BY: NATASHA BURKE
Ms. Burke is director of communications, St. Mary's Hospital, Brooklyn,
NY.
A New York City System Provides Special Housing for Patients with Mental Illness
or HIV/AIDS
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SUMMARY
Since 1977, Saint Vincent Catholic Medical Centers of New York City has
been creating and maintaining supportive housing offerings for at-risk
populations, such as individuals with HIV/AIDS, those with substance abuse
challenges, and the mentally ill. By providing a continuum of medical
and social services, the organization aims to help residents stabilize
and rebuild their lives.
Saint Vincent sees empowerment as a key step toward helping individuals
maintain their health, re-enter the community, seek employment, and pursue
other goals.
Some of the supportive services Saint Vincent offers in its housing communities
are care coordination, counseling, peer support networks, self-help groups,
leisure activities, help with finances, and referrals to community agencies
offering other resources. Recognizing the importance of job training and
assistance, the system also offers a unique program in which mentally
ill individuals are able to work in a recycling center or office cleaning
business, both of which are owned by Saint Vincent.
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Saint Vincent Catholic Medical Centers (SVCMC), a seven-hospital system in
metropolitan New York City, has been operating and developing residential and
supportive housing programs for people with mental illness since 1977. It currently
operates 12 residential/supportive housing programs serving 388 people, including
single adults, children, and adolescents.
"Supportive housing" is safe, affordable housing that is linked to
a continuum of medical and social services. Designed for at-risk persons and
families, it blends housing with health care, social supports, employment resources,
and other services, depending on the specific needs. The options vary widely
in terms of size, cost, services, and facilities, but what all supportive housing
facilities have in common is the goal of enabling residents to stabilize and
rebuild their lives, thereby experiencing community, self-reliance, dignity,
and hope. The combination of permanent, affordable housing and available services
works well for people who face complex challenges—who often are, for example,
not only homeless but also have very low incomes and such serious, persistent
issues as mental illness and HIV/AIDS.
In this article, I will, first, give an overall picture of SVCMC's supportive
housing services, and, then, focus on a particular program, St. Mary's Prospect
Place in Brooklyn, NY.
Saint Vincent and Supportive Housing
SVCMC is one of New York City's most comprehensive health care systems, serving
nearly 600,000 people annually. The system was established in 2000 as a result
of the merger of Catholic Medical Centers of Brooklyn and Queens, Saint Vincents
Hospital and Medical Center of New York, and Sisters of Charity Healthcare on
Staten Island.
SVCMC developed and provides supportive services and property management for
all of its properties. Funding for these housing programs has come predominantly
from the state Office of Mental Health and the city departments of Health and
Mental Hygiene and Housing Preservation and Development. Through its capacity
as a service provider and property manager, SVCMC has very rarely needed to
evict anyone from its housing programs, maintaining a 98 percent occupancy rate
for its facilities. The system sustains this high occupancy rate by maintaining
a strong referral network, including effective linkages with the NYC Continuum
of Care Coalition, a local not-for-profit group; centralizing outreach for all
of its housing programs; quickly processing referrals through a centralized
agency committee approach; and maintaining a waiting list of potential residents.
SVCMC operates its housing programs through its Department of Residential Services
(which is, in turn, part of the system's Behavioral Health Services Division).
The residential programs comprise 232 units of permanent supportive housing
(both single-site and scattered-site); 84 beds for transitional supervised community
residences (group homes with intensive rehabilitation services) with around-the-clock
staff coverage; 15 beds for adult family care; 34 units of licensed apartment
beds; 20 family-based treatment program beds for children and adolescents (temporary
foster homes in which the foster parents are trained to deal with emotionally
disturbed kids); and two beds for adult respite care.
These programs target people who have been diagnosed with serious and persistent
mental illness (often considered among those hardest to house); mentally ill
drug abusers; HIV/AIDS patients; and the geriatric mental health population.
SVCMC views residents' training for and achievement of meaningful, gainful employment
a critical component of any successful supportive housing program. In addressing
this goal, SVCMC has created two businesses for people with psychiatric disabilities,
Rainbow Recycling and Rainbow Brite, which provide recycling and office-cleaning
services, respectively. The system also offers training and placement for "companions,"
people who provide respite care for families with a mentally ill member in residence.
Supportive Services
The residential services program provides supportive services geared towards
meeting tenants' individual needs and providing them with a flexible array of
support. These services enable residents to re-enter the community; maintain
physical and psychiatric health; participate in therapeutic and rehabilitative
programs; pursue employment, education, or other productive activities; sustain
healthy relationships; and improve the quality of their lives. A major objective
of the program is "recipient empowerment"-enabling a resident to retain
his or her housing and obtain meaningful, gainful employment.
The specific services provided for residents are:
- Development of a comprehensive individualized service plan and functional
assessment
- Supportive housing case management
- Coordination of medical care for those with HIV/AIDS
- Supportive counseling
- Crisis intervention
- Assistance in establishing a household
- Instruction and/or support in carrying out daily living tasks
- Access to and knowledge of necessary community supports
- Assistance in establishing natural support networks
- Assistance in establishing and maintaining entitlement to benefits
- Assistance with money and medication management
- Assistance in gaining employment
- Coordination of psychiatric services
- Transportation to and from day treatment and psychiatric, medical, and dental
appointments when necessary
- Recreation, socialization, and leisure activities
Some residents in the supportive housing program carry the dual diagnoses
of mental illness and substance abuse. Given the nature of their illnesses,
they may at times relapse into drug use. Supportive housing residents who
relapse are given additional substance-abuse counseling and support, such
as:
- Relapse intervention and relapse prevention groups
- Behavioral de-escalation techniques (anger management, for example)
- Modified therapeutic-community techniques (for people receiving treatment
for both mental illness and substance abuse)
- Peer support through the creation of social support networks
- Linkage with self-help groups, including transportation to groups if necessary
In addition, residents are taught life-safety skills: how to evacuate a burning
building, for example, and use of fire extinguishers and equipment maintenance.
St. Mary's Prospect Place
In July 2004, SVCMC began constructing a new supportive housing facility, located
across the street from St. Mary's Hospital, a 269-bed acute care facility in
Brooklyn. On completion in December 2005, the new facility-to be called St.
Mary's Prospect Place-will be a permanent supportive housing program. The program
will comprise 78 efficiency apartments: 50 for adults with serious and persistent
mental illness with high service needs and 28 for adults with HIV/AIDS. Besides
the apartments, the facility will also contain common areas-a large community
room with kitchen, a library, a fitness room, and laundry facilities-and on-site
supportive service offices.
St. Mary's Prospect Place will provide numerous benefits to the general community.
Among these are:
- An attractive, modern, fully landscaped building that will help beautify
the community
- Safe, affordable, permanent, supportive housing for its residents, many
of whom are currently living in transitional residences in the community
- Employment opportunities for qualified applicants from the community, including
positions for case managers, vocational and employment counselors, an entitlement
counselor, clerical and secretarial workers, a building superintendent, a
maintenance and porter staff, and a security staff
To ensure the safety of both St. Mary's Prospect Place residents and the surrounding
community, the management will provide 24-hour security in and around the building.
In addition, the facility will have large common areas that can be used for
community events, such as health fairs, arts and crafts fairs, and meetings.
St. Mary's Prospect Place is intended to provide extended-stay housing with
on-site services for persons with either mental illness or HIV/AIDS who want
permanent, private housing but lack self-maintenance and socialization skills,
and, because they lack such skills, have a tendency toward homelessness.
St. Mary's Prospect Place will be accepting referrals from community residences,
psychiatric centers, hospitals, shelters, outreach programs, transitional living
programs, community support programs, and other sources serving the target population.
Residents will be offered access to St. Mary's Hospital's comprehensive network
of mental health and substance abuse programs and medical services (including
HIV/AIDS services); if they prefer, they will be linked to the services of other
community providers. Residents will also be encouraged to accept linkages with
community-based mental health and medical treatment (e.g., day treatment programs,
medical clinics, and vocational programs).
Saint Vincent Catholic Medical Centers
Cosponsored by the Diocese of Brooklyn and Sisters of Charity of New York, SVCMC
serves as the academic medical center of New York Medical College in New York
City. The system comprises seven hospitals: Mary Immaculate Hospital, Queens;
St. John's Queens Hospital; St. Mary's Hospital, Brooklyn; St. Vincent's Hospital
Manhattan; St. Vincent's Hospital Staten Island; Bayley Seton Hospital, Staten
Island; and St. Vincent's Hospital Westchester.
SVCMC's resources include more than 3,000 physicians; four skilled nursing
facilities; a systemwide home care service; a hospice; and more than 60 ambulatory
care sites, which provide a broad array of medical, psychiatric, and substance-abuse
services.
In 2002, SVCMC recorded 100,000 inpatient discharges; 1,920,000 outpatient
visits; and 524,000 home care visits. Its emergency rooms, which include three
trauma centers, received 285,000 visits that year. SVCMC is the largest private
provider of emergency medical services in the New York City Fire Department's
911 service.
Copyright © 2005 by the Catholic Health Association of the United States
For reprint permission, contact Betty Crosby or call (314) 253-3477.