Minnesotans with Serious and Persistent Mental IllnessThe Long Road to Stability, Engagement, and Life SatisfactionThe Population Individuals with serious and persistent mental illness (SPMI) have chronic mental health conditions1, which require a stable lattice of community and mental health supports throughout the lifespan to maintain wellnss.2 1 in 17 Minnesotans live with SPMI.3 These individuals are overrepresented in Minnesota emergency departments, homelessness shelters, residential crisis stabilization facilities, and within the homeless population and yet are underserved or unserved in health care.2 People with SPMI can and do experience long periods of stability and achievement, but due to the chronic nature of their disease, they often cannot function without long-term support, even with consistent medication management.2,4When he was a boy, OCD made Swartz wash his hands hundreds of times, get up at all hours of the night to check the locks on the doors and wipe down the bathroom for an hour after showering lest anybody slip and fall. Now, intrusive thoughts, which can last hours and days, swipe his focus and concentration by day and steal away his sleep at night. "OCD is something Im going to battle every day. I guess its my life work, my project."5The Problem Despite the development of much more effective medications in the past 30 years, many individuals require long-term residential services to maintain stability.44

People with SPMI are using emergency and crisis services in record numbers: 56% of Minnesotans presenting in emergency settings in 2012 had a serious mental illness.6,7Nationally, emergency department mental health presentations have increased by 20% since 2006.4 And yet services are scaling back or being eliminated. Minnesota leads this troubling trend, having closed more than 50% of its acute care beds since 1990.8 In short, utilization of actute care services is in the rise, yet services are disappearing.4

It makes you feel desperate as a parent. I hoped it would be psychotic depression. Isnt that something for a mother to hope for? Something that could be successfully treated? The diagnosis was difficult to accept because schizophrenia was something that wasnt going to go away. Vicky, mother 5The Costs Despite closing doors and turning people away, weve doubled our spending on mental health services since 1996.4 In addition to burdens on emergency rooms and other acute care, jails and prisons are our psychiatric facilities for the 21st century. There are more individuals with mental health issues in these setting than any state psychiatric facility. About a fourth of inmates have a mental health diagnosis. Only about 1 in 6 individuals received needed mental health care.9 The leading barrier to improved mental and physical health among adults with SPMI is lack of housing stability.10 Annual Total Direct and Indirect Costs of Serious Mental Illness in 20027

Housing stability helps people avoid avoiding hospitalization. Its even a better predictor than receiving mental health services.11 50-70% of the homeless population in Minneosta reports having a mental health diagnosis.12 Innapropriate placement is a twofold expenditure: not only are acute services more costly7, but they prevent individuals with SPMI from being in a living arrangement conducive to contributing to their communities and staying well.4 Consistency in housing enables individuals to develop commuity connections, thus contributing to less need for acute services. These individuals are more likely to seek preventative treament and less of an economic burden on the community. Most importantly, they are more equipped to achieve meaninful life goals.12,13 There are a very limited number of housing options in the Southern Minnesota region for individuals with SPMI. When people feel a sense of agency in housing, they are motivated to engage in services.14 To stay off the street, we lived with various family and friends, sometimes renting a room in their home. We applied for every assistance program we could find, but found ourselves caught in a frustrating loop. I was denied low-rent Section Eight housing because my credit was bad, the result of my undiagnosed and untreated illness. No one wanted to rent to us because I did not have a stable work history, or bank account, or references. But when you dont have an address or phone number, you cant give a contact number for jobs. In addition, it also makes it difficult for clinics to make an appointment with you. Ramiro Guevara, consumer advocate5 Cost-effective treatment for individuals with SPMI exists, and they entail responsive community-based long-term care. These services need to be expanded in Minneosta. Health Professional Shortage Areas in MN16

Housing Supports for Adults with Serious Mental Illnesses (HSASMI) helps Minnesotans living with SPMI that are homeless, have experienced long term homelessness, or are exiting institutions and also face housing barriers. In 2013 there were 420 households served by HSASMI. In 2015 advocates are pushing for a Minnesota state budget proposal to serve an additional 840 households for a total of 1260 households.15 Bridges Housing Program provides rental assistance and support services for households in which at least one adult is living with a mental illness. Bridges serves over 500 households per year in-state. In 2013 there were 1366 households on the waiting list for Bridges, and demands is likely greater. While the 2013 Legislature increased funding for Bridges by $400,000 there was over $1.4 million in requests for those funds. There is a current proposal to budget services for an additional 200 households.15 References1 Minnesota Statues 2014, section 245.462, subdivision 20.2 Boardman, J. (2006). Health access and integration for adults with serious and persistent mental illness. Families, Systems, & Health, 24(1), 3-18.3 National Institute of Mental Health. The Numbers Count: Mental Disorders in America. November, 6, 2012. 4 American Hospital Association (2012). Bringing Behavioral Health into the Care Continuum: Opportunities to Improve Quality, Costs and Outcomes. Trendwatch, January 2012. 5 National Institute of Mental Health Policy Research Institute. Roadmap to Recovery & Cure. 2004. 6 The Wilder Foundation. (2013). Long-term homelessness among individuals and families. [Survey].7 National Institute of Mental Health. Annual Total Direct and Indirect Costs of Serious Mental Illness (2002). 8 Minnesota Department of Health. (2003). Profile of rural hospitals in Minnesota. Office of Rural Health Primary Care. 9 James, D, and Glaze, L. (2006). Mental health problems of prison and jail inmates. US Department of Justice, Bureau of Justice Statistics. Bureau of Justice Statistics Special Report.10 Smith, Daryl, "Barriers to Maintaining Independent Housing Faced by SPMI Adults" (2014). Master of Social Work Clinical Research Papers. Paper 387. 11 Browne, G. and Hemsley, M. (2010). Housing and living with a mental illness: exploring carers views. International Journal of Mental Health Nursing, 19(1), 9-22. 12 The Minneapolis Foundation. (2007, November). Homelessness in Minnesota [Fact sheet]. 13 Harkness, J., Newman, S. J., & Salkever, D. (2004). The cost-effectiveness of independent housing for the chronically mentally ill. Health Services Research,39(5), 13411360. 14 O'Hara, A. (2007). Housing for people with mental illness: update of a report to the President's New Freedom Commission.Psychiatric Services,58(7), 907-913.15 State Advisory Council on Mental Health (2012). 2012 Report to the Governor and Legislature. http://archive.leg.state.mn.us/docs/2013/mandated/130119.pdf16 Health Resources and Services Administration. Medically Underserved Areas/Populations (MUA/P) State Summary of Designated MUA/P. 2015.