Mr. Finley’s response is very accurate relative to the value (both direct and indirect) of the supportive case management services that are provided in a PSH. This kind of therapeutic, clinically based relationship is essential to the “success” in empowering individuals to move from the streets to a place of their own and their ability to sustain and maintain their own place.

The issue of a resident “refusing their medications” is both a troublesome and trying dilemma for all concerned. Folks who refuse their meds diminish their quality of life and the community is affected by that diminishment. Forced treatment can become a protracted and legal entanglement. The community is faced with this kind of issue regardless. Until we as a community (local and national) make a more intentional effort to both acknowledge and provide behavioral health care, we will always be faced with the issues that Mr. Proctor raises. However, I do think and am confident that Permanent Supportive Housing is a positive response and step to the issues raised by Mr. Procter.

The ability to have a clean, safe and permanent supportive living environment enhances both the opportunity and ability for a chronically homeless individual to reclaim their full life. The presence of case management services is one way the community can insure that proactive therapeutic conversations and need interventions are on-going and possible. Far too often, we only end up “reacting” to situations that are disturbing. PSH is a constructive, effective and a proactive solution. A total solution? Maybe not just yet. A good and measurable step towards healing and ending chronic homelessness? Absolutely.

Let me start with this observation: there are already a lot of people who are mentally ill who live in all parts of our community. Most of them are housed, and some are homeless. They have a variety of illnesses, and many are untreated. Those who are in treatment have a variety of treatment protocols. Lots of them are on medication for their illness, and sometimes they go off their meds. Relatively few of them have a relationship with a knowledgeable mental healthcare service provider that’s anywhere near as intensive as the relationship between a permanent supportive housing resident and his or her case manager. That’s a good thing to keep in mind.

Every resident in permanent supportive housing (PSH) will have a relationship with a case manager. Case managers are trained (they’re social workers) to engage with people who are mentally ill, and it’s their job to do that. The relationships they have with their clients allow them to anticipate problems and deal with them before they become critical.

Hypothetical: If a PSH resident goes off her meds, her case manager will know that before anyone else does, and will be responsible for addressing it. The case manager will see signs like deteriorating personal hygiene, disorganized behavior, poor care of living space, etc. The case manager cannot force the client to take her meds, but her case manager is in the best position to intervene and persuade her that it’s in her best interest to get back on them. That kind of conversation between a case manager and a client is not unusual, and the usual outcome is successful: the client gets back on her meds, stays housed, and the relationship continues.

Another key thing to remember is that residents of PSH really want to be in housing. They’ve made a commitment to leave the streets, and they don’t want to go back. Residents who do not comply with their treatment protocols will not be capable of staying in housing. That’s a huge incentive to them to work with their case managers and do what they need to do to stay housed. Some residents do fail. Close to 90% stay housed. PSH is not a perfect strategy, but it works better than any other approach we know about.

What happens when someone fails to stay housed? Many times they return to the streets and are subsequently re-housed. That does happen sometimes. I can’t speak authoritatively to the civil liability issue, but what happens when someone becomes a real threat to safety? Well, what happens when a person who is mentally ill and who’s not in PSH becomes a threat to safety? Doesn’t that usually become a law enforcement issue? Nobody can guarantee that that sort of thing will never occur. What we can do is put systems in place to ensure that it’s rare. Very rare. That’s our aim.

We believe neighbors will play an important and positive role in helping PSH residents succeed in the community. We are encouraging a positive conversation in our community about what it means for each permanent supportive housing development to be a good neighbor in the specific community in which it is located, and what it means for residents of those communities to be good neighbors to residents of permanent supportive housing developments. That’s what the meeting on March 30 is about.

I hope I’ve been helpful. Please let me know if there’s anything else you’d like to know.