Recovery From Schizophrenia: Psychiatry And Political Economy

278 DESEGREGATING SCHIZOPHRENIAmay be required. Group homes with varying levels of supervision are common inEurope and the US. 21 In the Boulder supervised living program, staff members holdhouse meetings for the residents at least once weekly in their apartments andprovide individual outpatient counseling in addition. Help with householdmanagement often includes sorting out problems with “crashers”—initiallywelcome guests who end up exploiting the residents or stealing from them. Theadvantage of such group living is that it offers a substitute family to clients whomay have difficulties in setting up a stable family of their own or in living withtheir parents. Achieving amiable domestic relations, however, may require theresidential staff to arbitrate disputes.For many people with schizophrenia, living alone is the best arrangement-thestresses of cooperative living may provoke relapse; others find loneliness to be amajor problem. Supervised living situations in Boulder range in size fromapartment buildings with one- or two-person apartments and a staff memberpresent for a few hours a day to six-person households with round-the-clock staff.At some of the living situations people with mental illness are hired to providesupervision. The larger, better-staffed living situations can accommodate clientswho have more limited capacity for independent living. By supplying increasingamounts of staff support on the premises it is possible to develop a range ofcommunity living arrangements for clients with progressively lower levels offunctioning.In high-rent Boulder, some form of rent subsidy is necessary for clients whomust often exist on limited Social Security income. Such financial assistance isavailable through the federal Department of Housing and Urban Development,either as direct rent subsidies or as grants to mental health agencies to build or buynew accommodation. In some instances, the center operates as a tenant,subleasing the house or apartment to the residents.RESIDENTIAL SETTINGS BASED ON MUTUALSUPPORTSome residential settings provide security and support for the residents bydeveloping a strong sense of community and employing the tenants in staffpositions. An interesting cooperative housing project of this type, ColumbiaUniversity Community Services, operates five apartment buildings on the UpperWest Side of Manhattan for mentally ill and mentally healthy poor people. In thisproject, a private non-profit housing corporation owns the buildings (obtainedcheaply from the city of New York), the mental health agency at ColumbiaUniversity provides treatment and practical assistance (case management) to alltenants, and a board composed of residents, mental health staff and representativesof the landlord screens potential tenants and manages the day-to day operations ofthe building. Some tenants are given paid jobs on the 24-hour-a-day “tenantpatrol” which provides security and assistance to the residents. 22