Public Housing:

Housing Persons With Mental Disabilities With the Elderly

RCED-92-81: Published: Aug 12, 1992. Publicly Released: Aug 12, 1992.

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Pursuant to a congressional request, GAO reviewed issues concerning housing nonelderly, mentally disabled persons in subsidized housing for the elderly, focusing on: (1) the problems associated with mingling the two populations; (2) screening mentally disabled applicants; (3) delivering mental health services and the need for additional support services; (4) laws and regulations governing placement of mentally disabled persons in public and other subsidized rental housing; and (5) procedures used to place and evict tenants with mental disabilities.

GAO found that: (1) nonelderly, mentally disabled persons (NMDP) are a small percentage of the population occupying subsidized housing for the elderly, although the percentage is significantly greater in larger public housing agency (PHA) projects; (2) NMDP cause a disproportionate share of problems, and those problems take longer to resolve because PHA staff do not have mental health training; (3) the incidence of problems is increasing and varies by PHA size; (4) the numbers of NMDP in subsidized housing for the elderly may be increasing, due in part to lack of affordable housing and recent antidiscrimination regulations; (5) PHA determine applicants' eligibility and suitability for public housing subject to HUD regulations, particularly antidiscrimination rules; and (6) revised HUD guidance gives PHA more freedom in the screening process, but PHA are still unsure whether their actions violate antidiscrimination laws. GAO also found that: (1) states are required to provide case management services to mentally ill individuals who also receive substantial amounts of public funds or services; (2) information on mental health and other community-based support services or the sufficiency of funding is not available; (3) community support services and case management can prevent or lessen NMDP behavioral problems; (4) cooperative agreements between PHA and local mental health service providers help in case management by coordinating delivery of housing and support services; and (5) NMDP eligibility for subsidized housing for the elderly varies, but the issue is not specifically addressed in any program authorizing legislation.

Matters for Congressional Consideration

  1. Status: Closed - Implemented

    Comments: The fiscal year 1994 HUD Appropriations Act included $30,000,000 for service coordinators in public housing pursuant to section 9(a)(1)(B)(ii) of the United States Housing Act of 1937.

    Matter: In order to assist PHA in establishing cooperative agreements and coordinating service delivery, Congress should consider providing appropriations for the public housing service coordinator position authorized under section 507 of the Cranston-Gonzalez National Affordable Housing Act of 1990.

  2. Status: Closed - Implemented

    Comments: The Housing and Community Development Act of 1992 addressed the issue of housing the nonelderly disabled persons with the elderly. Among other things, section 621 authorized public housing agencies to provide public housing designated for only elderly families.

    Matter: Congress should consider addressing the issue of housing the nonelderly mentally disabled with the elderly on the basis of the information contained in this and other reports and any congressional oversight hearings. Actions that Congress could consider include, but are not limited to, the options discussed in this report. In considering these actions, Congress will need to reconcile the rights and needs of both groups in a manner that is fair and equitable to both persons with disabilities and the elderly.

Recommendations for Executive Action

  1. Status: Closed - Not Implemented

    Comments: HUD has not taken any action to address this recommendation as yet and did not indicate any intended action. Further, in 1997, key authorizing Senate and House subcommittees are considering legislation that would substantially reform the public housing program.

    Recommendation: The Secretary of Housing and Urban Development should direct PHA to report on situations where local mental health providers do not exist or are unable to enter into cooperative agreements because of insufficient resources. This information would begin to provide a nationwide assessment of the sufficiency of mental health services available to public housing tenants. It will also provide Congress, through HUD, with an initial assessment of the need for targeted resources. Such resources could enable PHA to contract directly for on-site delivery of case management services.

    Agency Affected: Department of Housing and Urban Development

  2. Status: Closed - Implemented

    Comments: HUD has no plans to require PHAs to enter into cooperative agreements with mental health providers and no plans to develop a model cooperative agreement in guidance to be provided to PHAs.

    Recommendation: To facilitate cooperative agreements for case management services, the Secretary of Housing and Urban Development should work with the Department of Health and Human Services (HHS) to issue guidance now being developed for PHA on establishing cooperative agreements with local mental health service providers. As planned, a model cooperative agreement should be included in such guidance.

    Agency Affected: Department of Housing and Urban Development

  3. Status: Closed - Implemented

    Comments: HUD has no plans to require public housing authorities to enter into cooperative agreements with mental health providers. However, HUD partially addressed this recommendation by issuing a report (entitled "Creating Community, Integrating Elderly and Severely Mentally Ill Persons in Public Housing," June 1993) in cooperation with the Department of Health and Human Services to encourage coordination of housing and services for low income and homeless families and individuals, including those with severe mental illness. The report also included sample Public Housing Agency/Mental Health Agency Agreements. In fiscal year 1994, HUD also provided $43 million to 93 housing agencies for funding of service coordinators in elderly and disabled housing developments. An additional $6 million was provided in fiscal year 1998.

    Recommendation: To assist PHA in addressing the service needs of tenants with mental illness, the Secretary of Housing and Urban Development should require PHA to actively seek out mental health service providers for the purpose of entering into cooperative agreements for case management services.

    Agency Affected: Department of Housing and Urban Development

  4. Status: Closed - Implemented

    Comments: HUD does not intend to provide guidance that would detail the questions than can be asked of any applicant to public housing. However in partially addressing this recommendation, HUD sponsored 20 training sessions on "Nondiscrimination in Public Housing Occupancy." The sessions were attended by approximately 800 housing agencies and HUD staff, as well as disability advocates. The purpose of the training, among other things, was to ensure that housing providers understand how to conduct tenant selection and screening so as to: (1) avoid discriminating on the basis of disability or other protected class designation; and (2) accept only applicants who are likely to comply with essential lease obligations.

    Recommendation: To assist PHA in screening all applicants, including those with mental disabilities, the Secretary of Housing and Urban Development should provide fair housing guidance that details the questions that can be asked of any applicant to public housing.

    Agency Affected: Department of Housing and Urban Development

 

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