Moving Towards Home: Strategies for Ending Homelessness in Ten Years
City of Burlington, Vermont
February 2004

People are homeless because mental illness and/or substance abuse interferes with their ability to obtain and retain housing.

Two-thirds of the homeless surveyed nationally reported indicators of alcohol use, drug use and/or mental health problems. 

1996 National Survey of Homeless Assistance Providers and Clients, Interagency Council on the Homeless.

In the mid-1950s, "deinstitutionalization" began to shift responsibility for caring for those with severe mental illnesses from long-term residential stays in state mental hospitals to community mental health centers. However, the funds that were supposed to support community-based mental health care were never appropriated or were cut.[32]

• In 1971, the census at the Vermont State Hospital was 1,200. Today it is 50.[33]

Nonetheless, most deinstitutionalized mentally ill men and women avoided homelessness until the late 1970s - many by living in SRO units in low-cost hotels affordable on Supplemental Security Income (SSI) benefits. Then, low-cost SRO units began to disappear. Between 1960 and 1990, the number of people living in hotels and rooming houses who had no other permanent addresses dropped from 640,000 to 137,000. At the same time, housing costs rose dramatically - so that by 1990, a person would have had to spend their entire monthly SSI check on rent.[34]

• The problem got worse in the early 1980s, when the federal government instituted a policy of aggressively reviewing claims for disability benefits - with a resultant drop of almost 500,000 people from the SSI rolls. Although a class action suit resulted in back payments of SSI into a trust to develop permanent housing, many of those forced into homelessness were never found.[35]
• In 1995, Congress amended the Supplemental Security Income program to deny benefits to anyone whose drug and alcohol addiction is a "contributing factor material to" their disability. It's estimated that in the three years after the law took effect, over 100,000 people lost benefits as a result - including health care previously available through Medicaid.[36]

Today, an SSI check doesn't even cover rent. An SSI recipient in Vermont receives $604 monthly, while the Fair Market Rent for a one-bedroom unit is $638.[37]

Mental illness and chemical dependence frequently co-occur. However, treatment has historically been segregated - which means that many people do not receive the treatment they need.

• National data indicates that 47% of individuals with schizophrenia and 61% individuals with bi-polar disorder also have a substance abuse disorder. To receive needed treatment, individuals with co-occurring substance abuse and mental disorders must negotiate separate provider systems and only around 19% receive treatment for both disorders.[38]

For one local resident experiencing chronic homeless, the Fletcher Allen Hospital spent $12,600 over a two-week period in January of 2003. He could not be discharged - because both local shelters were full, and because of his mental health and medical needs. In contrast, the cost of providing him with housing and comprehensive outpatient supportive services is estimated to be $15,000 a year.

The public costs of allowing these citizens to be chronically homeless are high. Many will visit the emergency room at Fletcher Allen Hospital at least five times a year, at an estimated cost of $540 a visit. Each day's stay in the State Psychiatric Hospital costs $560. Police interventions average $200 per intervention, while incarceration in the correctional facility costs $1,000 per day.

In contrast, the costs to provide housing and comprehensive services to these residents is estimated at around $15,000 a year, or $41 a day.

The solution for many of these residents is supportive housing, which is housing linked to services (which may range from a resident case manager to more intensive onsite services). The experience of local providers is that the Shelter Plus Care model works very well, as do the Howard Center for Human Services' facilities funded with HUD 811, McKinney, Shelter Plus Care, and other programs.

• In Burlington, there are currently 71 permanent supportive housing units for people with mental disabilities. In Winooski, there are 7 units. There are none available in the rest of the county.
• There are also 67 affordable SRO units available in Burlington, and 27 in Winooski. There are no SRO units in the rest of the county.

For some, lifelong support may be required to prevent them becoming homeless again. Few people who have been chronically homeless because of a serious and persistent mental illness (with or without a co-existing substance dependency) are likely to ever generate livable earnings through wages. While they may have some income from wages and/or public benefits, many will require long term subsidization of both housing and services because of their disabilities.

There is not enough funding for supportive services. In order for any agency to take on more supportive housing, they would need to be assured of the continuity of funding for services - when developing a budget with 30-year debt obligations, the developer must be able to rely on the funding stream for services in order to ensure the long-term viability of the project.

• While there will be public savings over the long-term by providing adequate housing and supportive services for these citizens, we do not believe that needs can be met in the short, or even intermediate, term simply by shifting resources from existing programs. What is needed is a guaranteed funding stream dedicated to this purpose.

Services should be provided by well-trained, well-compensated professionals. Providing services to those suffering from mental illness and substance abuse can be difficult and challenging. Wages should not only be at a livable level, but should be sufficient to attract and retain high-quality staff.

Most chronically homeless families are single mothers with a history of childhood sexual abuse and adult stranger violence plus chronic major depression and/or substance abuse. 

Bassuk, E. L., Perloff, J. N. & Dawson, R., Multiply Homeless Families: The Insidious impact of Violence, Housing Policy Debate, 12(2) 299-320, 2001; Henry Cisneros, Searching for Home: Mentally Ill Homeless People in America, Cityscape, 155-172, U.S. Department of HUD, Office of Policy Development & Research, December 1996.

Families in which the head of household has a chronic and longstanding illness such as a substance abuse disorder and/or mental illness may require treatment (with housing for family members) followed by an intermediate level of supportive housing that has appropriate services attached.

Statutory/regulatory definitions of mental illness and disability often exclude those who need services. For example, those who are just above the defined "cutoff" for developmentally delayed, and those with mental illness that does not meet the criteria for "severe and persistent," often need supportive services to maintain stable living situations.

Providing a range of options, which allow for consumer choice, promotes residential stability.[39]

Page last updated April 19, 2004