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Housing and Mental Health Recovery

Access to housing is a vital foundation stone in mental health recovery. The housing needs to be decent, safe and stable. Such housing needs to be in place before a person is expected to engage fully in efforts toward their own recovery.

Note Abraham Maslow’s famous hierarchical pyramid of human needs. At its base is “Physiological Needs” including health, food, water, sleep, clothing and SHELTER. According to Maslow’s theory “Physiological Needs” should be in place before needs higher on his pyramid are aspired to and achieved.

However, the symptoms of mental illness can make attainment and maintenance of housing complex and difficult. Combine this with low income, and finding and maintaining decent and safe housing can approach the impossible. Yet, to seek recovery or to avoid a worsening of mental health symptoms and the resulting negative social fallout, housing needs to be a primary consideration. Social fallout includes repeated use of expensive and inefficient emergency medical services, similarly expensive repeated hospitalizations and repeated ill-fitting incarcerations.

Lacking immediate access to more permanent housing, emergency shelter is an option. Not the best option but an option. The problem is “high density living”. By nature emergency shelters are very populated busy places serving a diverse demographic. Those in shelters tend to be struggling with many very human and very difficult issues. Such an environment would be a challenge for anyone to inhabit much less when experiencing mental illness or even more complex mental illness and a co-existing addiction. In addition, when living in a “high density” situation, adherence to norms are expected and often necessary. For these reasons, some risk life on the street as the demands of emergency shelter are prohibitive.

Another housing option available in some areas is “supervised group settings”. This type of housing is staffed 24/7. Assistance with medications, daily living skills, meals, paying bills, transportation and treatment management is provided. This kind of shelter is helpful to some, however there is still an expectation to observe norms. Further, there is typically a mandate to take part in programming and treatment. Despite the supports in place the latter complicates the ability or willingness of some to take part in this kind of shelter option.

“Partially supervised group homes” are another option available depending on a person’s location. Within this option a person can complete daily tasks with some assistance. Staff, while not always present, can be contacted should a pressing need or emergency arise. Here the complications of high density living remain as does the mandate to observe norms and in many cases the mandate to take part in programming and treatment.

“Supportive living” is a shelter option for those able to function largely independently. Staff touches base regularly and case management is in place. Mandates remain in place, however.

“Rental housing” is an option for those able to function independently, perform daily tasks, and provide for their own needs. Again, depending on location, subsidized rent is available but often limited. Typically, a low-income person is required to pay 30% of their adjusted income for rent and utilities. The remaining amount is paid to the landlord by government or another third-party payer. In such a living situation a person must still find ways to meet their other needs such as food, clothing, transportation and medical co-pays. The location of subsidized housing too often is less than ideal. Far too much of the available subsidized housing stock is in unsafe areas. And still others are far from needed services and have limited, or no access, to public transportation.

A newer option less available is called “Housing first”. This type of housing recognizes the work of Abraham Maslow in that housing is provided up front. The human need for housing is in place without a mandate to take part in any programming or treatment. Absent housing, the expectation that a person seeks human needs higher on Maslow’s Pyramid is less viable or likely.

Common to all housing types is the reduction of the needless human and economic expense of repeated use of emergency services, hospitalization, and incarceration. Clearly, not all housing options are currently available in all areas, and they are not equal. What is clear is that choice needs to be added to the equation for any housing strategy to be beneficial.

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