This Web site is a component of the SAMHSA Health Information Network
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This Web site is a component of the SAMHSA Health Information Network |
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This Web site is a component of the SAMHSA Health Information Network. |
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How States Can Use SAMHSA Block GrantsSupporting Services to People with Mental Illnesses Who Are HomelessWhile the Mental Health (MH) Services Block Grant does not require States to develop services for people who are homeless and have mental illnesses, it does require them to address outreach and homelessness in their block grant plans. MH block grant dollars represent only a small portion of State mental health funding. States also receive Federal PATH funds to serve this population. Even with this targeted funding stream and the required State match, there is still a need to target other resources to people who are homeless and have mental illnesses. Specific State approaches use various policy, planning, and funding strategies, particularly those involving use of MH block grant dollars. While PATH program funds represent a critical resource for supporting key services, use of these funds to support services to people who are homeless are not described here in detail. Creating Linkages with the Criminal Justice System in Maryland Policy and Planning The Mental Hygiene Administration (MHA), part of Maryland’s Department of Health and Mental Hygiene, oversees the delivery of public mental health services in the State. MHA’s commitment to providing mental health services and housing to people who are homeless is evident in its structure, policies and planning activities. The Agency’s Clinical Division of Special Populations addresses a number of issues including homeless and housing services. MHA also has an Adult Services Division which addresses residential housing and home ownership. The State has a policy that designates people who are homeless and have serious mental illnesses a priority for services. Providers receiving Federal PATH and Shelter Plus Care funds are required to develop plans to address the housing and service needs of this population. The Clinical Division of Special Needs Populations focuses on the housing and service needs of people with serious mental illnesses who have been in the criminal justice system. These individuals often are homeless. MHA participates on Jail Advisory Boards throughout the State to ensure appropriate discharge planning and dedicates staff to work in detention centers to provide aftercare follow-up services. In addition, the State has issued recommendations for discharge to stable housing from hospitals. Staff within the Division of Special Populations also participate on local HUD Continuum of Care planning boards and provide input into development of the HUD Consolidated Plan to ensure the availability of mainstream housing for people with mental illnesses. Funding for Homeless Services Maryland’s specialized services for individuals with mental illnesses who are homeless include outreach, case management, mobile treatment, vocational services, emergency, transitional and permanent supportive housing, and specialized services for people who have been in contact with the justice system. Overall, the State estimates that it spends 12 percent of $8.5 million in Federal mental health block grant money, $766,000 in Federal PATH money, $1 million in State funding to support PATH, transitional housing and supportive services for Safe Havens, and $4.7 million in Federal HUD Shelter Plus Care dollars to provide permanent supportive housing. Specialty mental health services in the State’s public mental health system are provided on a fee-for-service basis. MHA collaborates with county mental health authorities to manage the public mental health system. Several counties receive State funds for outreach, a portion of which is Federal block grant funds or State PATH matching dollars. In addition, some counties use block grant funds for case management, and for emergency and transitional housing and services. Special Programs, Incentives, or Initiatives Outreach, case management and transitional housing services. Many Maryland counties use mental health block grant dollars and other State funds for services to people who are homeless and have mental illnesses. In Baltimore City and Montgomery County, block grant funds are used to fund supportive services to people in HUD Shelter Plus Care housing, and to provide transitional housing services. Anne Arundel, Prince Georges, St. Mary’s and Washington counties use mental health block grant money to support either outreach, Assertive Community Treatment, homelessness prevention services, transportation, emergency housing, and crisis intervention services. State funding through the public mental health system also supports services targeted to people who are homeless. For example, targeted case management is provided through 28 approved programs in 22 jurisdictions. The State also funds 25 mobile treatment programs using the Assertive Community Treatment (ACT) model. In addition, supportive services are provided at two HUD-funded Safe Havens. Shelter Plus Care housing. In 1995, MHA was awarded $5.5 million in funding from HUD to provide tenant and sponsor-based rental assistance through its Shelter Plus Care program. Now operated in 21 counties, the program is targeted to serving individuals with serious mental illnesses who are homeless and coming from jails or hospitals, or who are in the community on parole or probation and are in danger of being reincarcerated. Case management and supportive services are provided to individuals receiving rental assistance. The effectiveness of the program has been demonstrated in recidivism rates of less than seven percent to jails, one percent to hospitals, and one percent to homelessness. Community Criminal Justice Treatment Program. Begun in 1992, the Maryland Community Criminal Justice Treatment Program (MCCJTP) provides comprehensive care to meet the needs of people who have serious mental illnesses and co-occurring substance use disorders, and who are involved with the justice system. The program works through interagency partnerships in local jurisdictions. Local advisory boards are required to develop a Memorandum of Agreement specifying the services each agency will provide; MHA provides $1.5 million annually for case management services. Eligible individuals have access to an array of services through the public mental health system. Lessons Learned Maryland considers people who are homeless and have serious mental illnesses a top priority for services. MHA’s Clinical Division of Special Populations has the staff and a number of programs dedicated to ensure that this priority is carried out where housing and mental health services are delivered—at the local level. The State takes an active role in planning activities to ensure that appropriate discharge planning and housing and services are available to these individuals. Participation in local HUD Continuum of Care planning efforts is directly linked to the State priority on homeless people with criminal justice system involvement. Collaboration between MHA and county mental health authorities also has resulted in targeting Mental Health Block Grant Funds to serve individuals who are homeless and have serious mental illnesses and co-occurring disorders. Block grant dollars, in turn, are used for an array of services that have proven effective with this population. MHA has blended Federal, State and local funding resources successfully to meet the specialized needs of this population for housing and services. This includes combining permanent housing resources available through HUD’s Shelter Plus Care program with block grant funds and with various State and local program resources. Partnerships among agencies at the local level also are encouraged through the development of local advisory boards that enter into interagency agreements to better coordinate resources and provide comprehensive care. Making Housing a Local Priority in Ohio Policy and Planning Housing has been a top priority for the Ohio Department of Mental Health (ODMH) since establishment of the Ohio Mental Health Housing Task Force in 1985. The Agency’s homelessness prevention strategy considers a stable living situation in the community critical to one’s recovery. In ODMH’s view, cooperative planning and leadership by the State is key to ensuring quality and accountability in housing and services at the local level. The State Agency has a five-part strategy:
Ohio’s mental health system has long counted on the expertise of its 16 mental health housing agencies whose mission is to develop and/or operate housing for people with serious mental illnesses. Over the next year, these experts will partner with NAMI-Ohio to develop a Mental Health Housing Leadership Institute to provide greater access to housing. In addition, the State is working to implement Assertive Community Treatment (ACT) as a reimbursable service under Medicaid. This will provide greater opportunity for people with mental illnesses who are homeless to access and maintain housing. Funding for Homeless Services Prevention, housing development, outreach and engagement, and advocacy for increased housing and services are the basis of Ohio’s approach. ODMH spends more than $20 million biennially on housing and homeless services. The funding comes from several sources including capital development and operating funds for housing, and Federal PATH and mental health block grant dollars. Of the $10 million ODMH allocates annually for housing operations costs, $770,000 is from the Federal mental health block grant. Fiscal and service responsibility for mental health services in the State rests with 50 local boards that serve Ohio’s 88 counties. The Department works collaboratively with and provides resources to local boards with established priorities and plans to meet the housing and homeless service needs of people with serious mental illnesses. In addition, ODMH collaborates with other State agencies and advocacy groups to coordinate resources. Special Programs, Incentives, or Initiatives Incentives to localities. Local mental health boards are not required to submit a housing plan. However, if they do and the plan is consistent with ODMH’s framework, they become eligible for additional funding through the Community Capital Assistance Program, described below. The ability to achieve certain performance-based outcomes also must be demonstrated. For example, localities must show they are able to serve the maximum number of people by using State rental assistance dollars as a bridge to permanent subsidies such as HUD Housing Choice vouchers. The Department also makes it a priority to invest in local systems that can stretch the State’s dollar to meet housing needs. Mental Health Housing Assistance Program (HAP). This program is designed for people with mental illnesses who are homeless or at risk of homelessness, and for people exiting psychiatric hospitals. ODMH funds it through local mental health boards, which, in turn, contract with local providers to provide start-up loans and temporary rental assistance for permanent housing. One-time grants are made to people to cover housing-related expenses, such as security and utility deposits, or furnishings. Alternatively, the money can be used to subsidize rent until the person receives federal housing assistance or becomes self-sufficient. HAP funds only can be used to subsidize housing costs at or below Fair Market Rent so that individuals are not forced to move once they receive HUD Housing Choice assistance. With annual funding of $5 to $6 million, the program serves roughly 5,600 households. Community Capital Assistance Program. In FY 2002, ODMH received about $10 million in State bond revenue for the Community Capital Assistance Program. To apply for the funds, local mental health boards are required to submit housing plans which then are used to weight the scores of local projects. The Department awards up to 75 percent of the required match for construction and development costs for permanent supportive housing projects funded through the HUD Continuum of Care. In FY 2001-02, ODMH provided almost $1.5 million to local mental health systems to leverage other funds in order to increase housing availability for individuals with mental illnesses. Lessons Learned Ohio’s example points to the role that State mental health agencies can have to support local housing and service programs for people who are homeless and have mental illnesses. ODMH has clearly defined its leadership role with localities. At the core of ODMH’s approach is ensuring quality and accountability in housing and services at the local level by investing in local planning strategies that are outcome driven and make the most of State and other resources. The Agency invests in local housing plans consistent with its overall strategy. ODMH also supports localities’ efforts to apply for other sources of funding, and provides leveraging funds. Further, the use of bridging subsidies and assistance is supported as a way to provide short-term assistance to individuals while linking them with mainstream resources for housing and supports. Ohio’s mental health system uses a portion of its Federal mental health block grant to invest in housing operations costs. ODMH also collaborates with localities and other State agencies and organizations to coordinate State and local resources with Federal resources. Influencing Local Priorities in Washington Policy and Planning The Mental Health Division (MHD) of Washington State’s Department of Social and Health Services considers people who are homeless a priority population for mental health services. MHD’s planning and funding priorities changed in the past two years, designating this and other subgroups of people with mental illnesses, including individuals with co-occurring substance use disorders, a priority in the State’s mental heath block grant plan. The State’s planning and funding priorities for serving people who are homeless are carried out at the local level. Funds are distributed to Regional Support Networks (RSNs)—individual or multiple county authorities responsible for local mental health services. The RSNs, in turn, contract with mental health services providers to deliver services. RSNs are required to plan for services to this population as part of the State’s prepaid health plan network. The State works closely with RSNs to ensure the efforts support the objectives of the mental health block grant plan. The State also encourages RSNs to participate in local HUD Continuum of Care planning efforts to assess needs, and to develop housing and service resources for individuals with mental illnesses. When the priority populations shifted at the State level, localities had to focus on better serving those groups. In 2001, the State’s mental health planning council sought proposals for innovative projects that would be funded with Federal block grant funds. Several communities developed plans, submitted through their RSNs, for new projects. As a result, the types of programs and services offered at the local level changed and innovative projects were funded in some localities. An example of how this took place in Seattle is described below. Funding for Homeless Services Washington’s 14 RSNs receive about 80 percent of the State’s Federal Mental Health block grant. The RSNs use the funds according to locally identified needs. At the local level, block grant dollars may be used for outreach services, case management, housing assistance, and ongoing supportive services for homeless people with mental illnesses. In Fiscal Year 2002, $688,000 in Federal PATH funds also were distributed to eight of the fourteen RSNs to supplement needed outreach and services. In addition, about $35,000 of the State’s share of Federal block grant dollars is used to support technical assistance and training for providers as described below. The State uses block grant dollars to help localities increase available housing resources for people with mental illnesses. Special Programs, Incentives, or Initiatives Technical assistance and training. Washington’s MHD uses a portion of its mental health block grant dollars to help localities increase available housing resources for people with mental illnesses. For example, two training workshops are being conducted this year for RSN staff, and both mental health and homeless service providers to help increase the number of successful housing applications submitted. The State also is contracting for on-site technical assistance in three geographic areas to develop local plans to expand housing options for people with co-occurring disorders at risk of homelessness. Outreach, integrated services and housing. The King County Mental Health, Chemical Abuse and Dependency Services Division of the Department of Community and Human Services is the RSN responsible for local delivery of mental health services in Seattle/King County. As a result of the shift in priorities at State level, the RSN recently retargeted funding to support the Homeless Outreach Stabilization and Transition (HOST) program. Operated by the Downtown Emergency Services Center (DESC) in Seattle, HOST provides outreach, engagement, and service linkage for hard-to-serve homeless individuals with mental illnesses on the street. DESC, which serves over 10,000 people a year, provides an integrated continuum of housing and services including emergency shelter, clinical services, and low-demand and permanent supportive housing options supported by Federal, State, county, city, and private dollars. Individuals engaged by the HOST program have access to the full array of services and housing resources offered by DESC. HOST is an outgrowth of the Federal Access to Community Care through Effective Services, and Supports (ACCESS) demonstration program. Local funding was used to sustain the program when ACCESS funding ceased. It is now partially funded by local funds, and by Federal PATH and mental health block grant dollars. Crisis Triage Unit. King County also recently shifted Federal mental health block grant funding to partially support a Crisis Triage Unit (CTU) for people in behavioral health crisis, many of whom are homeless. The five-year-old CTU is located in the emergency department at the county hospital. The program provides a single point of entry, or "no wrong door," to multiple treatment systems. The program also serves as a pre-booking diversion site for non-violent misdemeanants with mental illnesses and substance use disorders, providing alternatives for community treatment rather than jail. Lessons Learned The Washington State example demonstrates how shifting priorities at the State level can influence local service priorities. The recent designation of people who are homeless and have co-occurring mental illnesses and substance use disorders as a priority population has helped refocus services at the local level on reaching some of the most difficult-to-serve individuals. The State has worked with RSNs, responsible for local delivery of mental health services, to ensure that the change in priorities is being carried out at the local level with services offered and supported by Federal block grant dollars. The State also was able to work through its mental health planning council with the RSNs to fund innovative programs aimed at serving hard to reach homeless individuals using block grant dollars. Technical assistance and training to increase the housing options available to people with mental illnesses in local communities is supported by Mental Health Block Grant Funds as well. |
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