How funding to house #MentallyIll, #Homeless is a financial gain, not drain

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A director of a supportive housing center in Bronx, New York, talks with a resident and case worker in December 2015.
Bebeto Matthews/AP

Carol Caton, Columbia University Medical Center

As Congress considers the federal budget proposal for fiscal year 2018 to reduce funding for services to poor and homeless Americans, programs with proven cost-effectiveness should not be on the chopping block. One such program is supportive housing for homeless people with severe mental illness. The Conversation

Supportive housing, funded and coordinated by several different federal agencies and nonprofits, provides homeless people who have severe mental illness with housing coupled with treatment and support services. There is no increase in net public cost compared to street and shelter living.

While it may appear that paying for supportive housing is a drain on the federal budget, research has shown that ending homelessness for the severely mentally ill saves taxpayers money.

Because funding comes from several different agencies, it is hard to know specifically from the president’s budget plan how deep the cuts to supportive housing could be. Yet we do know that the president has proposed cuts in funding to Housing and Urban Development by 13 percent and to Health and Human Services by 19 percent. Both these agencies provide significant funding for supportive housing.

I research mental illness and homelessness. Cutting funds to house the homeless would cost us more money than it would save.

Supportive housing and the homeless mentally ill

Since the 1980s, homelessness has plagued cities and towns across the country. Today, more than a half-million people in the U.S. are homeless. One in every three homeless people suffers from a mental illness, which is often compounded by multiple health problems and substance abuse.

The homeless mentally ill are likely to remain undomiciled and without treatment for long periods of time. This brings a high social and economic cost to society. Disabled by mental illness and unable to work, these individuals have little hope of exiting homelessness without public assistance.


Beset with extreme poverty and disability, their inability to work renders them heavily dependent on the largesse of government agencies for disability income, housing support and health care.

The challenges facing homeless people in general are daunting. Security, privacy and creature comforts are in short supply. The daily burden of being homeless involves finding ways to assuage exhaustion and hunger, and to sidestep the violence and victimization that regularly occurs in life on the streets. An estimated 14 to 21 percent of homeless people are victims of crimes, compared to about 2 percent of the general population.

Supportive housing, started in the early 1980s, has shown to make a big difference. Unlike the temporary respite provided by crisis shelters, it provides access to permanent housing, mental health treatment and support from mental health professionals to guide the adjustment from homelessness to stable residence in the community.

Supportive housing tenants must have a behavioral health condition that qualifies them for a federal disability income. Residents pay one-third of the cost of rent and utilities with their disability income (about US$733 per month). The balance is covered by a housing subsidy provided through private or governmental sources. In some cases, eligibility for a housing subsidy is based on duration of street and shelter living.

The numbers tell the story

In concert with the federal plan to “End Chronic Homelessness in Ten Years,” supportive housing has helped to reduce chronic homelessness by 35 percent between 2007 and 2016.

At an annual cost ranging from $12,000 to nearly $20,000 per unit, permanent supportive housing is expensive, but it is substantially less than the annual cost of a stay in a homeless shelter, jail or prison, or psychiatric hospital.

Some of the funding comes from the federal government, including from the Department of Housing and Urban Development’s Continuum of Care and from Section 8 housing subsidies. The Department of Health and Human Services and the Department of Veterans Affairs also provide funding.

States including New York, California, Washington and Connecticut have helped to fund housing for people with mental illness, as have some city and county governments.

Other sources of funding include low-income housing tax credits, private foundations and charitable donations to nonprofit housing providers. The Affordable Care Act Medicaid expansion program provides Medicaid reimbursement for services provided to individuals in supportive housing.

And the winner is…everyone

Controlled trials conducted in the United States and Canada have found the majority of people who have had access to supportive housing remain housed for a year or more, showing greater housing stability than that among comparison subjects. In addition, individuals in supportive housing not only stayed longer but also had a reduction in subsequent homelessness and decreased use of emergency departments and hospitals.

Cost offset studies show that supportive housing leads to less use of costly public services.

A landmark analysis of administrative data from multiple public service systems examined the impact of supportive housing placement on 4,679 individuals and their use of the public shelter system, public and private hospitals, and correctional facilities. The study found that persons placed in supportive housing experienced significant reductions in use of homeless shelters, hospitals and time incarcerated. In fact, public service cost reductions following housing placement nearly offset the cost of the housing itself.

Significantly, supportive housing is nearly half the average cost per year of $35,578 for a chronically homeless person. Part of the reason is that stable housing resulted in a shift in service use from expensive crisis services to less costly community-based care.

Strong and compelling evidence indicates that supportive housing is a “win-win” for both the homeless mentally ill and the holders of the public purse. It offers people with mental illness safe and adequate housing and greater access to treatment, essential elements in their recovery. And it can lead to greater cost-efficient use of public services.

Currently there are not nearly enough supportive housing units to house the thousands of individuals with severe mental illness who are currently unstably housed or are at risk of falling into homelessness.

It would not make economic sense to cut funding for a cost-effective intervention that provides a solution to homelessness. Rather, what we need now is the public will to bring supportive housing to scale so that the most fragile among us might achieve stable residence in the community. They, too, deserve the opportunity for personal fulfillment and involvement in mainstream society.

Carol Caton, Professor of Sociomedical Sciences (Psychiatry and Public Health), Columbia University Medical Center

This article was originally published on The Conversation. Read the original article.


An Activist’s Playbook: How to Influence Trump’s Cabinet and Policies

Sen. Jeff Sessions listens as then-Republican presidential candidate Donald Drumpf speaks, October 2016. AP Photo/ Evan Vucci, File
Sen. Jeff Sessions listens as then-Republican presidential candidate Donald Drumpf speaks, October 2016. AP Photo/ Evan Vucci, File

Sarah Snyder, American University School of International Service

As Donald Trump works to fill his cabinet, his choices have inspired considerable anxiety among his critics. Advocacy organizations such as the American Civil Liberties Union and Human Rights Watch have reacted with concern and outright objections, in particular to the nomination of Sen. Jeff Sessions as attorney general and Rep. Michael Pompeo to lead the Central Intelligence Agency.

They claim these appointments show that “Trump’s administration will threaten human rights protections.”

In 1980, Ronald Reagan’s election similarly raised widespread anxiety among human rights advocates. His nomination of Ernest W. Lefever to head the State Department’s Bureau of Human Rights and Humanitarian Affairs heightened their fears. Lefever had been a vocal critic of Jimmy Carter’s emphasis on human rights in U.S. foreign policy.

Lefever’s nomination elicited a groundswell of opposition among members of Congress, human rights activists and the public that helped defeat his nomination.

My research shows how this coalition succeeded. Its efforts could serve as a model for concerned activists today.

‘Outspoken apologist’

President Jimmy Carter shakes hands with Republican candidate Ronald Reagan after debating in 1980.
AP Photo/Madeline Drexler, File

During the campaign, Reagan and his aides had criticized elements of Carter’s human rights policy. They charged that Carter’s criticisms of repressive governments threatened U.S. national interests without meaningfully improving human rights. Such criticisms raised expectations that the Reagan administration would decrease the prominence of human rights in its foreign policy. At the outset of his presidency, Reagan’s aides suggested he would emphasize spreading democracy and defeating terrorism, rather than championing human rights.

In February 1981, the administration nominated Lefever, confirming these suspicions.

Opposition to the nominee was driven by policy differences, doubts about his qualifications for the role and concerns about his cultural arrogance toward human rights abuses in Africa and Latin America. Extensive and contentious congressional hearings followed, which undermined Lefever’s candidacy.

Lefever had a record of questioning the relevance of human rights to U.S. policy. An editorial in The Nation pointed out, “He is an outspoken apologist for the barbarous practices of right-wing dictatorships.”

In the 1970s, Congress had played a leading role in U.S. human rights policy. Many members of Congress interpreted Lefever’s criticisms of Carter’s policy as opposition to their own efforts. As a result, there was also some rivalry between the executive and legislative branches during Lefever’s confirmation hearings.

Members of Congress who resisted Lefever’s nomination believed he opposed human rights legislation, public support for human rights and even the bureau to which he was nominated. Chair of the Senate Foreign Relations Committee Charles Percy, a Republican from Illinois, expressed doubt about Lefever’s commitment to human rights and personal integrity: “Concern for human rights is not just a policy of the United States. It is an underlying principle of our political system and a fundamental factor in the appeal of democracy to people throughout the world.”

They also expressed concerns about the candidate’s demeanor. Sen. Rudy Boschwitz, a Republican from Minnesota, said Lefever “lacks the diplomatic skills needed for the post.”

Not surprisingly, many in the human rights community also actively opposed Lefever. They made repeated trips to Washington to campaign against his confirmation. Some attended and testified at his confirmation hearings. Prominent human rights scholar Louis Henkin testified before the Senate committee, “I do not believe that this law can be faithfully executed by someone who thinks there should be no such law, who has been firmly opposed to it in its spirit and in every detail.”

Activists at Helsinki Watch, a precursor to Human Rights Watch, agreed. According to Aryeh Neir, “We thought it vital for the future of the human rights cause to defeat him.”

Reagan’s supporters argued that Reagan “has just won an election,” and therefore deserved to have his nominee confirmed, as columnist William Safire wrote. Yet, the committee voted 13 to four against Lefever – the first instance since 1959 that a president’s nominee had been rejected by a Senate committee.

New approach to human rights

In the wake of the defeated nomination, the White House worked to convey its concern about human rights to Congress, the American public and an international audience. To do so, the administration deliberately leaked parts of a State Department memorandum entitled “Reinvigoration of Human Rights Policy,” which stated, “human rights is at the core of our foreign policy.” In addition, it nominated a new candidate, Elliott Abrams, who garnered bipartisan support and a unanimous Senate confirmation.

After criticizing Carter’s policy on human rights during the 1980 campaign, Reagan and his aides had indicated that they wanted to transform U.S. policy once in office. Reagan may have been able to accomplish such a change through an evolutionary process, but observers viewed his selection of Lefever as extremist.

The efforts of members of Congress, human rights activists and the public prevented Lefever’s confirmation and ensured that human rights remained a rhetorical and substantive element of U.S. foreign policy in the years that followed. Members of Congress and concerned citizens can play a similar role in shaping the new president’s policies in the months to come.

The Conversation

Sarah Snyder, Associate Professor, American University School of International Service

This article was originally published on The Conversation. Read the original article.