboration beyond the boundaries of traditional mental health systems
Perception that the system is fragmented, has big gaps and too many people fall through the cracks of the system
Financing does not reinforce provision of services proven to be effective. Thus, many people don’t have access to effective services
All the above problems have resulted in a lack of confidence in the specialty mental health sector which in turn means this sector is no longer the single payor or policy maker
This in turn requires collaboration beyond the boundaries of traditional mental health systems
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Why MH TransformationWhy MH TransformationWhy MH TransformationWhy MH Transformation
MH 4/06
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Why MH TransformationWhy MH TransformationWhy MH TransformationWhy MH Transformation
MH 3/06
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Why are we talking about it today?Why are we talking about it today?Why are we talking about it today?Why are we talking about it today?
50-60% of single adults who are chronically homeless have mental health problems
Consensus that traditional mental health systems don’t have services that are either desired by or work for people who are homeless
Demonstrations and specialty serves for people who are homeless work well but don’t translate into changes in the mainstream service delivery system or long term funding
50-60% of single adults who are chronically homeless have mental health problems
Consensus that traditional mental health systems don’t have services that are either desired by or work for people who are homeless
Demonstrations and specialty serves for people who are homeless work well but don’t translate into changes in the mainstream service delivery system or long term funding
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Why are we talking about it today?Why are we talking about it today?Why are we talking about it today?Why are we talking about it today? State and local MH systems are now or soon will be engaged
in transformational activities
They will make choices about what activities they are engaged in—and they have many choices
Shifting mainstream resources to reimburse services that are effective for people who are homeless requires a significant shift in resource allocation
MH systems need to have the tools and understand the need to make services and supports for people who are homeless a priority
State and local MH systems are now or soon will be engaged in transformational activities
They will make choices about what activities they are engaged in—and they have many choices
Shifting mainstream resources to reimburse services that are effective for people who are homeless requires a significant shift in resource allocation
MH systems need to have the tools and understand the need to make services and supports for people who are homeless a priority
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Why is housing essential to MH Why is housing essential to MH transformation?transformation?
Why is housing essential to MH Why is housing essential to MH transformation?transformation?
Many people who could benefit from mental health services could also benefit from stable affordable housing
Having your own place to live promotes recovery
The service strategy that helps people get and keep housing—community support—is both clinically and cost effective; if “housing first” is used, the system becomes adept at engagement and relapse prevention
Reduces the need for and likelihood of a costly, duplicative system (homeless services system)
Many people who could benefit from mental health services could also benefit from stable affordable housing
Having your own place to live promotes recovery
The service strategy that helps people get and keep housing—community support—is both clinically and cost effective; if “housing first” is used, the system becomes adept at engagement and relapse prevention
Reduces the need for and likelihood of a costly, duplicative system (homeless services system)
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What are the benefits of PSH + MH What are the benefits of PSH + MH transformation?transformation?
What are the benefits of PSH + MH What are the benefits of PSH + MH transformation?transformation?
Maximizes three sets of resources: housing capital, housing subsidies/ operating funds and services funds---stretching existing resources and bringing new resources to the table
Provides useful, practical tasks for staff who have responsibilities to help people become stable, contributing community members engaged in their own recovery and on their own terms
Provides a platform for MH system to demonstrate value to stakeholders, public officials and policymakers and most of all to consumers and family members
Maximizes three sets of resources: housing capital, housing subsidies/ operating funds and services funds---stretching existing resources and bringing new resources to the table
Provides useful, practical tasks for staff who have responsibilities to help people become stable, contributing community members engaged in their own recovery and on their own terms
Provides a platform for MH system to demonstrate value to stakeholders, public officials and policymakers and most of all to consumers and family members
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What are the benefits of PSH + MH What are the benefits of PSH + MH transformation?transformation?
What are the benefits of PSH + MH What are the benefits of PSH + MH transformation?transformation?
More people have access to PSH; PSH provides choice, rights of tenancy and removes conditions for treatment
Community Support Services are tailored to: Increase emphasis and resources directed toward people getting help to
get and keep jobs Assure integrated MH and SA services are the expectation Streamline and increase access to benefit programs/ with incentives for
going to work Value social and peer supports
Housing support is a high priority of the Community Support System
More people have access to PSH; PSH provides choice, rights of tenancy and removes conditions for treatment
Community Support Services are tailored to: Increase emphasis and resources directed toward people getting help to
get and keep jobs Assure integrated MH and SA services are the expectation Streamline and increase access to benefit programs/ with incentives for
going to work Value social and peer supports
Housing support is a high priority of the Community Support System
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What is community support in a What is community support in a transformed MH system?transformed MH system?
What is community support in a What is community support in a transformed MH system?transformed MH system?
Combined mental health and substance abuse and rehabilitation services and complimentary supports
Organized to resolve the interrelated clinical, social, financial, and residential challenges encountered by priority public mental health system constituents
With services are delivered in natural community settings such as homes, neighborhood venues, schools, homeless shelters, drop-in centers, and on the streets – often delivered by peers
Overcomes barriers to engagement and service access, develops coping skills, and promotes recovery in ways that traditional mental health service can not
Combined mental health and substance abuse and rehabilitation services and complimentary supports
Organized to resolve the interrelated clinical, social, financial, and residential challenges encountered by priority public mental health system constituents
With services are delivered in natural community settings such as homes, neighborhood venues, schools, homeless shelters, drop-in centers, and on the streets – often delivered by peers
Overcomes barriers to engagement and service access, develops coping skills, and promotes recovery in ways that traditional mental health service can not
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What is housing support in a What is housing support in a transformed MH system?transformed MH system?
What is housing support in a What is housing support in a transformed MH system?transformed MH system?
The system explicitly commits resources to one of two service models: stand alone Housing Support Teams or integrated housing support functions to Community Support/ ACT Teams
Housing support functions include: outreach/ engagement, helping a person select housing, move in, access benefits, sign a lease
and meet all the required functions of tenancy and other supports so a person can “keep” their housing
How to pay for it: Medicaid, state institution downsizing or health care reinvestment, new state plan requirements, re-direct current allocations
The system explicitly commits resources to one of two service models: stand alone Housing Support Teams or integrated housing support functions to Community Support/ ACT Teams
Housing support functions include: outreach/ engagement, helping a person select housing, move in, access benefits, sign a lease
and meet all the required functions of tenancy and other supports so a person can “keep” their housing
How to pay for it: Medicaid, state institution downsizing or health care reinvestment, new state plan requirements, re-direct current allocations
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What is housing support in a What is housing support in a transformed mental health systemtransformed mental health system
What is housing support in a What is housing support in a transformed mental health systemtransformed mental health system
Access to continuous and sufficient bridge and long term rental assistance and to contingency funds for deposits and furnishings
How to pay for it: HOME, state and local trust funds, Medicaid or state institution downsizing reinvestment, SSI Supplement, small grants
Interagency agreements to meet service and housing policy imperatives for affordable housing and MH reform – LIHTCs, Trust Funds and other state and local capital or rental and capital funds, private philanthropy
A better trained and compensated workforce with more opportunities for peers
Access to continuous and sufficient bridge and long term rental assistance and to contingency funds for deposits and furnishings
How to pay for it: HOME, state and local trust funds, Medicaid or state institution downsizing reinvestment, SSI Supplement, small grants
Interagency agreements to meet service and housing policy imperatives for affordable housing and MH reform – LIHTCs, Trust Funds and other state and local capital or rental and capital funds, private philanthropy
A better trained and compensated workforce with more opportunities for peers
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What happens to people in systems that What happens to people in systems that do notdo not have PSH + a transformed MH system?have PSH + a transformed MH system?
What happens to people in systems that What happens to people in systems that do notdo not have PSH + a transformed MH system?have PSH + a transformed MH system?
Institutional care/ incarceration/residential treatment siphons funds away from effective services,
While at the same time costs for maintaining institutions will continue to rise with little to show in return
MH system blamed for homelessness which in turn reduces credibility---ability to attract new resources
People with mental illness even more likely to disengage from the service system
Institutional care/ incarceration/residential treatment siphons funds away from effective services,
While at the same time costs for maintaining institutions will continue to rise with little to show in return
MH system blamed for homelessness which in turn reduces credibility---ability to attract new resources
People with mental illness even more likely to disengage from the service system
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For discussion: For discussion: State Transformation StrategiesState Transformation Strategies
For discussion: For discussion: State Transformation StrategiesState Transformation Strategies
Pennsylvania
North Carolina
New Mexico
Connecticut
Your state……
Pennsylvania
North Carolina
New Mexico
Connecticut
Your state……
Is PSH a priority?
If not, why not; what can be done to make it a priority
If it is, what is working?
What needs to be done?
What are the challenges to success?
Is PSH linked specifically to MH system transformation?
Is PSH a priority?
If not, why not; what can be done to make it a priority
If it is, what is working?
What needs to be done?
What are the challenges to success?
Is PSH linked specifically to MH system transformation?