CLINICAL HANDBOOK OF SCHIZOPHRENIA

296 IV. PSYCHOSOCIAL TREATMENTsettings, hospitals, and jails, and is therefore an effective less restrictive alternative.Olmstead also demands avoidance of future unnecessary institutionalization among thosenot previously institutionalized.The National Association of State Mental Health Program Directors (NASMHPD;1989) has had a supported housing policy for nearly 20 years. The initial policy stated:All people with long-term mental illness should be given the option to live in stable, affordable,and safe housing, in settings that maximize their ability to function independently.Housing options should not require time limits for moving to another housing option. Peopleshould not be required to change living situations or lose their place of residence if theyare hospitalized. People should be given the opportunity to actively participate in the selectionof their housing arrangements from among those living environments available to thegeneral public. Although public mental health systems need to exercise leadership in thehousing area, addressing housing and support needs is a shared responsibility and requirescoordination and negotiation of mutual roles of mental health authorities, public assistanceand housing authorities, the private sector, and consumers them selves.Necessary supports, including case management, on-site crisis intervention, and rehabilitationservices, should be available at appropriate levels and for as long as isneeded by persons with psychiatric disabilities regardless of their choice of living arrangements.Services should be flexible, individualized, and provided with attention topersonal dignity. Advocacy, community education and resource development should becontinuous.Several states have formal supported housing policies or housing assistance programsthat fund bridge rental subsidies that support people with psychiatric disabilities innormalized rental housing until they are able to attain a Federal rent subsidy. Researchshows that supported housing helps to balance the system of care, can be delivered at acost less than that of formal residential programs, and actually costs less than maintaininga person with a psychiatric disability in a state of homelessness.KEY POINTS• A large number of people with serious psychiatric disabilities are unnecessarily institutionalized,jailed, or homeless because they lack access to decent, affordable housing and supportiveservices.• There is no housing market in the United States in which a basic apartment is affordable toa person living on SSI.• Sense of home plays several crucial roles in achievement of positive mental health.• Supported housing is an important basis for effective treatment and turnaround to recovery.• Even people who have severe disabilities, severe problems in functioning, dual diagnoses,and those considered “most difficult to serve,” can be served successfully in supportedhousing.• Residential stability and life satisfaction markedly increase when people perceive they havechoices, and when their housing and support preferences are honored.• People with serious psychiatric disabilities can successfully live in the community if they aresupported adequately with a combination of housing assistance and individualized, intensive,flexible supportive services that change as their needs change.• Supported housing increase people’s community tenure and sharply reduce homelessness,use of psychiatric hospitals beds, and days in jail.• Best practice involves small caseloads, the capacity for frequent contacts, and the directprovision of supportive services in the person’s housing or other natural community setting.• Supported housing advances the social policy of community integration.