Housing Concerns Loom Large for Patients

A number of families have anticipated future problems by establishing a special needs trust. This type of trust, which holds the title for the house, allows the adult child with mental illness to continue living in the parental home without losing eligibility for Supplemental Security Income and Medicaid. On the other hand, many families have not prepared, Sperling said. In addition, other issues arise, such as whether the child can maintain the house and keep up on property taxes and other financial obligations.

If a person lives in substandard housing, whether it is the result of a low-paying job or being unemployed, chances are they won't be receiving ongoing services, according to Wendi Cook, program coordinator for adult mental health services at the National Mental Health Association. Most often, the person is more concerned with being safe in the community, or staying warm or having enough to eat.

Consequently, when the person does receive services, often they are the most expensive kind, such as emergency department visits and incarceration, Cook told PT. And, once they get into the health care system, they usually end up in psychiatric institutions. This dynamic puts a financial strain on the entire system, from publicly funded programs to the clinicians and facilities that care for the patient.

If someone lives in substandard housing and a crisis occurs, most likely the person will eventually lose their home and end up on the street. At that point, it becomes a much larger community problem.

People with mental illness who are employed and receive private insurance are not immune from this. Most people are two paychecks away from homelessness, Cook said. An increase in insurance premiums, a layoff or a long-term crisis that affects employment can quickly push a private-sector patient into the public sector.

Policy changes currently being debated in Washington, D.C., might make that transition even more difficult. Currently, HUD's budget is set up so that a portion of its money goes to housing and a portion goes to services, Cook said. The goal is to get people into services that help them maintain housing.

However, the Bush administration is seeking to channel most HUD money toward housing, rather than services. In theory, those services would be picked up by the U.S. Department of Health and Human Services (HHS), but that does not appear to be happening, Cook said. People will receive housing but not the services that help keep them housed unless this issue is addressed. As budget proposals for 2004 make their way through Congress, mental health care advocates will be pushing for HHS to designate services for people in low-income housing who otherwise would have received service supports through HUD.

Regier has a patient with schizoaffective disorder who he has followed for 20 years. The patient was lucky to have parents with enough money to set him up with a condominium that was completely paid for before they died. He also has a healthy sibling who keeps track of him.