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The House Committee on Public Health and the House Committee on Urban Affairs met in a joint hearing on September 12 to hear invited and public testimony regarding housing instability, homelessness, and mental illness.

This report is intended to give you an overview and highlight of the discussions on the various topics the committee took up. It is not a verbatim transcript of the hearing, but is based upon what was audible or understandable to the observer and the desire to get details out as quickly as possible with few errors or omissions.

 

Study the overlays among housing instability, homelessness, and mental illness. Review the availability of supportive housing opportunities for individuals with mental illness. Consider options to address housing stability and homelessness among people with mental illness.

 

Panel 1

Trina Ita, Health & Human Services Commission

  • Gave Presentation
  • Housing is a gap in behavior health services
  • Roughly 25,152 individuals self-identified as homeless in 2018 – believes that this is an under estimation
  • Healthy Community Collaborative Program – grants awarded to 5 most populous communities providing services through this program and focuses chronic issues of homelessness associated with mental illness
    • Expanded to rural communities this past session (SB 1849)
    • Goal is top leverage local matching funds on a dollar to dollar
  • Burkett – has that made any differences? And how does that compare to 5 years ago?
    • Ita – does not have specific data at present, will provide that information to the committee. Will also include before and after data
  • Guerra – mentioned matching funds, how does that work?
    • Ita – about $25 million was allocated, as entities applied for the funds, they were required to have matching funds through local communities or donor dollars
  • Projects to Assist in Transition for Homelessness (PATH) – intended to mitigate homelessness – operated by 14 providers across the state to enroll individuals into services at their local mental health authority (LMHA)
    • Utilizes SAMHSA funds – Texas received $4.5 million to operate the program
    • 2 non-profit providers as well as 14 LMHAs
  • Supportive Housing Rental (SHR) – $11.6 million was appropriated for short-term and long-term rental assistance
    • Operated through LMHAs
    • Intended to assist with stable housing and help plan for longer term housing needs
  • Price – you are measuring the program to be sure it is successful – this program has been around for more than one biennium, would like to see how success is measured and trend data that may show how it is providing the intended stability that allows them to get the needed treatment
    • Ita – will provide that information to the committee
  • Project 811 – a collaborative project between HHS and TDHCA
    • Provides housing units with rental assistance for low income individuals with disabilities
    • Implementing regional calls with local providers
    • Have received 1,200 referrals
  • Noted collaboration between HHSC and other entities to partner in addressing the housing issue identified in the Strategic Plan – specifically the Texas State Affordable Housing Corporation and MCOs

 

Brooke Boston, Texas Dept of Housing and Community Affairs

  • Study shows roughly 1 in 5 people experiencing homelessness are also experiencing severe mental illness
    • Believes that is an underrepresentation
  • Homeless population is comprised by many subgroups causing often leading to population silos that make it difficult to estimate the total population
  • The top 7 cities in Texas noted veteran population within the homeless group and the top 5 barriers to homeless veterans receiving services include mental disorders other than PTSD
  • Homeless youth – TDHCA and the Texas Interagency Council for the Homeless conducted study of homeless youth up to 24 years old (Youth Count Texas) – of the total 750 youth counted as part of the study 40% identified as having a mental illness
  • Emergency Solutions Grant Program – received from HUD, which administers funds to non-profits, cities and communities
    • Roughly $8-9 million per year
    • Intended to use funds to assist with stabilized housing so individuals can get needed treatment
    • 2017 – served roughly 29,000 individuals
  • Price – do you have to be homeless or can at-risk individuals qualify?
    • Boston – at risk can qualify as well
  • Section 811 program – also HUD funding, Texas was not an automatic recipient and had to actively go after the funding
    • To provide project housing assistance
    • $24 million provided for this program
    • Those eligible are able to pick an apartment from a qualified list and are able to utilize assistance for that apartment
  • Section 811 program serves three populations: those with disabilities exiting institutions that are Medicaid eligible, those eligible to receive behavioral health services through LMHAs, and youth exiting foster care
    • Active in 8 metropolitan areas
  • Zedler – how many people who have a mental health issue that are offered housing stay there or refuse to stay there?
    • Boston – anecdotally have served 80 people in less than a year and had turnover of 2 people. There is a good infrastructure to help those individuals.
  • Oliverson – what are the age ranges of the youth you are serving?
    • Boston – it can go up to age 24 but could be from birth – from a family that is homeless. The survey only included those who voluntarily participated
  • Oliverson – you mentioned 40% indicated history of mental illness, are these people who would otherwise be eligible for services through schools and does that include substance abuse disorders?
    • Boston – if they are in the school system they would have access to services, but it out of the purview. Will get additional information related to that to the committee
    • Boston – related to substance abuse – the survey included “mental illness or other related conditions” so some people may have included substance abuse and others may not have
  • Burkett – 80 families have been assisted through the Section 811 program, what is the capacity?
    • Boston – up to 600 units
  • Burkett – what is the cost of the program?
    • Boston – there are $24 million available, and the cost of each unit varies widely – on average probably $750-800 per unit for housing and utilities
  • Burkett – is there a limit to how long they can stay in the program?
    • Boston – the program at was funded for 5 years but it is intended to continue past 5 years
  • Section 811 program requires income below HUD’s extremely low-income requirement – participants do not pay more than 30% of their income in utilities
    • Each eligible household must have at least one eligible member (18-62) to qualify
  • Burkett – why is the age range 18-62?
    • Boston – that was a HUD requirement – the idea is that there are other services for the elderly
  • Project Access program is coordination with HHSC uses program vouchers to assist low income, non-elderly individuals with mental illness to transition back into the community from institutions
  • Homeless Housing and Services Program – only state funding program that specifically serves the homeless population
    • Total of $4.9 million annually to the state’s 9 largest cities
    • Noted flexible use of funds
    • 2015-2016 – served just over 8500 households
  • Guerra – what was the determining factor in those cities being chosen?
    • Boston – it was based on population cut off figure in the original legislation, likely through the population projection figures but will find out for the committee
  • Community Services Block Grant Program – not homelessness specific but are able to be used locally on issues that affect that community specifically
  • Price – referenced the veteran population, does TDHCA have any collaboration with the Texas Veteran’s Commission?
    • Boston – there is, the Texas Veteran’s Coordinating Council has participation as well as other agencies that have active veteran’s representation
  • Price – are there any grant programs specifically targeted for the homeless veteran population?
    • Boston – there are not any specific programs for veterans only
  • Isaac – on the Texas Veteran’s Coordinating Council is there coordination with the Workforce Commission to increase earnings opportunities for veterans?
    • Boston – will have to check with TVC
  • Alvarado – are you finding trends that we need to be aware of related to homelessness?
    • Boston – HUD coordinates a point in time count that is aggregated, we can try to get some information related to trend data
  • Alvarado – it seems like there has been an increase in the Houston area. Have all the funds that you mentioned been dispersed or are the cities utilizing them?
    • Ita – all those funds are accounted for

 

Stephen Glazier, UT Health Houston

  • 2019 new facility will break ground with 264 beds to treat mental health patients
    • Mix of acute and sub-acute patients to serve all age ranges
  • More time in the hospital allows for more time to better understand the issues as well as to educate the patients on their illness
  • Allows for opportunity to reintroduce patients into the community while still being treated
  • Recent study from pilot program shows that patients that complete the program are 300% less likely to readmit than those who had a short-term in-patient admission
  • Have just been awarded 5-year SAMHSA grant for care coordination and housing assessment for homeless population
    • This program can have an outpatient opportunity to coordinate with in-patient system

 

Jair Soares, UT Health Houston

  • Data shows that mental illness is a major driver of homelessness
    • Includes substance abuse
  • If individuals are not guided through levels of care and are kept in supportive housing opportunities, they are highly likely to relapse
  • Early detection is hugely important in concert with access to care and a stable support system
  • About 30% of those treated at the Harris County Psychiatric Center are homeless
    • Many are so chronic and will not be ready to reenter the community after an acute treatment (usually 7-10 days)

 

Kenny Wilson, Haven for Hope

  • Gave Presentation
  • Has become a national model to serve homelessness
    • Almost every person served has some level of mental illness
  • Studies show that housing, mental illness and homelessness are linked
  • Roughly 1700 people are living at Haven for Hope including children and veterans
  • Collaboration with 185 nonprofit partners allows for wrap around supports
  • Intended to serve the root cause through trauma informed care
  • Believes that becoming homeless is traumatic on its own
  • This model helps keep people out of jail and emergency rooms
  • Challenges include: Housing capacity – currently have a waiting list of roughly 7 years for affordable housing, Service capacity – resources do not adequately cover expenses for support services, and sustainability – ongoing funding is needed
  • Recommendations: continue funding the Healthy Community Collaborative program, establish funding for Permanent Supportive Housing (PSH) site-based units, seek investment from non-traditional funders (hospitals and health plans)
  • Described specific experiences with patients

 

Questions to the Panel 1

  • Alvarado – discussed a similar organization, Search, in Houston.
  • Guerra – proud that Haven for Hope is anchored in San Antonio
  • Bernal – can you speak to having Prospect and Courtyard immediately next to Haven for Hope?
    • Wilson – Courtyard is a low barrier entry that is free and safe and an entry into a mental health program or recovery program
    • Wilson – related to trends, emergency overflow families- close to 100 people that are families with no place to live
  • Leach – described vast majority of homeless youth coming from single aren’t homes – have heard the same thing from families in Dallas – that we are causing mental illness by utilizing solitary confinement within the justice system, do you have thoughts on improvements to the criminal justice system to improve mental illness?
    • Wilson – not an expert on criminal justice- but believe that what you are speaking to is accurate
    • Wilson – Haven for Hope does have an outreach with the jail – data shows if they come to Haven for Hope they are far less likely to return to prison
  • Price – related to the business model and individuals that need long term housing – what does that do to your ability to treat those people?
    • Wilson – we think of it as a pipeline – the lack of supportive housing it creates a back up in the pipeline – need to get people from Haven for Hope into supportive housing
  • Price – Haven for Hope has received state appropriations as well as tremendous local community support, and your model is working in your area, do you have any suggestions for other communities to replicate your success?
    • Wilson – it is key to having the services on site
  • Alvarado – the UT Health facility will break ground in 2019?
    • Glazier – that is correct
  • Alvarado – how will you receive people?
    • Glazier – most will come from hospital emergency room, probate court, and walk-ins
  • Alvarado – what else can the state to do tackle the mental health issue?
    • Soares – there is clearly a much higher awareness and more resources being put into it over the past few legislative sessions, it is critical to build on the momentum

 

Panel 2

Greg Hansch, National Alliance on Mental Illness Texas

  • Gave Presentation
  • Briefly described NAMI Texas
  • We hear from membership regarding housing constantly
  • Over 90% of members indicated housing is very or somewhat important
  • Recovery is contingent on availability of housing
  • We should strive to support individuals with mental illness to live independently as much as possible
    • Supported housing is essential into integration back into the c community
  • Supports around and integrated into housing like education substance abuse services and transportation will achieve greater outcomes
  • Supportive housing can save money to the Medicaid system
    • Studies show it saves up to $22,000 per person per year in Medicaid costs
    • Studies show Housing First to be a promising approach
  • January 2017 Point In Time: roughly 23.5 thousand Texans experiencing homelessness
    • 20-30% have a serious mental illness
  • Homelessness is going up in the state over the last few years
    • Many are experiencing chronic or repeated homelessness
    • Unaffordability of housing is a main reason people find themselves homeless
  • Recommendations:
    • Build upon Healthy Community Collaboratives program – highlighted the Oak Springs Development as example of permanent supportive housing
    • Increase Rental and Utility Assistance for Clients at LMHAs – program has not seen any increases since 2013 even though we know there is an increase in need
    • Providing funding to Maintain Service Levels for Mental Health Grant Programs – noted HB 13 and SB 292 – supports HHSC exceptional item 37 to maintain fiscal year 2019 funding and service levels
    • Invest in small group home model for those with high needs – group homes are the de-facto option, and many are low quality
    • build a true continuum of care in and around psychiatric hospitals
    • Special Needs Supportive Housing set-aside: Low Income Housing Tax Credit (LIHTC) program

 

 

Public Testimony

 

Tanya Lavelle, Hogg Foundation for Mental Health

  • Housing is a huge barrier for people with mental illness
  • Must take a community approach
  • Housing affordability is a major issue for those with mental illness
  • Highlighted the Section 811 and the Supportive Housing Rental programs as being particularly effective

 

Eric Samuels, Texas Homeless Network

  • Housing is the reason we have thousands of people experiencing homelessness in Texas
  • We are not coordinating the services that we do have, and we need more services available
  • Recommends:
    • More affordable housing/affordable housing subsidies
    • Supports a housing academy to educate communities on resources
    • Supports increasing funding for mental health care and services supported by Medicaid
    • Concerned with lack of coordination
  • Working on creating a data warehouse

 

Carl Hunter, RecoveryPeople

  • Urges the committees to recommend legislation that would increase access to recovery residences

 

Talbot Presley, Self

  • Described personal experiences
  • Aids to all homeless persons include: access to temporary privacy, access to free transportation, access to clothing and hygiene, straight forward income options, telephones, food and money
  • Isaac – discussed the witness’s personal experiences with homelessness including access to communication, transportation, experience in shelters, work opportunities
    • Has been most beneficial to utilize services and work on the root of homelessness

 

Closing Remarks

  • Committee on Urban Affairs has concluded all interim charges