CLINICAL HANDBOOK OF SCHIZOPHRENIA

29. Supported Housing 295in mainstream housing. Instead, people are housed in their own apartments, directly offthe street or out of shelters. They are served with a modified assertive community treatment(ACT) case management program. Outcomes indicate that 88% of participants remainstably housed at 5 years. This program is being replicated in hundreds of sitesaround the country.One challenge in the provision of supported housing concerns the problem of lonelinessand social isolation. A few researchers examining social connectedness have identifiedsocial isolation as a pitfall of scattered-site housing approaches. Others have foundsocial isolation to be a general problem among people with psychiatric disabilities; lonelinesshas been found to be a common experience among those living in a variety of otherhousing options, including shared housing and congregate residential facilities. Nonetheless,there is clearly a need to address development of an adequate social support networkand meaningful community connections as one important aspect of helping people withserious psychiatric disabilities achieve successful community integration.SUPPORTED HOUSING AND SOCIAL POLICYSupported housing advances several important social goals, such as the community integrationmandate under Olmstead v. L. C. (119 S. Ct. 2176, 1999) Supreme Court decision,and goals that promote the development of consumer-directed care and meet the unmetneed for housing that were identified in a variety of Federal Task Force reports andthe President’s New Freedom Commission. This approach also serves to fulfill the currentmission statement of the Federal Center for Mental Health Services (CMHS) “to ensure ahome and a life in the community for everyone” with psychiatric disabilities.Supported housing advances the doctrines of least restrictive alternative, or most integratedsetting, and nondiscrimination as exemplified in Olmstead. The case concernsthe right of the class of mentally disabled persons to live in the most integrated and leastrestrictive setting that appropriately meets their needs, rather than being held unnecessarilyin socially segregated environments. The Supreme Court ruled that unnecessary socialsegregation of people with mental disabilities constitutes discrimination under the Americanswith Disabilities Act, and further, that institutional life perpetuates unwarrantedassumptions about people with disabilities and curtails everyday life activities, such asfamily relationships, social contacts, work, educational advancement, and cultural enrichment.The argument that a state lacks sufficient resources to provide communitybasedalternatives was found to be an inadequate defense or justification of prolongedinstitutionalization. The Court found that states must have some means to demonstratenondiscrimination to protect themselves from legal action. States must develop specificmeans, such as having an effective working plan, to create a range of alternatives for thecare and treatment of individuals with mental disabilities, and must demonstrate throughsome means, such as a waiting list that moves at a reasonable pace, that people who areunnecessarily institutionalized are moving into less restrictive settings in an equitablemanner.Each state is required to involve consumers and families in developing a stateOlmstead plan; to prevent future unwarranted institutionalization and social segregation;to ensure the availability of a range of alternative services that will end social segregationand integrate people with mental disabilities into the community; and to assist peoplewith disabilities to make informed choices about how their needs can best be met. Althoughthe Olmstead case does not speak directly to the issue of homelessness, it can reasonablybe argued that supported housing sharply reduces the use of more restrictive institutional