Saturday, January 30, 2010

When can a mental health housing provider remove a mentally ill person from his or her apartment?

Under what circumstances might a housing provider for people with mental illness in this area remove a resident from a group home or apartment? And in what cases may a housing sponsor refuse someone with mental illness who has applied and waited his or her turn for an available bed? Answers are a bit elusive while the questions get more important now. The state Office of Mental Illness has scaled back its annual contract awards to the counties for apartment and group home beds in the severe economic environment we have. The implication is that the state is pressuring the housing agencies to move people along faster from the more heavily serviced end of the spectrum of publicly subsidized beds to those with less support or to beds with no support at all. And there is evidence for this happening here.

Also, in the group homes and apartments run by mental health housing providers today there are more seriously mentally ill than before and those with a variety of co-existing medical and behavioral conditions. The state is known to pressure the housing providers to take in more patients from this mix, including the worst off, rather than have them sent to nursing homes or special care facilities which are more costly. So issues are sure to come to the forefront in the agencies about accepting someone with greater health complications for placement or not, and whether a resident is entitled to stay on with the agency once a complicating condition is noticed or aggravated.

The two main suppliers of apartments and group home beds in this county are Mohawk Opportunities and Rehabilitation Support Services (Schenectady YMCA has state subsidized beds but it primarily serves a broader clientele). Word has leaked out from families that here and there are examples where group home and apartment dwellers have been asked to move along the line or even out of the apartment system altogether. There might be several reasons for this, for example, the person's social and rehabilitation goals no longer fit the program at the level he is in with the housing sponsor. So he can logically be switched to another apartment giving him more independence, even if he isn't ready to move.

What are tenant rights in this regard? First, it's clear those who reside in the subsidized apartments have the same protections granted to all tenants under landlord-tenant laws in NY State. That means that tenants have due process—the tenant has to be notified of the charges against him ahead of a hearing in court, and can only be evicted for non payment of rent or behaviors that have led to complaints and would let a judge find good cause for removal, or for some other rules that favor landlords' regaining possession of their property.

And for the mentally ill specifically, here are rules in Section 595.9 of the state Office of Mental Health regulations: “A discharge planning process shall include, at a minimum, the following: (1) involvement of the resident, program staff, other community service providers, and collaterals as appropriate and agreed to by the resident; (2) clinical assessment of the resident's psychiatric status as well as his rehabilitation, physical, social and residential needs and goals, which is conducted by clinical staff. (3) p rovision to the resident of options. (4) referrals to appropriate community service and residential providers and (5) arrangements for appointments with service and residential providers.” It also says that to be “discharge-ready,” “the resident is willing to relocate to such housing.”

Furthermore there are the policy guidelines of the housing sponsors themselves. One of the agencies has these rules: “Decisions to discharge are based upon an individual's needs and circumstances. Discharges from the program are planned to correspond with an individual's achievement of rehabilitation goals....every effort is made to fully involve the individual, other service providers and his or her family in implementing a positive, planned discharge from the program.

“A written discharge summary/service plan is completed for every individual leaving the program. (It) indicates the circumstances surrounding discharge, summarizes progress in key areas, lists participants in the plan and includes services arranged and follow-up contacts. The guidelines also state, “when an individual satisfactorily demonstrates abilities in such areas as medication and symptom management, money management, personal hygiene, performing household chores, shopping, preparing meals, maintaining an adequate diet, etc., discharge is encouraged.”

With these safeguards would come the right to legal defense from attorneys at the Mental Hygiene Legal Service, part of the state Appellate Division court system.

Nevertheless, these rules don't make clear whether an agency can refuse to admit someone or remove a person who has a complex medical condition or behavioral problem or physical limitations. Many people living in the group homes have these special circumstances. Others have been asked to leave if they are using drugs or alcohol in the building, for instance, or if they are violent and pose a safety hazard to anybody else. It's the same with the broader population in the city--housing for the mentally ill doesn't seem different from group housing for drug dependent people or youth with problems or men and women living at the YMCA and YWCA.

Among the complicating conditions, the providers report that they are asked to take patients upon discharge from a hospital who are incontinent, and some of these people do reside in the homes. Are they entitled to refuse these patients from admission to a group home? There are residents with the HIV-AIDS virus. A staffer has suggested there is no reason for the other residents to fear having any of them as housemates. More objections might be posed to admitting someone with a criminal background because there have been occasions of reported theft of belongings or credit cards and misuse of the phone, for example. A parent insists the providers have to be more alert to this, given the vulnerability of these residents. There are also residents who cause accidents that might result in harm to themselves or others and endanger the facilities.

In each of these cases it would seem to depend on individual circumstances whether to admit someone or allow him to stay on. It should be up to the housing agency to decide if staff has the capability to manage patients with these complications, and not be forced by the state to accept patients otherwise. At the same time it is up to the agencies to show responsibility to admit patients waiting discharge from Ellis Hospital when they have a bed and reasonable ability to provide care for them. It would certainly save on the cost of care. (Roy Neville)

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