Marie Williams, LCSW

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T E N N E S S E E D E P A R T M E N T O F M
E N T A L H E A L T H A N D D E V E L O P M E
N T A L D I S A B I L I T I E S
Tennessee Creating and Expanding Housing Options
that Promote Recovery Opportunities

• Marie Williams, LCSW
• Assistant Commissioner, Division of Recovery
  Services Planning
• 615-253-3049 Marie.Williams_at_state.tn.us

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What is Recovery?When is a Person Recovered?

• WHEN REVIEWING LITERATURE WRITTEN BY THE LEADERS
  IN THE FIELD OF RECOVERY
• DR. PAT DEEGAN
• MARY ELLEN COPELAND
• DR. BILL ANTHONY
• AND OTHERS
• IT IS CLEAR THAT RECOVERY IS A JOURNEY
• WHOSE DESTINATION INCLUDES..

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The process in which people are able to live,
work, learn, and participate fully in their
communities. Recovery is the ability to live a
fulfilling and productive life despite a
disability.
Presidents New Freedom Commission on Mental
HealthReport to the President, 2003
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RECOVERY HAPPENS
R

• ecovery means that the mental illness is no
  longer the central focus of

a persons life even when symptoms persist.
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DEFINING TERMS

• RECOVERY refers to the ways in which a person
  with a psychiatric disorder manages his or her
  disability in the process of reclaiming his or
  her life in the community.
• RECOVERY-ORIENTED CARE refers to what psychiatric
  treatment and rehabilitation practitioners offer
  in support of a persons recovery.
• The Matrix Model _at_ Horizon House

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THREE GOALS OF RECOVERY
C

• onsumers engaged in the process of
  reintegration (recovery) strive to achieve three
  goals

• restoring relationships
• moving toward independent living and
• obtaining meaningful work.

Reintegration Today Summer 2004
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The Tennessee Department of Mental Health and
Developmental Disabilities Response to Expand
Community Recovery Options
THE RESPONSE
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THE SETH CAMPAIGN
The SETH Campaign is a strategic plan to partner
with Tennessee community providers to increase
the following community options for persons with
mental illness and co-occurring disorders on the
path to recovery
Housing - Phase 1 Employment/Education - Phase
2 Support Services - Phase 3 Transportation -
Phase 4
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Phase 1
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CHI CREATING HOMES INITIATIVE
A
strategic plan of the Department of
Mental Health and Developmental Disabilities to
partner with communities to create housing
options for people with mental illness and
co-occurring disorders effectively and
strategically in Tennessee.
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Recovery HousingOur Current Reality

• Housing ranks as a priority concern of
  individuals with serious mental illness.
  Locating affordable, decent, safe and appropriate
  housing is often difficult, and out of financial
  reach. Stigma and discrimination also restrict
  consumer access to housing.
• Mental Health A Report of the Surgeon General,
  1999

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Recovery HousingOur Current Reality

• Housing is, perhaps, the first line of treatment
  for people with serious mental illness.
• The lack of decent, safe, affordable, and
  integrated housing is one of the most significant
  barriers to full participation in community life
  for people with mental illnesses.

Presidents New Freedom Commission on Mental
Health Report to the President, 2003
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Americans with MentalIllness

• Persons with mental illness and co-occurring
  disorders receiving SSI benefits average monthly
  income (623) are among the lowest income
  households in the country.
• There is not a single housing market in the U.S.
  where a person on SSI can afford to rent a modest
  efficiency apartment.

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Tennesseans with Mental Illness

• There are a total of 173,377 persons assessed
  with severe and persistent mental illness in
  Tennessee who have used some service covered by
  TennCare (Tennessees Medicaid waiver program).
• Of those, approximately 2,000 individuals live in
  212 licensed supportive facilities.
• Approximately 20 of the criminal justice system
  and 25 of the homeless populations are diagnosed
  with mental illness and co-occurring disorders
  totaling 12,000.
• Therefore, it is safe to conclude that
  approximately 187,377 persons in need of housing
  assistance.

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Tennesseans with Mental Illness

• For every 100 households at or below 30 of
  median income, there were only 36 units both
  affordable and available for rent.
• The cost of a one-bedroom apartment is 80 of SSI
  monthly income
• Current estimates show that over 180 persons in
  our regional mental health institutes could be
  discharged if appropriate housing, with the
  proper support services existed.

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Creating Homes InitiativeThe Milestones

• February 2000 - Origins
• Commissioner Elisabeth Rukeyser establishes
  Office of Housing Planning and Development (OHPD)
  with Marie Williams as Director
• August 2000 - Kicks Off
• Announces Creating Homes Initiative (CHI) at
  TN/KY Housing Institute
• September 2000 - 2.5 million for Phase One

Nashville
Jackson
Chattanooga
Memphis
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Creating Homes InitiativeThe Milestones

• January - April 2001 - Moves forward

• 2 million from Tennessee Housing Development
  Authority
• HUD Section 8
• Statewide group proposal review and rank
• Funding announcements
• Produces media events
• Fights NIMBY/Legal issues

A Place to Call Home

• www.housingwithinreach.org
• click on NIMBY (Not In My Backyard)
• click on NIMBY literature

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Creating Homes InitiativeThe Milestones

• April 2001 - Hires Staff, Submits Grants
• Hires Regional Housing Facilitators
• Applies for new funding with CMS, THDA, HUD
  Continuum of Care, Section 8 and 811
• October. 2001 - Accepts Additional Project
• Receives 1.8 million CMS Real Choice Systems
  Change Grant
• October 2001 - Phase II Begins

Clarksville
Nashville
Johnson City
Knoxville
Jackson
Murfreesboro
Memphis
Chattanooga
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Creating Homes InitiativeThe Milestones

• October 2002 - Successes
• Surpasses goal of 2005
• Announces new goal of 4010 by 2005

• December 2002 - Receives funding awards
• 8 million from Federal Home Loan Bank Affordable
  Housing Program
• 5 million from HUD Continuum of Care
• Continues to work on HUD Collaborative Initiative
  to End Homelessness

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Creating Homes InitiativeThe Milestones

• July 2004 DMHDD Reorganization
• Commissioner Virginia Trotter Betts forms the
  Division of Recovery Services to coordinate
  provision of services in areas of Support,
  Employment/Education, Transportation, and
  Housing/Homelessness (SETH).
• Regional Housing Facilitators become Regional
  SETH Facilitators
• Regional SETH Facilitators continue CHI activities

• January 2007 Regional Housing Facilitators
  reinstated and return to Housing as single focus
• Initiative doesnt miss a beat!

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CHI THE VISION
o create and expand affordable, safe, permanent
and quality housing options for people with
mental illness and co-occurring disorders in
Tennessee
T
CHI Packet on the Internet http//www.tennessee.go
v/mental/publications/CHIpacket.pdf
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CHI THE MISSION
T
o partner with local communities, assertively
and strategically, to educate, inform and expand
affordable, safe, permanent and quality housing
options for people with mental illness and
co-occurring disorders.
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CHI THE GOAL
Set in 2000 2005 by 2005 Met in 2002, so reset
to 8009 by 2009
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Creating Homes Initiative Current Outcomes

• More than 200 million has been leveraged
• More than 7,100 new or improved units have been
  developed
• More than 1,155 individuals from local, regional
  and statewide organizations have participated in
  making CHI success
• 95 statewide decrease in re-hospitalization

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Creating Homes InitiativeRecognition and
Replication

• Eli Lilly National Housing Award
• CMS Best Practices Award
• HUD Best Practices in Fair Housing Award
• NAMI - Phillip and Sarah Francoeur Award for
  Housing
• The Commonwealth Fund State Behavioral Health
  Innovations Best Practice
• Many regional and local awards
• CHI Model in Georgia
• CHI Model in Kentucky

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• REGIONAL HOUSING
• FACILITATORS

Seven Regional Housing Facilitators in Seven
Mental Health Planning and Policy Council Regions
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• CONSUMER HOUSING
• SPECIALISTS

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TOTAL CHI UNITS CREATED
Supervised Group Housing 24-Hour On-Site
Staff Ex Multi-person Supportive Living Facility
Partially Supervised Group Housing Staff
On-Site as Needed Ex Multi-person Group Homes
Residential Homes
Independent Congregate Living No
Staff On-Site Ex Non-supervised Group Homes,
Boarding Homes
Rental Housing/ Voucher (Home or
Apartment) Ex Private Market, Public and
Non-Profit Housing
Home Ownership Ex Permanent Homes or
Condos
365 417 185
5,684 485
Total Units Created 7, 136
Total Amount Leveraged 200,722,055
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CHI THE FUNDING PARTNERS
CHI
CHI Carry Forward Grant 1,125,875
CHI Downpayment Assistance 149,578
CHI Leverage 4,493,457
CHI Leverage and THDA HOME 2,082,818
CHI Permanent Supportive Housing 8,603,394
CHI TOTAL 16,455,122
FEDERAL HOME LOAN BANK
FHLBank Affordable Housing Program 22,163,429
FHLBank American Dream 1,813,217
FHLBank New Neighbors 20,000
FHLBank Welcome Home 278,005
FHLBank Pilot Program 15,000
FHLB TOTAL 24,289,651
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CHI THE FUNDING PARTNERS
HUD
HUD 202 / 811 22,561,275
HUD ADDI 8,310
HUD CDBG 1,070,000
HUD COC SSO 4,484,106
HUD HOME 15,000
HUD Home Counseling 45,000
HUD HOPE VI 11,900,000
HUD Housing for Homeless Persons Addicted to Alcohol 999,936
HUD Housing Options for Persons with AIDS 1,367,145
HUD RHED GRANT 780,988
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CHI THE FUNDING PARTNERS
HUD (continued)
HUD/RHED THDA/HOME 140,000
HUD Ross 494,040
HUD Section 8 10,283,717
HUD Section 8 (Designated) 2,140,353
HUD Section 8 (Fair Share) 446,172
HUD Section 8 (Mainstream) 2,160,467
HUD Section 8 (Project based) 1,576,500
HUD Shelter Plus Care 20,719,115
HUD SHOP 30,000
HUD Supportive Housing Program 13,686,551
HUD/VA/HHS 2,600,000
HUD/VASH 284,000
HUD TOTAL 97,792,675
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CHI THE FUNDING PARTNERS
THDA
THDA 288,723
THDA ADDI 7,500
THDA HOME / CHDO 16,011,704
THDA Housing Trust Fund 3,879,601
THDA Low Income Tax Credit 9,670,000
THDA Section 8 10,000
THDA TOTAL 29,867,528
OTHER SOURCES
City of Johnson City CDBG 10,000
City of Bristol CDBG 30,000
City of Brownsville 75,000
City of Memphis HDC Continuum of Care Match 1,637,500
City of Memphis CDBC 306,660
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CHI THE FUNDING PARTNERS
OTHER SOURCES (continued)
City of Memphis HCBG 60,000
City of Memphis HCD - HOME 697,500
City of Memphis HCD - TBRA 1,366,149
City of Memphis HCD - CHDO 500,000
City of Murfreesboro 10,000
CMS Real Choice Systems Change Grant 1,768,604
Contributions 2,411,498
Delta Regional Authority 115,000
Dept. of Human Services ESG grant 348,905
Dept. of Labor 700,000
Dept. of Justice 255,000
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CHI THE FUNDING PARTNERS
OTHER SOURCES (continued)
DHHS SAMHSA 8,740,000
Eastern Eight 1,000
Fairview Housing Management Corp. 1,900,000
FAHE 93,750
FIHE 27,900
First TN Bank Grant 550
Gala (Fund Raiser) 21,000
Hawkins County Habitat for Humanity 296,790
Hawkins County Inner Club Council 10,000
HOME CHDO 202,260
Landlord Equity 2,570,000
MDHA 50,000
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CHI THE FUNDING PARTNERS
OTHER SOURCES (continued)
MDHA HOME 295,000
Neighborhood Reinvestment 51,692
Owner equity and mortgage 6,619,024
RCDI 3 and 4 Rural Development 23,400
Rural Development USDA 175,951
Rural Development Telemedicine 50,000
Rutherford County Habitat for Humanity 22,000
TDMHDD Suspender 766,000
Tennessee Habitat for Humanity 20,000
United Way 26,000
VA 62,946
TOTAL OTHER SOURCES 32,317,079
GRANT TOTAL ALL SOURCES 200,722,055
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FUNDING NEEDS

• Capital
• Acquisition
• Rehab
• New Construction
• Operating
• Recurring Housing Costs (utilities, maintenance,
  reserves, etc.)
• Services

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AFFORDABLE HOUSING CHALLENGE

• Assume homeless individual has or can get on SSI
• (SSI/SSDI Outreach, Access Recovery)
• 623 per month income
• 30 to spend on housing (including utilities)
• 187 per month for housing
• vs. Fair Market Rent for 1 Bedroom
• 586 per month or
• 399 over affordability

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FUNDING STRATEGY

• In order to keep housing affordable for very low
  income consumers,
• Reduce or eliminate mortgage
• Reduce or eliminate property taxes
• Build or rehab for energy savings
• Rental subsidies

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CONDO OWNERSHIP, NASHVILLE

• TDMHDD 9,000
• FHLB Am. Dream 13,300
• FHLB Welcome Home 7,500
• Owner deposit 500
• Owner mortgage 32,100
• Cost Closing 62,400

Total monthly payments inc. PITI Condo fee
377 Two brothers with severe mental illness,
both on SSI Cost savings to State in saved rental
subsidy in 30 yr. 180,000
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HOME OWNERSHIP,JACKSON, TENNESSEE

• Habitat for Humanity new construction
• 4-bedroom, 2-bath home valued at 80,000
• Total cost of Habitat Home 65,000
• THDA HOME grant -14,999
• FHLB American Dream -15,000
• FHLB Welcome Home - 7,500
• Owner mortgage with Habitat 27,501
• 30 yr. mortgage _at_ 0
• Monthly payments 78 per month

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ALPHA OMEGA VETERANS SERVICES, MEMPHIS

• THDA 238,362
• Plough Foundation 245,000
• HUD SHP 300,000
• City of Memphis 500,000
• FHLB AHP grant 575,140
• Owners Contribution 337,627
• TOTAL 2,296,129

• Operations and Support
• HUD SHP 190,000
• United Way
• Permanent supportive housing for homeless
  veterans who are disabled by mental illness
  and/or substance abuse
• New construction of two-story, 32 one-bedroom
  units plus common meeting and dining area
• Support services on and off site

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FREEDOM RECOVERY COMMUNITY, NASHVILLE

• Permanent supportive housing for formerly
  homeless women with mental illness and/or
  substance abuse and returning to the community
  from prison
• Twenty 2-bedroom apartments plus laundry, meeting
  room, office space
• Support on and off site

• FHLB AHP grant 251,000
• HUD SHP 135,000
• Memorial Foundation 75,000
• TDMHDD 100,000
• THDA Trust Fund 500,000
• TOTAL acq. rehab 1,061,000
• Operations and Services
• HUD SHP 241,551

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BULLS GAP, TENNESSEE

• Eight 2-bedroom apartments for homeless people
  who have mental illness
• Bulls Gap Historical donated land and building
• Clinch Powell Rural Dev. and First TN Dev. Dist.
  Applied for HOME

• Kingsport PHA supplies Section 8 vouchers
• Frontier Health, using MCD, provides case
  management

• THDA HOME 460,732
• Bulls Gap Historical Railroad
• (land and building) 60,000
• Operations
• Kingsport Housing Authority
• 16 Section 8 vouchers annually 92,928
• Frontier MHC /TN Care

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Housing and Economic Recovery Act of 2008PL
110-289
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Potential Opportunities

• Relative to Increasing Housing Opportunities For
  People Diagnosed with Mental Illness and
  Co-occurring Disorders

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• Establishes new, independent agency, Federal
  Housing Finance Agency, to regulate Federal Home
  Loan Banks (FHLB) (as well as Fannie Mae and
  Freddie Mac) with broader management and
  enforcement powers, including revision of goals
  of FHLB and expanding use of FHLB advances for
  use in community development projects and
  mortgage foreclosure avoidance.

• Impact Unknown at this time, but will likely
  modify FHLB focus and funding of Affordable
  Housing Program and American Dream Home Ownership
  Challenge Program which have been major sources
  of housing for CHI. Broader use of AHP funds
  will reduce funding available for new housing
  projects, at least for short-term future.

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• Creates National Housing Trust Fund. 65 of
  revenue from 4.2 basis points of Fannie and
  Freddie profits will create this fund to be
  distributed on formula basis to states, likely to
  supplement or create parallel THDA Housing Trust
  Fund in Tennessee. Very rough guess, depending on
  formula created, may provide 6 million - 10
  million annually to be distributed through THDA.
  Minimum 90 to be spent on rental housing
  minimum 75 on families at 30 or less AMI
  remaining 25 for families at 50 or less AMI.

• Impact As early as 2010, this could be a major
  source of added funding for developing housing
  opportunities for those people with very low
  income that we serve, especially rental housing
  projects, but also including some home ownership
  options.

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• Creates Capital Magnet Fund. Designed to attract
  private investment into affordable housing. 35
  of the revenue from 4.2 basis points of Fannie
  and Freddie profits (rough guess 200 million
  annually) goes to a competitive grant program
  operated by Secretary of Treasury and open to
  community development financial institutions
  and non-profit housing developers (e.g. CHDOs)
  for affordable housing, economic, and community
  revitalization projects. Aggregate cost of all
  projects funded must be at least 10 times grant
  amount.

• Impact Beginning 2010, potential new funding
  layer for affordable housing projects.

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• Creates fund to redevelop abandoned and
  foreclosed homes. Although it is currently not
  clear what locations in Tennessee might qualify,
  this provides nearly 4 billion nationally for
  states and local governments to purchase, rehab,
  resell, or tear down abandoned and foreclosed
  homes. Funds distributed like CDBG money, i.e.
  70 to localities, 30 to state. At least 25 of
  these funds will be used to house individuals or
  families at 50 or less of AMI. Funds are to be
  used within 18 months.

• Impact May provide opportunities for low income
  rental housing development by agencies or even
  free acquisition of properties with rehab
  financed by local housing authority with
  restriction that low income families, such as our
  consumers, be housed there. We should talk soon
  with local housing authorities and THDA about the
  option of using these funds for our consumers
  housing and then carefully monitor what funds
  come to what places in Tennessee so we can act
  where funding is allocated.

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HELPFUL WEBSITES

• www.hud.gov
• Extensive info on all HUD funding and Ohio HUD
  activities
• www.csh.org
• Corporation for Supportive Housing
• Click on Resources click on Financing guide
• www.nlihc.org
• National Low Income Housing Coalition
• Current info on National Housing Trust Fund

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HELPFUL WEBSITES

• www.housingwithinreach.org
• Tennessees Creating Homes Initiative
• Click on Housing Developer Information
• www.tacinc.org
• TAC is a non-profit organization that works to
  achieve positive outcomes on the behalf of people
  with disabilities and other special needs.

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WE WILL MAKE A DIFFERENCE
N

• ever doubt that a small group of
• thoughtful, committed citizens can change the
  world indeed, its the only thing that ever has.
• Margaret Mead

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WHAT I REALLY WANT TO KNOW IS . . .

• Questions
• and
• Answers