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There’s Too Much We Don’t Know About Adult Residential Facilities

Where can the unhoused seriously mentally ill, co-occurring, or addicted populations go and what occurs once they are there? For many communities, dealing with a lack of data and accountability, this question is simply unanswerable.

That is why Heart Forward LA hosted a CORO fellow for four weeks to evaluate the current state of the board and care system in Los Angeles County and beyond.

As communities realize the need for more clinically and therapeutically oriented residences for the unhoused with SMI, along with co-occurring and SUD, the Housing First approach is becoming less and less attractive. California experienced a loss of more than 32,000 beds in state mental health hospitals from 1960 to 1985. Community-based adult residential facilities emerged to house those that needed care. These facilities, however, have failed to garner enough state support leading to their decline and the loss of beds for those that need them.

Through support from Coro Southern California and Heart Forward, a new review of housing for the SMI subpopulation in adult residential facilities (ARFs) illustrates the tremendous gap in information about these valuable community resources. The report seeks to understand this critical type of housing and why they are disappearing.

No Time to Waste: An Imminent Housing Crisis for People with Serious Mental Illness Living in Adult Residential Facilities, by Jonathan Wisner, describes the poor state of knowledge about ARFs and how immediate action is needed to keep this vital industry alive. Wisner points out a lack of accountability and data that distances ARFs from homelessness and behavioral health programs that have caused ARFs to die on the vine often leaving their residents homeless. The neglect of ARFs as a vital part of the array of housing and treatment options has caused disinvestment, poor quality of care, and closures.

To remedy this significant problem, Wisner recommends the funding of new research to understand the specific conditions of the ARF industry and how it serves those residing in ARFs. Wisner’s recommendation of an immediate funding patch to keep existing ARFs operating is combined with the serious need for research to create a sustainable, system of Housing that Heals emphasizing quality and therapeutic outcomes.

Hope Street Coalition participated as a member of the Heart Forward ARF Research Advisory Panel to guide the direction of No Time to Waste. The better we understand the existing residential structures and support systems that often fail those with a serious mental illness in our communities – housed and unhoused – the better we are able to create appropriate interventions.

Many people are left living on the streets because they need so much more than a subsidized place to live from the Coordinated Entry System. They cannot navigate a lease or get to needed treatment appointments. They need a community where this is provided in what mirrors a campus.

No Time to Waste is the necessary alarm pointing out the silent crisis that exists in counties throughout California. Given how mental health policy and coordination has been delegated to counties, it underscores that unintended consequence of the state relinquishing authority to this domain. It documents how lack of data results in disinvestment, unknown quality, and the destruction of needed community assets. Without sufficient residential treatment facilities to provide homelike clinical care for people living with serious mental illness in our communities as well as the co-occurring or addicted populations, unsheltered homelessness and human suffering will increase.

Policy makers, think tanks, government agencies, and foundations should take up Wisner’s call and start doing the work of understanding the state of ARFs, who they serve and how they serve them, and what needs to be done to improve these facilities and the systems of which they are a part. To continue the status quo and see these valuable community assets disappear harms people and harms communities.

By Paul Webster

Paul is an advocate, legislative and policy expert, and the Director of Hope Street Coalition. Hope Street focuses on the intersection of homelessness, mental illness, and chronic addiction. He has worked at the local, state, and federal levels most recently as a Senior Policy Advisor at the U.S. Department of Housing and Urban Development.

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