According to the Johns Hopkins Institute for Policy Studies, “among studies of psychiatric inpatients, one consistent finding is that the greatest risk of homelessness occurs immediately following hospital discharge.
“Thus, if homelessness is to be prevented among this group of the SMI population, hospital discharge planning must include explicit housing arrangements and service supports that will be available to the individual as he or she re-enters the community.”
Consistency and diversity of the severely mentally ill (SMI) population require a range of housing and service options. Policy should encourage interventions that can be tailored to individual needs, as people with mental illness are individuals, at the very least. There must be continuity of care due to the unpredictability of illness episodes. Case management is the way to go with this issue. Housing and services must be linked, as neither alone is sufficient.
The cost of keeping one person with SMI in a nursing home per year is around $88,000. It has been estimated that to support a person with mental illness in the community would cost, on average, $44,000.
A solution to this would be to convert abandoned hotels, larger school or office buildings into housing in the Hartford area. This would help reduce urban blight that one cannot miss driving through the metropolitan area.
The problem of urban decay is not new. Like many other urban centers, Because of shifts in population, the economy, poverty and declining political influence, Hartford is struggling with urban blight and its associated problems, including crime, the decrease of economic opportunities, unsafe public spaces, drug problems, etc.
Correction of this problem requires that there be a positive interaction between an economic upswing and controlled social behaviors on the one hand, and a city’s physical infrastructure on the other. Combining the needs of the SMI population and slowing down the progression of urban blight could be mutually beneficial.
As a registered nurse who has been transitioning people with severe mental illness into the Greater Hartford community from nursing homes for the past two years, I suggest these steps:
* We need a building that can house as many people as possible in private and semi-private apartments. Think old hotels, apartment building and school buildings;
* We need an expansion of the HUD Shelter Plus Care Program to support the renovation, construction, updating, retrofitting, cleaning and accessibility-adding part of this task;
* We need a band of roving case managers and other mental health professionals to scour the streets, nursing homes, hospitals, shelters to talk to individuals and assess them, and to attempt to meet their needs in a meaningful way;
* We need a safe, beautiful place that is social model-based vs. medical model based, that will provide programs that will address the biggest problems that people with SMI face when trying to live independently: medication management, maintenance of mental and physical health, cooking, home maintenance, hygiene and social safety;
* We need a place that will be accepted into the community for its safety, service and beauty.
We need to use the boarded up buildings and bring a community back to life for everyone who lives there, a place that will protect some of their compromised citizens and encourage them to live a meaningful life.