This is what I learned about housing after working as a mental health nurse on the streets with high-risk homeless individuals in two large cities. I asked one individual why he was so successful in maintaining his housing over a long period of time. He told me that prior to being able to obtain housing he was required to take a class where he learned how to shop for groceries and cleaning supplies, make a meal, do laundry, clean his apartment, take public transportation and make a budget.
We worked with clients on conservatorships by teaching them skills that would be helpful for ending the conservatorship and regaining independence over the handling of their own affairs. When they thought they were ready to challenge the conservatorship, we requested an independent assessment. Even when the assessment ended in continuing the conservatorship, the bond between the individual and team remained strong. The skills learned along the way were extremely useful.
Simply giving out housing to homeless individuals is a recipe for failure. People need supports in the community, including mental health support, housing maintenance support and medical care. Many interventions can be implemented by non-licensed staff. Staff need to be utilized according to the specific needs of the client, and that includes their perceived needs translated into a treatment plan.
Many times I had clients who requested a visit from a peer and not a nurse or social worker. We used true treatment teams that offered flexibility according to the task at hand. Of course, there were times when both the psychiatrist and I assisted a client in washing dishes, sweeping up and taking out the trash. Not one member of the team ever said “that’s not my job.” These were important opportunities for us to help people learn what is needed to maintain their housing.
The most effective supports in this area are the full-service partnership teams and the transitional age teams. Home visits are also important to ensure stability and success.
We also found that medical assessment and linkage for screening, diagnosis and treatment is essential. This group suffers from a severe lack of access to medical care and death occurs decades earlier for them than for their counterparts who do not experience mental health problems. Good physical health is integral to good mental health. Strong advocacy and follow-up in terms of medical care and educating individuals about good physical health will contribute to longer, healthier lives for this special group.
It is time to put more time and resources into housing support rather than just providing a roof over one’s head.