Housing Options for Individuals Living with Mental Illness: Can the Board and Care System Survive?
September 12, 2016
I have learned a lot about the systems that exist to help and house people suffering from mental illness by my friendship with a man who suffers from schizophrenia. Up until we met in 2008, he was homeless off and on for most of his life. Since that time, he has had many experiences – SRO hotel, county jail, psychiatric hospitals, IMD (Institute for Mental Disease) facility, “step-down” facility, Full Service Partnership (FSP) and now a Hollywood board and care home. Our Hollywood 4WRD Top 14 team has been following individuals like my friend on their journey from the street to the hospital, to locked residential facilities (until stabilized) and then into the board and care system. We have been trying to understand why it is so hard to seek help for people with severe mental illness, and why they often end up back on the street again. It’s complicated.
One piece of this puzzle involves the board and care system. I sat in the sunny courtyard of the Hollywood board and care home recently, visiting with my friend. Over the course of the hour, about a dozen of the 64 residents walked out into the courtyard to smoke a cigarette or drink a Big Gulp from the local 7-11. My heart was heavy with the sense of loneliness that prevailed.
I introduced myself to one woman and she started crying when she told me her son and his wife have moved back east and she doesn’t know when she will see him again. Another young man said his mother had moved him out of a board and care in San Diego because she thought this one was better for him. He wished he could get a job, but he didn’t see how that was possible, given his illness. My friend has become pals with a woman in her early 50’s who tells me she suffers from schizoaffective disorder and paranoia. She used to sell tours for one of the tour companies on Hollywood Boulevard.
These board and care homes represent a precious housing resource for individuals living with mental illness. However, with all the talk about providing housing for people with mental illness, no one seems to be talking about the board and care system. Why is this? I don’t have all the answers yet, but I have some clues:
- Even though someone might have been chronically homeless for decades, if they spend time in a facility or institution (e.g., incarcerated for more than 90 days or in an IMD facility — Institute for Mental Disease), they will no longer be characterized as “chronically homeless,” thus rendering them ineligible for permanent supportive housing (PSH). Permanent supportive housing is the “housing first” destination for someone moving directly from the street into an apartment with supportive services – but people who fall into the category of Hollywood’s Top 14 are too ill to move directly into permanent supportive housing.
- Even if the rules regarding the “chronically homeless” requirement for PSH were to be changed, it is doubtful that most severely mentally ill individuals we see on the streets of Hollywood could live with even that much independence. As we have observed some of our Hollywood people move off the street, I am not sure that any of them are capable of purchasing food and making their own meals. A board and care provides this type of service (and laundry) and may be the best option available.
- The traditional “teams” associated with permanent supportive housing (nonprofit housing developers, property managers, service providers) do not appear to be involved in the board and care system. I have not yet seen any evidence of overlap – yet I would argue that both systems are options for formerly homeless people living with mental illness.
Finally – a stunning reality that is coming to light is that the board and care system in Los Angeles County – a safety net which prevents homelessness for those disabled by their mental illness – is in danger of collapsing under a non-sustainable financial model. What I am learning, as I dive deeper into this industry, is that the meager $35 a day that board and care operators are paid to provide a basket of essential life services – safe and clean housing, three meals a day plus snacks, laundry and bedding, medication management, personal funds disbursement, 24 hour care and supervision, and compliance with a host of regulations and paperwork – is woefully inadequate.
My understanding is that the Department of Mental Health is working to develop an inventory of such beds in LA County, which would be important information for us to have to ascertain whether this important inventory is shrinking or expanding, in the face of such obvious need given the number of people suffering from mental illness who are homeless in the county. And appreciation is owed to Supervisor Sheila Kuehl, whose staff is on a learning curve and taking this issue seriously as well.
We’ve all seen evidence of the devastating impact of untreated mental illness as we see people struggle to survive on our streets. It’s a helpless feeling. Injecting financial and community support into the board and care system in Los Angeles county may be one key to reverse this trend.
Kerry Morrison is executive director of the Hollywood Property Owners Alliance. She serves on the United Way/LA Area Chamber Home For Good Task Force and blogs at www.onlyinhollywood.org. @KerryHMorrison