As residential facilities are built / reshaped and the inventory of supported housing and subsidized housing is increased, opportunities to develop new resources to meet specialized population needs will be available. There are a number of specialized populations that have been identified that will require special residential and supported housing programs.
Minimal Barrier Housing
As previously discussed, many communities are facing an increasing number of individuals requiring minimal barrier housing. These individuals are faced with significant challenges
including serious mental illness, substance use issues, physical illness, and behavioral problems. They are frequent users of many of the current support systems. A number of forensic clients would fall into this category and would require minimal barrier housing.
For many of these individuals, maintaining proper housing is a constant challenge. This is due in many cases to a transient lifestyle, poor problem-solving skills and a reluctance to engage in any form of support systems - including Mental Health. Many have difficulty managing money and are in constant financial crisis. Many cannot organize their daily activities to provide themselves with proper nutrition.
Many individuals requiring minimal barrier housing have “burnt their bridges” with many of the traditional supports available to them. This is due to ongoing problematic behavior and chaotic lifestyle. As a result, they often end up on the street, or live in low rent motels located in crime ridden areas of the community.
The minimal barrier housing programs would be specially designed where the expectation of problematic behavior is built into the program and allowances are made accordingly. Services provided to these individuals must be provided in non traditional ways. A “housing first” approach would be utilized whereby housing is supplied based on need and not on treatment requirements. A philosophy that subscribes to a “no evictions” policy is important to ensure housing is
maintained throughout most situations. Infractions of the law will be dealt with by the criminal code and court system.20 Housing will be governed by the Residential Tenancy Act.
Due to the nature of the clients’ need for housing, opportunities for the client to obtain housing must be delinked to the participation in rehabilitation services or programs. The goal is to provide stable housing and to build trust for future engagement in services when the client is ready. Support is provided on site on a daily basis and may be accessible from 4 – 12 hours per day depending on the type of program. Residents decide to access the support if they choose. There are very few minimal barrier housing resources purposely designed in Fraser Health to accommodate clients with these special needs. A regional minimal barrier resource for this population group may not work as well as an individual community resource due to clients reluctance to move out of their home community. All communities in Fraser Health need to build minimal barrier housing capacity to meet this growing need.
Housing and residential programs targeted toward youth or younger adults
There has been an identified need to develop housing resources that are specifically designed for younger clients. Youths in the transitional ages from 17 to 21 require age appropriate housing resources that currently are not available. These youths would be transitioning from Child & Youth Mental Health within the Ministry of Children and Family Development or be new referrals to the Mental Health system. Supported housing or subsidized housing would work well for these individuals who prefer less restrictive housing models.
A licensed residential resource for Early Psychosis Intervention has also been identified as a specialized resource needing development for younger adults. The EPI facility would be considered a Fraser Health resource due to the specialized nature of such a resource. Dually disordered individuals who have a mental illness in conjunction with another mental disorder. This may include individuals with a mental illness and an organic brain syndrome, developmental disability, or an acquired brain injury.
As mentioned previously, there has been an identified need to plan residential and housing resources for individuals that have a concurrent mental illness and other mental disorder. These individuals have been identified as having a “dual disorder”. This may include individuals who have a mental illness along with organic brain syndrome, developmental disorders or an acquired brain injury. Typically, they may not fit the current program mandate of many mental health residential facilities due to behavioural problems or significant care needs. Clients who may also be included in this grouping would include medically complex psycho-geriatric clients. Many times these individuals “fall through the cracks” and are provided minimal housing resources due to “jurisdictional issues” between Ministries and Health Authorities. Many times, Mental Health services within the Health Authority have provided care to these individuals in “one off” type arrangements as there were no other resources or options available. These special contractual arrangements have been made with private operators at significant expense to the Health Authority and a specialized resource could address these needs more readily.
It will be important to work in partnership with other Fraser Health programs such as the Head Injury program, Dual Disorder program (mental illness / developmental disability), and Fraser Health Residential Services. The Ministry for Children and Family Development will also be an important partner to develop specialized housing partnerships with.
Due to a wide range of needs required by concurrently disordered individuals, both supported housing models and licensed residential care beds will need to be developed.
Support to Inpatient Psychiatry units
There is a growing issue that many inpatient psychiatric units are facing. Individuals have been admitted onto the inpatient psychiatric units for treatment only to find there is no place to be discharged to when their illness is stabilized. Many clients spend weeks and sometimes months on inpatient units waiting for placement. At the other end of the spectrum, clients are admitted to the inpatient psychiatric units and discharged earlier than anticipated due to pressures for the bed. There is a need to develop transitional housing and a “step-down” capacity to support Fraser Health’s inpatient psychiatric units. This will ensure improved flow-through and reduce the number of beds being blocked on inpatient psychiatric units.
“Step-down” capacity could be developed by designating a few beds in current licensed
residential facilities as “step-down” beds where individuals who are stable and waiting for longer term placement could be discharged to. Each health area could identify one facility to provide this step-down capability.
Eating disorder residential resource
It has been identified that an eating disorder residential program be established as a specialized residential resource in Fraser Health. Currently there is only one family care home bed in Fraser South for this specialized population. This resource would be a licensed residential facility due to the treatment orientated nature of the program. This would be a Fraser Health regional resource due to the specialized staffing, resources and costs required to operate the program.
Resources for concurrently disordered clients whose primary issue is substance use There has been an identified need to develop housing resources for individuals who have
concurrent disorders, but whose primary issue is substance use. These individuals would be best served in supported housing models where support is provided as needed. Also SIL type
subsidized rental units with support could meet this growing need. There is very little in the way of supported housing resources for concurrently disordered individuals in Fraser Health whose main issue is substance use.
Vancouver Coastal Health Authority has developed a partnership with BC Housing in providing 52 units of second stage housing for individuals leaving support recovery homes in the Vancouver area. This model is one that Fraser Health should adapt to develop increased capacity for persons recovering from addictions.
Aging in place facilities
Clients in many of Fraser Health’s residential facilities are aging. As new residential facilities are being developed, there is a need to design facilities for “aging in place” residents. This need will continue to become more acute as mental health clients age and the population increases in all communities.
The need to develop “complex care” residential facilities is also needed to manage aging clients with complex psychiatric and medical needs. Due to the complex nature of the care required, partnerships with other Fraser Health programs such as Home and Community Care will need to be developed.
Many of these specialized residential facilities will serve as regional resources. Current licensed residential facilities that have the physical capability may be identified as potential facilities to provide these specialized resources. This would be following consultation with the individual service provider.
Specialized Housing and Residential Resources
A number of identified populations will need specialized housing and residential resources developed to meet their specific needs. Due to the specialized nature of the programming, and development costs, many of these resources will serve as regional resources.
Objective Develop regional resources for specialized populations.
Activity Over the next five years develop regional residential and housing resources for specialized populations. These populations include clients needing minimal barrier housing, youth & younger adults, dually disordered with mental illness & a secondary mental disorder, persons with eating disorders, concurrently disordered individuals with mental illness and substance use whose primary issue is substance use, and clients needing aging in place resources.
Outcomes Specialized populations will have access to appropriate programming
Performance Measures
Within 5 years, each geographic region will have one residential facility that serves one identified specialized population.
Even though the development of new housing and residential resources are a significant aspect of this housing plan, there are also a number of other recommended changes that are being put forward that will improve the current housing and residential program significantly. Following are these additional recommendations.