Chairman Hogan and members of the President's New Freedom Initiative Commission on Mental Health Services, I am pleased to offer this testimony on behalf of the National Alliance for the Mentally Ill (NAMI). I am Carla Jacobs, of Tustin, CA and I currently serve on the national Board of Directors of NAMI. As you know, NAMI's national President, Jim McNulty, provided comprehensive and detailed testimony to this Commission at its meeting on July 18, 2002. This statement covered the broad range of issues and concerns within the Commission's jurisdiction related to public sector mental illness treatment services. The testimony I am offering today on behalf of NAMI is intended to concentrate on the issues of housing and homelessness - the major focus of the Commission's current meeting.
The Commission's Interim Report
At the outset, I would like to offer NAMI's congratulations on release for the Commission's Interim Report on November 1. In NAMI's view, this Interim Report represents an extremely coherent and sound statement of the current state of the public mental health system in our country. It defines critical problems that are facing the nation's public mental health system and confirms the fact that after three decades of broken promises, the system is worse than many policymakers across the country have ever imagined. This is especially troubling for NAMI given that the knowledge and tools for recovery from mental illness are available right now.
As the Interim Report recognizes, treatment works and real recovery is possible. However, because of a fragmented treatment system and inadequate adoption of evidence-based practices, millions of Americans are condemned to isolation, neglect and despair. This Interim Report can and should serve to guide and inform the final report and recommendations that you will be making to the President next year. As our nation's largest organization representing individuals with severe mental illness and their families, NAMI looks forward working with this Commission to ensure that the final report is as strong as possible in guiding the major reforms that are needed to fix our failing public mental health system.
The Need to Focus on Housing
NAMI is pleased that the Commission has come to California and we are especially grateful that this meeting has included such a heavy focus on the issues of housing and homelessness. Earlier this week you toured several housing developments and programs that are specifically geared to serving adult consumers with severe mental illnesses and co-occurring substance abuse disorders. You have seen first-hand how critical access to decent, safe and affordable housing is to the recovery process. The reality is that without access to housing and housing related supports, recovery from mental illness is nearly impossible to achieve. All of the major elements of recovery - access to evidence-based treatment, community supports, family and peer relationships, employment, independence and full integration into community life - collapse without a stable housing environment.
We are well aware of this reality in Southern California. The people of Southern California are better educated about this reality thanks to the outstanding work of the Los Angeles Times editorial board and its 2001 Pulitzer Prize winning writer Alex Raskin. His landmark series of editorials in the Times on chronic homelessness and mental illness has been a major factor in shifting the debate here in California towards solutions aimed at ending homelessness and addressing the failures of our public mental health system. NAMI would like to urge the Commission to review all of these editorials that have already been recognized with the highest honor in journalism. See: http://www.latimes.com/news/opinion/.
In recent years, we have seen a number of reforms undertaken in California. Over the past decade, The Homes for Life Foundation has developed hundreds of permanent supportive housing units for formerly homeless people with mental illness. Most recently, the California legislature and Governor Davis have taken key to address access to mental illness treatment services, chronic homelessness and the burden being imposed on our criminal justice system. First, last year the state allocated more than $55 million in funding for mental illness treatment services for people experiencing chronic homelessness as part of the AB 2034 program. In addition, this year the legislature passed, and Governor Davis signed legislation (AB 1425) to foster provision of services in supportive housing programs.
Finally, this year the legislature (through the leadership of Assemblywoman Helen Thomson) passed legislation - known as "Laura's Law" - to allow counties to develop programs to expand access to treatment for individuals with the most severe and disabling mental illnesses that do not come voluntarily to services. We are making progress in California in addressing homelessness and mental illness as a result of increased collaboration between diverse stakeholders - homeless advocates, mental health advocates, leaders in the criminal justice field and (most importantly) leading newspapers in our state that have drawn public attention to this critical state priority.
Housing: A Major NAMI Priority
Let me now turn to some of the major issues related to housing and homelessness that NAMI believes this Commission must focus on. In recent surveys of the NAMI membership and NAMI state leaders, housing has emerged as a top policy priority, second only to state level funding of adult mental illness treatment system. Why? The answers are obvious. For many consumers and families, getting access to decent, safe and affordable housing is the single most difficult struggle. Further, for many NAMI family members (especially aging parents), housing stability for their ill family member is their number one anxiety. They understand that stable housing is the foundation upon which long-term recovery is built.
NAMI believes that the problems and concerns around access to housing for consumers can be organized around 4 major themes:
Problems & Issues for the Commission to Recognize
As this Commission has already learned, housing is a complex issue and the affordable housing system is a complex web of agencies and funding streams for which accountability and dollars are widely dispersed - from HUD at the federal level, to state housing finance agencies, to public housing authorities, to local non-profit agencies, and finally to individual landlords and tenants. It is a system just as complex as our public mental health system that this Commission has been examining. It is also a system that has a relatively poor record in serving individuals with severe mental illness.
As this Commission moves forward in examining the issues of housing and homelessness, NAMI believes that there are major challenges that the must be faced head on:
Recommendations for the Commission
While alleviating poverty for all non-elderly adults with severe mental illnesses is far beyond the scope of the Commission's mandate, there are several concrete steps that can be made by HUD to address the affordable housing crisis for non-elderly adults with severe mental illnesses whose sole income support is SSI cash benefits. Most important among these is to ensure that existing HUD programs are better targeted to individuals living on SSI at the state and local level. As part of this effort, NAMI and its colleague organization in the mental retardation field, the Arc of the United States, are moving forward on a program to education and train our affiliates in how to more effectively participate in the affordable housing planning processes that HUD requires of states and localities. In order to advance this process, NAMI urges this Commission to recommend that the President:
2) Discrimination, NIMBYism & Lack of Attention from the Affordable Housing System
Discrimination in housing for individuals with mental illness remains a major barrier to housing. Since the 1988 amendments to the Fair Housing Act, discrimination against people with mental illness in housing has been illegal. However, many NAMI members know from personal experience that stigma and discrimination are still huge obstacles - from landlords that simply refuse to rent to tenants with a history of mental illness, to communities that organize against congregate housing in residential neighborhoods. Moreover, NAMI still sees significant discrimination in federal programs that allow local housing providers to restrict tenancy based on disability or simply limit eligibility for supportive services that are needed to allow a consumer to retain their housing. NAMI would therefore recommend the following steps for this Commission to consider:
3) Keeping Current Resources
While NAMI supports increased federal, state and local funding for affordable housing programs, we also recognize that the return of budget deficits at the federal level and significant revenue shortfalls at the state level make such expectations unrealistic for the immediate future. At the same time, NAMI believes that there is much that this Commission can do to ensure that those housing resources that are now directed toward people with mental illness are preserved and remain focused on high priority needs. NAMI would therefore urge that the Commission:
4) Public Mental Health System and Housing Retention
Much of NAMI's testimony has focused on what the affordable housing system can do to better serve people with mental illness. At the same time, NAMI believes that there is much the public mental health system can do to more effectively work with the housing system. The reality is that just getting someone access to housing is the easy part. The bigger challenge is helping a consumer retain that same housing over the long-term. Just as every acute episode of psychosis or mania complicates long-term recovery, every eviction leaves a consumer with a more difficult struggle to get back to stable housing.
The reality is that most individuals with severe and persistent mental illness need housing-related support services that are personalized and flexible in order to meet the obligations of a lease. Further, NAMI believes that there needs to be a continuum of housing options available at the community level - from congregate and supervised housing, all the way to independent apartments. It is critically important that the public mental health system be held accountable for making services accessible in all the full range of residential settings so that consumers can retain their housing on a long-term basis. Finally, NAMI believes that tenants with mental illness should not be discriminated against in housing based upon their status in the mental health system, i.e. individuals receiving treatment on an involuntary basis should not be ineligible for housing programs.
In order to further these goals NAMI urges this Commission to take the following steps:
Chairman Hogan and members of the President's New Freedom Initiative Commission on Mental Health Services, NAMI appreciates the opportunity to offer our views on this important issue.