On the fourth floor of a red brick building in the Bronx is a modest one-bedroom apartment with large windows. It is sparsely furnished and the off-white paint on the walls is peeling slightly, but to Carmela M.* it is a haven. Formerly homeless and struggling with substance abuse and bipolar disorders, Carmela moved into her apartment last December with help from the Mental Health Association of New York City’s (MHA-NYC) supported housing program.
About 50 percent of the total homeless population suffers from chronic mental illness, according to a 2010 study in Journal of Behavioral Health Services and Research. Public health research has shown that taking the mentally ill off the streets can reduce health care costs and improve their lives, but housing alone can’t solve the complex challenges of homelessness and mental illness. Many programs struggle to help their clients integrate with the community, and the absence of a strong support network can lead to relapse.
Carmela has worked as a peer counselor at a self-help program in the Bronx for almost two years. She guides people through the bureaucracy of the Housing Authority to secure a subsidized apartment – a process she recently went through herself. Her history of substance abuse and homelessness allows her to empathize with people who come to the program desperate for housing, and to share her own experiences navigating the mental healthcare system.
“I feel that I’ve made a big connection with my consumers because I understand where they are coming from,” she says.
Carmela grew up in the Bronx with eight brothers and sisters. Her father was an alcoholic who was in and out of psychiatric emergency rooms. She describes herself as having a “short temper,” and says she began acting out in high school. At age 19, she started using crack cocaine. She was on and off the drug for 20 years.
One particularly frigid day when she was using, she sat on a rock feeling dirty and tired when she broke down and started crying. She told another user that she “couldn’t do this anymore,” and he gave her the number of a detox center.
In drug rehabilitation, Carmela met a young woman who told her about Recovery Works, a transitional housing program run by MHA-NYC. In Recovery Works, Carmela received counseling for her substance abuse problems and learned how to manage her bipolar disorder, which was diagnosed in 2003. She was also treated for post-traumatic stress disorder, after years of alternating between homelessness and incarceration left her with severe anxiety.
After 14 months in transitional housing, Carmela moved to her own subsidized apartment. A case manager visits her once a month to check in and monitor her recovery.
Programs like the one Carmela is enrolled in “mark a real transition in the way housing and support services are delivered,” says Geoffrey Nelson, a mental health researcher at Wilfrid Laurier University in Canada. “Rather than providing the services that people think are best for them, it puts people with mental illness in the drivers seat.”
Taxpayers also benefit. Supported housing programs reduce the costs of homelessness and mental illness on society by close to 80 percent, suggests a 2011 report from the United States Interagency Council on Homelessness.
“The research shows that [people in supported housing] don’t use as many costly systems like hospitals and ERs, and they are less likely to get involved in the criminal justice system,” Nelson says.
It is more difficult to assess the effect that supported housing has on the symptoms of mental illness. In one such study, published in 2005 in the American Journal of Community Psychology, researchers did not find a relationship between housing placement and psychiatric symptoms. But they did find that supported housing positively enhanced people’s perception of control over their lives – a factor that has previously been associated with improvements in mental health. Nelson notes that psychiatric symptoms may take a while to stabilize, so measuring the results of supported housing is not always clear-cut.
Other researchers have found that while there are small but significant improvements in the symptoms of mental illness for people in supported housing, the individuals often remain socially isolated.
“One of the common complaints of people who were formerly homeless is that they are lonely,” says Jack Tsai, a professor of psychiatry at Yale School of Medicine. “They get bored, they miss their old life so they lapse into substance abuse.”
Carmela knows the feeling. At her apartment complex she mostly keeps to herself. Though she has the love and support of her family, she says they find it hard to trust her. She gets particularly sad when she talks about her oldest son, who is still angry with her for things she did while she was using, and refuses to see her.
And while Carmela is grateful for the peace and freedom her apartment gives her, she doesn’t like to be alone there for extended periods.
“Being that I suffer from depression, I don’t like being home alone doing nothing. My job keeps me busy and lets me interact with people,” she says.
“Carmela is a worker,” says Jasmine Rodriguez, director of MHA-NYC’s supported housing program and supervisor of the peer-counseling program. Rodriguez praises Carmela’s “resourcefullness,” but notes that people who work as hard as Carmela does sometimes neglect their personal lives. “She’s strong, and she tries to carry so much. And we are trying to work with her on the fact that, regardless of her diagnosis, regardless of her struggle with substance abuse, she is human and she needs to lean on someone.”
For now, Carmela’s job sustains her, and she is happiest when she is helping others. Her goal is to become certified as a substance abuse counselor.
“I’ve learned how to live a productive life,” she says. “Now, even just getting up in the morning and taking the train to work seems exciting to me.”
*Name has been changed.