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June 24, 2014

Rehabilitating the Substance Abusive/Mentally Ill Homeless

Rehabilitation of mentally ill homeless people is a serious problem to cope with. Most surveys estimate that on any specific night some 300,000 to 400,000 men, women and children are without a home (Jencks, 1994). Number of homeless people is sufficient to populate a medium sized city. In one of the richest countries on earth, people sleep on street, carry their belongings in grocery carts, and rummage through piles of garbage to find food.
Many of the homeless individuals have background of mental hospitalization, abuse as children and adults, and problems with drugs and alcohol. These deprived backgrounds produce a host of physical and mental illnesses that leave them weakened and vulnerable to losing their homes. Once homeless, they suffer new psychological traumas in the form of street violence and abuse as well as the harshness of shelter life. Problems like communal sleeping arrangements, overcrowding, lack of privacy, exposure to the weather, and other hazards make them vulnerable for mental and physical illnesses. Children, as well as the adults face the dangers of malnutrition, increased risk for HIV and other infections, stunted development, and academic underachievement (Rafferty and Shinn, 1991).
Government at Federal and State level try to rehabilitate such people who have mental illness, substance abuse disorder and who are homeless. There are several programs to rehabilitate them but there are two things without which this problem cannot be solved. First, extensive support from private sector is needed and second, welfare system has to be amended in order to cope and eliminate the problem of rehabilitation.

Some Successful Housing Programs

To rehabilitate mentally ill or alcoholic homeless people, communities must have various sources of funding and have the right to use these funds freely. As there are millions of people who need rehabilitation, it is a pretty daunting task for communities to serve all of them, especially the people with any mental illness, having alcohol or drug problems or prisoners (National Alliance to End Homelessness, 2000). Such people usually released from emergency rooms, inpatient care centers or prisons with no after-care plan. Thus, to face such realities, there must be a comprehensive strategy for communities to use scarcely available present resources and try to get more funding to fill the service gaps (Glover and Gustafson, 1999).
A plan for house financing and services should be a part of rehabilitation process (McMurray-Avila, 2001). It is the duty of the Community to first identify the housing and services needs of a rehabilitated person and then examine how existing programs can be used. There are several programs of rehabilitation for mentally ill or having alcohol problems homeless people. Several of such programs are administered by Federal government through Department of Health and Human Services, Department of Housing and Urban Development, and Department of Veterans Administration, while State governments also manage their separate rehabilitation programs in addition with these Federal programs (GAO, 1999).

Programs Administered By Health and Human Services

United States Department of Health and Human Services administer three specific programs for rehabilitation of people having serious mental illness or substance use disorder:

Healthcare for the Homeless (HCH) Program

Under this program, United States Department of Health and Human Services provides fund to hospitals, local health departments, community health centers, and other non-profit community coalitions to improve the services of healthcare, especially mental healthcare and substance use disorder services. In addition with providing healthcare services to mentally ill and substance abuse treatment, HCH program also provides assistance in acquiring a house and other entitlements (Health Resources and Services Administration, Bureau of Primary Health Care, 2001).
Project for Assistance in Transition from Homelessness (PATH) Program
Department of Health and Human Services, under this program, provides grants to local governments for mentally ill or chronic alcoholic people who are already homeless or at the verge of homelessness. Funds provided under PATH programs can be used for many services like “outreach, screening, assessment, treatment for mental illness or substance use disorder, supportive services, and housing services” (Center for Mental Health Services, 2001).
Grants for the Benefit of Homeless Individuals (GBHI) Program
This program provides grants for developing new or expanding current services for “treatment of mental illness and substance use disorder for such persons who are homeless”. These grants are awarded to non-profit agencies or to local public “to either provide treatment for mental illness or for substance abuse disorder or for both whichever is most appropriate and urgent (Substance Abuse and Mental Health Services Administration, 2002).
Programs Administered By Housing and Urban Development
United States Department of Housing and Urban Development administers the following programs to support mentally ill and alcoholic people.

Shelter Plus Care

This program provides rental assistance with social service support to the people, who are mentally ill, having any disability or drug and alcohol problems. This program provides the grant for up to five years and provides housing assistance for:
  • Tenant based rental Assistance: it is a contract with the mentally ill tenant directly
  • Project Based Rental Assistance: it is a contract with the owner of the building
  • Sponsor Based Rental Assistance: it is a contract with a non-profit organization
  • Single Room Occupancy Based Rental Assistance: it contracts with public housing authority
Although support services also provided in this program, but funding for support services will be required from sources other than Shelter Plus Care. These support services must be either equal or more than the amount provided by United States Department of Housing and Urban Development for rental assistance. 

Supportive Housing Program

This program provides home and support services to homeless people. Funds in this program available, for such people who are physically or mentally disable, for up to three years. Support services like operative cost of supportive housing, rehabilitation also provided through this program.

Section 811 Supportive Housing

This program provides home rental opportunities to disable and low income people. It provides interest free loans to such non-profit organizations, which develop housing projects with support services to these people. The amount provided through this program remains interest free for at least forty years. Rental assistance will also be provided to residents with the help of this program. Residents only pay 30 percent of their gross pay as rent while Section 811 pays the remaining balance. 

Home Investment Partnership Program (HOME)

This program provides funds to States and local governments for constructing, and buying houses for people who could not afford it. It is the largest program of Federal government for rehabilitation, which grants $1 billion per year to States and local government for this purpose. This program requires 25 percent payment from the recipients while HOME program pays the remaining 75 percent.

Emergency Shelter Grants Program

Under this program, “formula grants will be provided to the state and territories government to provide emergency housing facilities through a Consolidated Plan”. To achieve this grant, communities are required to present a comprehensive 5-year housing plan.

Community Development Block Grant Program

It is a grant divided between states and towns to provide affordable housing services to all such people, who could not afford it themselves. This grant will be provided for one to three years.

Programs Administered By Veterans Administration

Veterans Administration administers and manages several programs specifically for such veterans who have serious mental illness or substance use disorder and are homeless (Department of Veterans Affairs, 2002).
Domiciliary Care for Homeless Veterans Program
This program provides funds for the “support of medical services, treatment for mental illness and substance abuse”, and other social services to VA medical centers for such veterans who are homeless. 
Homeless Chronically Mentally Ill Veterans Program
This program provides funds for “treatment of mental and substance abuse disorder, case management and for other rehabilitation services in community-based residential treatment settings” to such veterans who are suffering from mental illness and are homeless.
Healthcare for Homeless Veterans Program
Services and support, under this program, provided for “case management, outreach and assessment treatment, and community-based housing facilities” to such veterans who are mentally ill, or having serious substance use disorder and who are homeless.
HUD-VA Supported Housing Program (HUD-VASH)
This program is funded by United States Department of Housing and Urban Development (HUD) and Department of Veterans Affairs (VA). “This program provides permanent housing opportunities to the people”, who are mentally ill, having Drugs and alcohol problems or veterans. HUD under its section 8 Voucher program provides $44.5 million for this program while VA provides clinical care for these people.

Programs Administered By National Mental Health Association

Several rehabilitation programs are administered by National Mental Health Association in different states, following is the example of one such program.
Mental Health Association Housing Program in North Carolina (Raleigh, N.C.)
Mental Health Association running a housing project for people having mental illness in North Carolina since 1985 (National Mental Health Association). Mental Health Association has developed more than 15,000 residential units including, single family homes, apartment complex, duplex houses, individual apartments etc.

Non-targeted Federal Program

There are several non-targeted federal programs for the rehabilitation of people having mental illness or substance abuse disorder and who are homeless. Here, we discuss only one of such programs (National Abandoned Infants Assistance Resource Center, 1997).

Social Security Administration’s SSI Program

This program provides income support to the people with “serious mental illness, substance abuse disorder, low income or having other disabilities and who are homeless” but such people who have only substance use disorder as their primary disability are not eligible for SSI and medical benefits of this program. 

Programs Administered by States

Most of the above-mentioned federal programs also administer by State and local governments. In addition to those programs, many states and local governments administer their own programs for the betterment of the community in general, and for mentally ill people in particular. Here we discussed some programs administer by State of California and Oregon.
Programs Administered by State of California
Following are two programs of rehabilitation administer by the state government of California.

Integrated Services for Homeless Adults with Serious Mental Illness Program

This program is managed by the State of California. This program provides funds for “housing development, and for other housing costs” (Foster and Snowdon, 2003).

Multi-Family Finance Program

“Funding for rehabilitation, acquisition, construction of new houses” etc is provided through this program to the homeless people who cannot afford it.

Programs Administered by State of Oregon

Following are the programs administer by the State government of Oregon for the rehabilitation of mentally ill and disable homeless people.
365 proposals
It is a private funded program for mentally ill people who have been in the State hospital for 365 days or more. This program is designed to provide community-based residences and specialized services for mentally ill people. In this program, providers are invited to present a comprehensive plan, including complete residential and other services support for the person they want to rehabilitate.
Passages Program
It is similar to the 365 proposals program. This program aimed towards such consumers, who are hospitalized for a long periods and suffered homeless after discharge. This program provides grants to community-based providers for the complete rehabilitation of such persons.


Hazards of rehabilitation need a more effective strategy to deal with. For example, solution along this line include creating an economy that guarantees employment at livable wages, provide healthcare for all, and has tax policies to transfer wealth to the poor instead of the well-to-do. The current welfare system includes medical care for the poor, food stamps, Supplemental Security Income for disabled and elderly, and aid to families with dependent children. Few people admire this system but they do not provide clear direction for reform. Some researchers believed that although it provides food and shelter to the poor, but also creates dependency and robs in recipients of their dignity and incentive (Murray, 1984).
Government has increased its efforts to cope with the problem of rehabilitation. It’s policies in the whole decade of 1990s based on two major themes (1) improvement of such Federal Government funded programs which deals with the requirements of poor and (2) start new and expand existing programs to provide rehabilitation for all the mentally ill, alcoholic homeless people.
Although Federal and State governments try their utmost to cope with the problem of rehabilitation, it is not an easy task unless private sector is not involved in such programs (McCambridge et al., 1992). But as more and more organizations are going in private sector for fundraising, competition for private funds is also increasing. Thus it is necessary to find such donors who are really eager to rehabilitate mentally ill or people with substance disorder in the society as useful citizens.
Most recent political responses to the homelessness problem have taken either of two approaches. One advocates changing the opportunity structure by providing low-cost housing, better wages and more jobs to the people who are either mentally ill or having alcohol problems. Otherwise, these people cannot cope with the strained economy and harsh job market. Critics reply that many of such people have no interest in taking advantage of an invigorated economy or new job slots, and that they need motivation rather than merely opportunity.
The second tack focuses on building incentives into the current welfare system. Proponents of this view argued that government welfare policies today do not reward people for holding down jobs and maintaining families. Instead, they say, the present system produces dependency. Cutting public assistance spending, offers one way to get poor and disable people back into the labor market.
Clearly homelessness is not caused only by the personal inadequacies of mentally ill and alcoholic people or external conditions beyond one’s control. It results from a complex interaction between the individual and social forces. Society cannot be changed without influencing the individuals who compromise it, and changing individuals requires that we alter the social environment that shapes them. Eliminating the problems of rehabilitation will require a comprehensive, perhaps even a revolutionary, approach.


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