Permanent supportive housing is defined as housing coupled with supportive services. Research and experience have shown that stable housing is essential for success at rehabilitation, therapy, and recovery.
In fact, Permanent Supportive Housing is considered the gold standard for ending homelessness among people with severe mental illness.
Most of us wouldn’t describe rental housing as permanent even if we choose that arrangement for years and years. A tenant and landlord sign a lease stating the rights and responsibilities of each party. If tenants follow the lease they can remain in the rented home as long as they like. Unless they violate those terms the landlord is very limited in his or her ability to evict the tenant.
It has a different meaning for homeless service providers. Yes, it follows the standard lease. The supportive part means the housing links tenants to flexible, voluntary support services designed to help the tenants stay housed. According to the model, that is how people who are most troubled build the necessary skills to live as independently as possible.
People who are homeless are just as varied as people who are not; the only commonality among them is a profound lack of support. Sometimes they’ve come from a background of family support and have lost it because mental illness and substance abuse damaged their relationships. More often, they never had that support to begin with.
Consider the children whose family life is so dangerous or unhealthy they are better off in a foster home, a place where they go lacking any ties to others living in the house. Eventually they may build trusting relationships, but data shows adults who were raised in foster care are much more likely to become homeless later.
Victims of domestic violence are cut off from anyone who might provide the support they need to escape. Even in this day and age there are parents who literally throw out a child who reveals he or she is gay.
The support in “supportive housing” is a medical service. Case managers at social service or health agencies generally are responsible for delivering services that meet Medicaid’s definition of medical necessity. And those services are needed; case managers may help clients get their housing, food stamps and medicine. The field is full of well-intentioned people who strive to help their clients recover and live a decent life, as long as those services can be billed to Medicaid, Medicare or another insurance provider.
Insurance is not known for the warm and fuzzy side of care. It won’t pay for someone to remember our birthday or take care of a pet when we’re in the hospital. Nor will it pay for someone to visit when we’re lonely. Medicaid does not think it’s medically necessary for someone to treat us with respect and dignity even if we are poor and homeless. It doesn’t pay for a hug.
These are human needs as much as adequate food or heat in the winter. These are the things that motivate us to quit drinking, stay out of trouble and risk feeling hope for a good future. Good permanent supportive housing lays the foundation for ending the misery of homelessness. A society with a conscience must make sure people have a decent place to sleep at night.
Let’s not confuse the support people get because Medicaid will pay for it as everything they need. We must connect with our clients as people who need a get well card as much as they need medicine if we want to see true recovery.