Permanent supportive housing for people experiencing homelessness: The new mental institutions?

People who reside at or are familiar with the goings on at permanent supportive housing buildings for the unhoused often liken them to mental institutions.

I live in one such building -- Fusion Studios in Denver. It is run by Colorado Coalition for the homeless.

I have written about people who scream profanities all night long. Others who constantly bang on the walls. Neighbors who blast music at all hours. I even was assaulted by a man with a lead pipe in my building.

Nobody denies this building is full of mentally ill people, some chronically. After all, I have a diagnosis of schizoaffective disorder bipolar I type and spent a year in the state mental hospital myself. However, I take my medication and no longer experience symptoms such as hearing voices.

Does permanent supporting housing help people?

What makes a mental institution different from permanent supportive housing is that people in permanent supportive housing are not required to participate in treatment. As a result, you have residents who smoke meth and fentanyl all day and down beers in the lobby. They don’t work and they don’t engage in treatment, they just work all day on destroying their lives.

But here’s the kicker: Housing First, the philosophy behind permanent supportive housing, is intended to empower individuals to participate in their own recovery. It acknowledges studies that show forced treatment for mental illness or substances often doesn’t work. This model may be appropriate for people experiencing homelessness who do not suffer severe symptoms. But for people who are as delusional as I was, who do not understand they are suffering from mental illness, treatment likely never will come because they don’t believe they need it.

As a result, the chronically addicted and mentally ill rotate between jail, hospitals, and living on the street. Hospitals routinely discharge homeless people back to the street. But efforts are afoot in places like Denver to house those who interact with the healthcare system.

Mixing mentally ill, physically disabled, addicted

Not only do permanent supportive housing buildings often end up providing a roof to the severely mentally ill, but they also get a large share of physically disabled people as well. Assisted living and memory care communities can deny a patient for any reason, even if they have Medicaid. People experiencing homelessness who are elderly and disabled, mentally or physically, often end up in permanent supportive housing. The Housing First philosophy, after all, is to house without conditions.

Permanent supportive housing is also a repository for people getting out of jail, including predators. Again, the Housing First philosophy allows everyone a chance at housing, which those who work with people experiencing homelessness often say is a human right.

A catch-all for the disenfranchised

Indeed, permanent supporting housing is a veritable dumping ground for disadvantaged people, all with profoundly diverse needs. I can tell you from experience that to have any peace in such communities everyone must acknowledge their blessings and respect their differences. This is not an easy thing for people struggling with addiction and/or mental illness to do.

In contrast, mental institutions—or psychiatric facilities—are designed specifically for individuals requiring intensive psychiatric care and supervision. Historically, institutionalization often carried negative connotations due to forced confinements and a lack of patient autonomy. Many of these practices have been reformed, but the stigma persists.

Permanent supportive housing isn't a cure-all. Success depends on the quality and accessibility of the support services provided, as well as funding and staff capacity. Striking a balance between autonomy and structured treatment remains a challenge for people managing permanent supportive housing programs.