The close connection between housing and health By Francie Broderick, PfP Executive Director
Originally published: 08/04/2008
A police car pulled up at our offices, and a very pretty but distraught young woman wearing pajamas and slippers and carrying plastic bags of clothing got of the car. The sympathetic police officer had found her on the street and brought her to a place he thought could help. Her newly diagnosed mental illness already had started to cause her life to unravel: She dropped out of college; she started fighting with her mother; she ended up on the street.
Not long after, another new face appeared on our parking lot, that of a heavily bearded young man wearing a long skirt and a bra who told me he had been homeless for years. "You can't help me," he said. "No one can help me."
These stories are repeated over and over every day. I work in a mental health agency, not a housing agency, but it has become increasingly clear that housing and health care are linked inextricably.
It is a dynamic that works both ways: Poor health puts one at risk of losing housing, and homelessness increases the risk of poor health.
John Lozier of the National Health Care for the Homeless Council, a non-profit advocacy group, quotes data showing that people who are homeless "suffer all illnesses at three to six times the rate experienced by others, have higher death rates and have dramatically lower life expectancy."
Homeless people are subject to infection, the elements, poor nutrition and hygiene and the ongoing threat of violence. The situation becomes even more complicated when they also have a serious psychiatric disorder.
People with untreated mental illness who are homeless often are frightened, distrustful and unable to understand their need for help or to maneuver their way through our fragmented mental health system. The result is that the sickest and most disabled people often are among the most chronically homeless.
In addition, homelessness and inappropriate housing situations among people with serious mental illness also are linked to higher use of expensive emergency room visits or hospitalization.
Working with a group of health care advocates and providers in the eastern region of Missouri, we have been identifying and analyzing "high users," people with the greatest number of emergency room visits or hospital days. A recurring theme is that these often are people who lack stable housing. They may be homeless and unable to participate consistently in their treatment. Or their living situation may include frequent interpersonal conflict or domestic violence, situations leading to police taking the person to the hospital.
After four decades of deinstitutionalization, we know that most people with serious mental illness can live successfully in the community if they have the right combination of safe, affordable housing and appropriate treatment. One without the other is insufficient.
We also know that one size does not fit all. Given the proper support, most people can live independently in homes or apartments of their own. Others may be able to manage in an apartment only if support is available on site. We should be able to provide the full array of necessary housing options.
The good news is that we have gotten very good at understanding how to get people into services and treatment. State government has provided funds for new assertive community treatment teams. The Mental Health Board of St. Louis helps provide homeless outreach and housing stabilization services.
The bad news is, we still have a crisis getting people housed.
It is time for a broad-based community effort to address this problem:
Foundations, legislators and providers need to understand the link between housing and health care. Banks and developers need to work with service providers to create the various combinations of housing and service options that will help people live decently, safely and productively. Housing trust funds need to reserve funding specifically for people with special needs. Neighborhood associations and community groups need to welcome housing for people with disabilities in to their neighborhoods. These are not strangers; they are our sons and daughters; our sisters, brothers, mothers and fathers.
On July 30, President George W. Bush signed into law a bill creating a national Housing Trust Fund, a permanent program with a dedicated source of funding to create housing. This legislation has long been sought, and it offers us a wonderful opportunity.
As the provisions of this legislation start taking effect, we must ensure that the housing needs of the seriously mentally ill -- the most vulnerable and often the most voiceless among us -- are not forgotten.
Francie Broderick of University City is a frequent contributor to the Commentary page. She is the director of Places for People, a nonprofit mental health center based in St. Louis.
