Dr. Michael Mancini

More than half of people with serious psychiatric illness have a co-occurring substance abuse issue, with estimates ranging even higher for people who are also homeless. Many of PfP's new clients are struggling with dependency and homelessness when they are admitted to the program.

For a majority of these individuals, substance abuse began in the early stages of their illness. Street drugs often offered immediate relief for the most troubling symptoms of mental illness -- creating a destructive cycle of use and dependency.

While Places for People has always placed housing as its first priority, adopting the Housing First model has been especially challenging for some healthcare providers. It has been a challenge that often required a radical shift in thinking and service delivery. For some mental health providers, the principles of Housing First have conflicted with their admissions policies. For decades, most providers denied housing assistance and healthcare to individuals with an active history of drug abuse. In order to access health and medical care, people seeking services would have to abstain from using drugs for a period of three to five months.

For people who were extremely ill, many times psychotic, and homeless, these conditions virtually locked them out of the healthcare system. It was not uncommon that people would deliberately attempt to be arrested, with the hopes that shelter and medical care would be available in prison.

Dr. Michael Mancini, Assistant Professor at Saint Louis University's School of Social Work, has been working in the field of mental health and addiction for the past decade. For the past three years, he has been working with PfP staff and clients at CJ's Place to determine the effectiveness of programs that house people first and then address mental illness and drug simultaneously.

Mancini contends that requiring complete abstinence before accessing housing and healthcare is an unrealistic expectation and sets an almost impossible standard for people seeking treatment.

"If people could achieve abstinence on their own, why would they need services in the first place? We wouldn't expect the same of people suffering from depression. We would not ask them to not be suicidal before receiving mental health services."

While substance abuse is a troubling and often volatile social and political issue, most healthcare providers realize that is is a human issue that requires a comprehensive and integrated approach. PfP has received a grant from the Missouri Foundation for Health to begin addressing the needs of integrating mental health and addiction treatment.

Labels: Addiction, Housing First, Summer 2007