It's a good idea, but is it enough? That's the question some mental-health advocates ask of a new public/private initiative to help provide housing and services for the chronically mentally ill in the nation's large cities.
The Robert Wood Johnson Foundation and the US Department of Housing and Urban Development (HUD) announced yesterday a $100 million program to be shared by eight cities. Under the program, cities will create an agency, either public or nonprofit, to wield financial and administrative authority for their mental health programs.
The program is for all chronically mentally ill, but the very visible plight of the homeless spurred the creation of the program, says Linda H. Aiken, vice-president of the foundation.
In another program the foundation sponsors aimed at providing health care to the homeless, it was obvious that the mentally ill were falling through the cracks.
For the past 30 years, there has been an effort to deinstitutionalize this population, and since 1955, over 400,000 patients have left institutions. But for a variety of reasons, many of the mentally ill have been left homeless or without services.
The newly created authority will be responsible for all of the mentally ill in the urban area, and for their medical care, housing, food, and social and rehabilitation services.
The Robert Wood Johnson Foundation, a private philanthropy, will provide a $28 million package. Each city can get a grant of $2.5 million to help establish the mental health authority, as well as provide seed money for special services such as day hospitals or sheltered workshops.
In planning the program, the foundation looked at two major models -- a program in Madison, Wis., and one in Boston. In both cases the programs were successful and more cost effective than institutionalization.
Using a loan pool of $1 million per city, the foundation hopes to attract additional funding for housing, which would be enhanced by 1,000 Section 8 existing housing certificates. HUD is not creating new funding for this project, which could cost it $75 million over 15 years. Rent subsidies come from Section 8 funds for FY 1986.
Dr. Aiken says the HUD contribution is not insignificant, but one homeless advocate in New York was skeptical. In that city, there are an estimated 35,000 homeless. The number of mentally ill among the homeless is estimated at between 30 percent and 50 percent. Taking a conservative estimate, there are over 8,000 chronically mentally ill. One thousand housing certificates split between eight cities, he says, will be a drop in the bucket to a city like New York.
Aiken points out that only 10 percent of the estimated 2.4 million chronically mentally ill are homeless, and the program is designed to service the entire population.
The issue of housing clearly has to be addressed beyond city and state government, says mental health advocate Jeffrey Solomon of Altro Inc. In New York City, Altro provides programs for the chronically mentally ill.
Although he had not seen the foundation/HUD program, he agrees that part of the problem is structural. ``If it would integrate state and local resources, it would make a contribution,'' he says. But he notes that the money involved appears to be ``petty cash'' compared with what a city like New York has to use.
HUD currently provides some housing for the chronically mentally ill through their Section 202 program. It gives direct loans to nonprofit organizations for housing for handicapped and the elderly.
``[The HUD Johnson program] is not directly aimed at the homeless,'' says Thomas Casey of HUD. ``Hopefully it is aimed at those in substandard housing or who have been displaced.'' The certificates will go to people who qualify as low-income.
Applications for the grants are due by May 1986, and the grants will be made by November 1986. The program is cosponsored by the US Conference of Mayors, the National Governors' Association, and the National Association of Counties.