One of the benefits I have been most excited about since joining PRA in September 2017 is the professional development benefit. Each employee has the opportunity to attend a professional conference of interest to the individual employee once a year for the purpose of enhancing their professional development. On April 9, I flew to Denver, Colorado to attend the 2018 Housing First Partners Conference (HFPC) presented by the Downtown Emergency Service Center (DESC) and Pathways Housing First Institute from April 10 to April 12.
In my work on the communications team for SAMHSA’s GAINS Center, I had the opportunity in December of last year to contribute to a GAINS Center eNewsletter article on innovative funding mechanisms for behavioral health and criminal justice reform, which highlighted Denver’s Social Impact Bond and the Colorado Coalition for the Homeless (CCH). I arrived in time to take a tour of CCH’s Stout Street Health Center and adjacent housing. One of the adjacent housing properties was paid for through Denver’s Social Impact Bond, and I was eager to see this fully funded housing program in person.
During my tour, I observed that CCH’s health center facilities are state-of-the-art, and provide the full breadth of health services a person could need, including pharmacy, medical, mental health, substance use, dental, and vision services. The apartments I toured were modern, spacious, and comfortable, bearing no resemblance to the now run-down project-based housing of the 1970s and 80s. My tour guide informed me that the project is based in a part of Denver that is a hub of services for people experiencing homelessness.
Seeing CCH’s housing project and health center brought to my mind a recent conversation with a Peer Specialist I met through my work with PRA. This individual was providing feedback from the consumer perspective on a local health center in his community. The health center he described, like the CCH health center, serves Medicaid and Medicare recipients living with serious mental illness. Like the CCH health center, it integrates behavioral health, physical health, and pharmacy services. Yet in the eyes of this Peer Specialist, despite improving access to health services in his community, this setting is not conducive to recovery and community integration. In the facility he described, people walking through the doors see a pharmacy immediately upon entering. Everyone who is going to the health center for care is a Medicaid or Medicare recipient, meaning they have extremely low income. The affiliated housing program, he described, has a plaque identifying it as part of a project to end homelessness. One can see how such a configuration promotes an almost institutionalized system of care, as opposed to one that connects individuals to mainstream services, helps people locate housing in mixed-income neighborhoods, and promotes upward economic mobility.
The field faces an urgent need to address the medical and behavioral health needs of people experiencing homelessness. People living with serious mental illness live a conservatively estimated 10 years less than the general population, a fact largely attributed to problems with access to healthcare and with social determinants of health, such as housing and employment (Walker, McGee, and Druss, 2015).
As we seek solutions to the public health crisis of disparities in mortality rates and the crisis of homelessness, it’s essential to consider whether we are perpetuating the cycle of poverty by continuing to physically segregate people by mental health status, socioeconomic status, and use of entitlements, such as Medicaid, Medicare, and the Social Security disability program.
Like many cities in the United States and around the world, Denver is seeing the cost of housing increase, with any increase in wages being insufficient to keep up. According to a recent report from the National Low Income Housing Coalition (one of the presenters at the HFPC), the Denver-Aurora-Lakewood area has a deficit of 61,066 affordable and available units for people who are living at or below the extremely low-income threshold (National Low Income Housing Coalition, 2018). This deficit reflects a crisis that cannot be resolved solely through the efforts of homeless service providers and policies that target people experiencing chronic homelessness:
Nationally, a worker earning the federal minimum wage needs to work an average of 94.5 hours per week (more than 2.3 full-time jobs) to afford a modest one-bedroom apartment….Extremely low-income renter households with severe cost burdens are disproportionately Hispanic and black (National Low Income Housing Coalition, 2018)
Clearly, many Americans are living on the verge of homelessness due to the cost of housing and low minimum wages.
The HFPC offered about 158 workshops across 50-minute simultaneous sessions each day. Some of the trends in topics I observed across the workshops were the sustainability of housing programs (Medicaid/Managed Care Organizations/mergers and affiliations); reports of outcomes from programs (health outcomes, cost-savings); deep dives into clinical topics within the Housing First model (harm reduction, motivational interviewing, supported employment); and solutions to homelessness through the creation of affordable housing.
The conference was an ambitious effort to engage not only with the Housing First model, but also with the larger root causes of homelessness. Housing First is an evidence-based practice created to increase housing stability among a small slice of the entire population of people experiencing homelessness. Yet providers and partners who are invested in ending homelessness for everyone must confront the larger issues of housing affordability; wage and income inequities across race, gender, and disability status; and the geographic segregation of marginalized groups. This social justice perspective must be at the front of our minds if we hope not to repeat our mistakes as we try to solve the public health crises that have been with us for generations.
As I was riding the light rail back to the Denver airport, I received a text from a co-worker at PRA that could not have been better timed. This year, for the second time, PRA has been awarded the Times Union “Top Workplace” for small businesses. The opportunity to attend the Housing First Partners Conference, to reflect on the experience, and to share my thoughts with my colleagues here on the PRA blog all exemplify what makes PRA such a great place to work.
National Low Income Housing Coalition (2018). The gap: A shortage of affordable homes. Retrieved from http://nlihc.org/sites/default/files/gap/Gap-Report_2018.pdf
Walker, E.R., McGee, R.E, and Druss, B.G. (2015). Mortality in mental disorders and global disease burden implications: A systematic review and meta-analysis. JAMA Psychiatry, 72(4): 334-341. doi:10.1001/jamapsychiatry.2014.2502.