What We Do
MHSA is a non-profit public policy advocacy organization that serves as the leading voice in the Commonwealth calling for an end to homelessness. Along with our 88 member agencies, we educate about the plight of homeless people; advocate for the strategic use of public dollars based on research and best practices; innovate approaches and technologies that provide more effective and cost-effective solutions to homelessness; and collaborate with all levels of government and the private sector to engage the public imagination in the effort to end homelessness.
Areas, Approaches and Current Initiatives
Massachusetts has reacted to homelessness with an emergency response for more than 20 years. While shelters and homeless services have indeed saved lives, it is time to move beyond this emergency response and move toward a permanent solution. Policy and resources at the federal level and practices at local levels dictate a new direction in tackling the problem of homelessness. While shelters have provided a safety net, they have not achieved outcomes that actually fix the problem of homelessness. MHSA believes that a transition to providing housing rather than temporary shelter is in the best interest of homeless individuals, government and society.
Chronic Homelessness
The federal government has made it a top priority to end chronic homelessness within ten years. This priority is rooted in the sound analysis of homelessness within our country today. National research by Dr. Dennis Culhane, the most widely recognized researcher on the adult homeless population, has provided a compass for policy and program development targeted to specific population profiles.
Dr. Culhane’s data show that about 10% of homeless adults who use the shelter system over the course of a year have long stays in homelessness, coupled with deep levels of mental and physical disability, including addictions. These individuals experiencing “chronic homelessness” constitute the most costly subpopulation of homeless people, and would be better served in permanent housing with supportive services, thus reducing the public expense of acute care and emergency services such as shelters.
MHSA supports the approach of making the chronically homeless a housing priority and works with local communities, state agencies and homeless and housing providers to advance these efforts. MHSA advocates for housing approaches for the chronically homeless that are locally-based, creative, innovative and effective.
Housing First
The Continuum of Care approach to addressing homelessness promoted a linear model that suggested that housing was the end result of an individual moving from streets to shelter, to transitional programs, or to permanent supportive housing. Housing was the prize at the end of the process for a client who could demonstrate compliance to a system of care that made any number of demands, ranging from sobriety to medication regimens. The end result of these models was service intensive programs that put very few resources into actual housing. New models have emerged that challenge these assumptions.
Commonly referred to as “Housing First,” this approach abandons the linear model of the Continuum of Care and puts housing at the front of the process, placing a person in housing first and then dealing with the service needs of the individual. Empirical research has indicated that the mere act of placement in housing produces a level of stabilization that allows the individual to address their other needs more effectively. MHSA believes that the Commonwealth should research these models and promote movement away from reliance on linear models for dealing with the chronically homeless population.
As a result of mounting evidence from around the country that Housing First strategies result in tremendous cost savings to cities and states and a decrease in the incidence of chronic homelessness, the Massachusetts Legislature passed line item 4406-3010 in the FY07 state budget to fund a pilot Housing First program for 130 chronically homeless individuals. The state allocated funds to MHSA through the Department of Transitional Assistance (DTA) to operate the program, known as Home & Healthy for Good (HHG). An evaluation of this pilot program, with a focus on the cost per participant and projected cost savings in state-funded programs, is ongoing. Please click here for comprehensive information on Home & Healthy for Good.
Housing as Health Care
Chronically homeless people have unique health vulnerabilities. This subset of people suffers from extraordinarily complex medical, mental, and addiction disabilities that are virtually impossible to manage in the setting of homelessness. With an extreme level of disability, these individuals are among the highest-end utilizers of our state’s health care systems.
Recently collected data from clinicians at Boston Health Care for the Homeless Program has catalogued some of the medical needs and costs associated with living unsheltered on the streets chronically. A cohort of 119 street dwellers accounted for an astounding 18,384 emergency room visits and 871 medical hospitalizations over a five year period. The average annual health care cost for individuals living on the street was $28,436, compared to $6,056 for individuals in the cohort who obtained housing.
A growing body of evidence in the mental and public health literature shows dramatic improvement in health outcomes, residential stability, and cost to society when homeless people receive supportive medical and case management services while living in permanent, affordable housing units. This concept, linking health to housing, has become the focus of the MHSA advocacy agenda and is consistent with the recent goal put forth by the federal government of ending chronic homelessness in the next ten years. Click here for some related articles of interest.
Discharge Planning
Discharge planning prepares a homeless person in an institution to return to the community. Discharge planning is the process, beginning upon admission to an institution, to prevent clients from falling into homelessness by linking individuals to essential housing and services.
Sadly, homeless shelters have become an acceptable “housing” alternative for those exiting state systems of care. MHSA finds this practice unacceptable: shelters are neither adequate nor appropriate placements for people coming from mental health, public health, corrections, youth services, and social services systems. Discharges into the shelter system are a costly and ineffective way to address the unique needs of mentally ill and other persons in the community and contributes to, rather than prevents, homelessness.
In the mid-1990s, MHSA instituted a monthly census of emerging subpopulations in shelters across the state. This effort documented the emergence of growing numbers of individuals falling into homelessness upon discharge from mental health facilities, substance abuse treatment facilities, state and county corrections, foster care, and managed care. Research regarding these homeless subpopulations dispelled the old myth that homeless people are anonymous street people wandering from shelter to shelter. Rather they are known – in fact, quite well known – to state funded residential treatment, corrections, and youth programs.
In conjunction with Quincy Interfaith Sheltering Coalition, MHSA is ready to launch the Greater Boston Consortium for Discharge Planning, an innovative collaboration that will address the discharge of mentally ill individuals from psychiatric hospitals to the streets. Not only will the initiative prevent homelessness by making housing resources available to hospital discharge planners and their patients, it will also explore broader trends in effective discharge planning.
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