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Housing

Access to safe, quality, affordable housing, as well as the supports needed to maintain that housing, constitute one of the most basic and powerful social determinants of health. This means that housing is a core part of supporting a person’s mental health and wellbeing. MAMH works to ensure all people have access to quality, safe, affordable housing to support their mental health needs in several ways.

Affordable Housing Crisis

37.8 million

US households were cost burdened in 2017 (nearly 1 in 3)—of these, 18.2 million households were severely cost burdened.

Joint Center for Housing Studies State of the Nation's Housing

159,578

Shortage of 159,578 affordable rental homes for extremely low-income households in Massachusetts

National Low Income Housing Coalition Gap Report

$35.52

Hourly wage needed to afford a two-bedroom apartment at Fair Market Rent (FMR) in Massachusetts

National Low Income Housing Coalition Out of Reach Report

Massachusetts does not have enough affordable housing options for individuals and families, particularly for those with the lowest incomes. Because of this gap in supply, individuals and families may be forced to live in substandard housing with increased health and safety risks and/or live in overcrowded environments. Overcrowding may affect mental health, stress levels, relationships, sleep, and may increase risk of infectious disease (Healthy People 2020).

People with disabilities (including mental health conditions) are especially vulnerable to lose their housing for an inability to pay high rent prices because of job loss, large medical bills, or lease violations related to their disability. Supplemental Security Income payments for individuals with disabilities is $897/month in Massachusetts; a one-bedroom at fair-market rent costs $1,498/month (167% of the monthly income) (National Low Income Housing Coalition).

The Massachusetts Department of Mental Health (DMH) provides services for people with the most serious mental health conditions.

Homelessness, Housing Insecurity & Mental Health

20,068

people are homeless on a given night in Massachusetts

National Alliance to End Homelessness

“Homelessness is housing deprivation in its most severe form.” (Healthy People 2020)

According to a 2019 California study, 78% of unsheltered adults reported a mental health condition, 75% reported substance abuse, and 50% reported co-occurring physical health, mental health, and substance abuse conditions (California Policy Lab). Additionally, unsheltered people, particularly unsheltered women, report disturbingly high rates of experiences of violence and trauma.

Mental health and homelessness are integrally related. Ensuring access to affordable, accessible, and safe housing plays an important role in the health and wellbeing of all Massachusetts residents.

Permanent Supportive Housing

Permanent Supportive Housing is the best-evidenced model for serving people experiencing homelessness with mental health conditions, because it integrates housing and healthcare to account for this critical social determinant of health. Housing brings stability to individual’s lives regardless of health history or personal challenges. The Massachusetts Housing and Shelter Alliance’s Home & Healthy for Good (HHG) initiative is at the forefront of how Massachusetts addresses homelessness, particularly for chronically homeless individuals.

With access to supportive services through HHG, individuals formerly experiencing homelessness no longer need to rely on public emergency services as their primary sources of care. Instead, tenants can use preventative and primary health care, better coordinate with mental health providers, and maintain consistent permanent tenancy rather than using more costly public systems, such as emergency shelters and detox facilities.

How MAMH Supports Housing Access

Research

MAMH has produced several People are Waiting reports to document housing availability and access for people with mental health conditions served by the Department of Mental Health. Our most recent report was published in 2018: People are Waiting.

MAMH also works with partner organizations like the Massachusetts Housing and Shelter Alliance to promote research into the best practices for housing, like Permanent Supportive Housing and Housing First.

Systems Oversight

Ensuring that our systems in Massachusetts help promote housing retention is another critical component to MAMH work. To accomplish this, MAMH serves on the Commonwealth’s Olmstead Advisory Committee.

In 1999, the U.S. Supreme Court decision Olmstead v. L.C. found that states have a legal obligation to administer programs and activities in the most integrated setting appropriate to the needs of qualified individuals with disabilities. This rule is commonly thought to mean that individuals with disabilities, including those with mental health conditions, must be served in the least restrictive setting possible to meet their needs – meaning non-institutional, community-based settings are preferred where possible.

The Olmstead Advisory Committee for the state documents historical progress toward Olmstead goals; reviews the state’s current system of housing and care; identifies systemic strengths, barriers, and gaps; and prioritizes areas to build or improve upon.

Massachusetts published its most current Olmstead Plan in 2018.

Advocacy

Finally, MAMH also advocates to Commonwealth agencies and to the Massachusetts Legislature to improve on the existing systems to promote housing accessibility, affordability, and safety. Legislative priorities and accomplishments include:

  • Promoting the expansion of the Department of Mental Health Rental Subsidy Program (DMH RSP), which provides rental subsidies to homeless DMH clients.
  • Partnering with the Association for Behavioral Health (ABH) and Massachusetts Housing and Shelter Alliance (MHSA) to promote housing equity, access, and supportive housing options.
  • Working with state and federal agencies like the Department of Housing and Community Development to promote equity and access to housing subsidies; MassHousing on the creation of housing for vulnerable populations and on care coordination; and the Department of Mental Health on the creation and maintenance of Permanent Supportive Housing and Housing First models.