A view from managed behavioral health.

Abstract

people who have serious mental illnesses. We learned many years ago in the community mental health center movement that getting people out of institutions is easier than keeping them out, and if they are to be kept out, they need to be provided with the services and supports necessary for a decent life. The paucity of supportive low-cost housing, which was exacerbated by the housing policies of the Reagan Administration, has been a serious problem for a long time. To those of us in managed behavioral health care, it is apparent that the lack of such housing is a significant contributor to the rehospitalization of people who could otherwise be maintained in the community. It is bad treatment and bad economics. Failure to adhere to a medication regimen is a major factor in rehospitalization and is much more likely when the living environment outside the hospital does not reinforce the need to do so. In the important area of housing, I am afraid that the Commission’s recommendations fall short of what is needed. Nowhere in the report is the Commission’s lack of freedom to recommend anything that would cost money more evident. In this context, the term “New Freedom” in the Commission’s name is ironic. Where will the “150,000 units of permanent supportive housing” that the report recommends come from? No amount of “collaboration” or “transformation” or reduced “fragmentation” (popular words in the report) or, for that matter, “enhanced access” to something that does not exist will produce more low-cost supportive housing. There is no doubt that the Commissioners understand this, and there is also no doubt that more housing for people who are seriously mentally ill will cost money— a lot of it. But the report does not say so, nor does it recommend allocating any additional funds for the 150,000 needed housing units. Without adequate housing, how likely is it that one of the report’s important recommendations—to “end unnecessary institutionalizations”—will be accomplished?