Skip to Main Content
NY.gov Portal State Agency Listing Search all of NY.gov
Ann Marie T. Sullivan, M.D., Acting Commissioner
Governor Andrew M. Cuomo

Supported Housing Guidelines

I. Background Information

In the mid 1970's, many states began to realize that people with serious mental illness often need assistance in securing housing and may need support and rehabilitative services to succeed in the housing. New York, along with many other states, responded to this need mainly though the development of transitional group homes and apartments.

Residence in these programs was often accompanied by requirements to attend service programs, and residents were expected to move as their rehabilitation progressed.

Although many individuals have received beneficial rehabilitation from the community residence program, which has helped them to live successfully in the community, the limitations of this approach have become apparent. People do not want to move each time they make progress in their rehabilitation; often affordable housing is not available for people to "transition" into; and many people do not want or may not require the structure of a residential program.

In recognition of these needs, New York State began the implementation of Supported Housing (SH). This initiative increases permanent housing options for people with mental illness and will make available recipient-specific support services designed to assist people in succeeding in their housing. This effort is not meant to replace existing services that are consistent with the principles of Supported Housing; rather, it is intended to stimulate the Supported Housing approach throughout the entire mental health services network. Within this context, the Supported Housing funding parameters detailed in these Guidelines should be viewed as one component of an overall shift in the Office of Mental Health’s (OMH) policy toward provision of services to mentally ill individuals residing in the community. To that end, local providers, counties and Field Offices should design support systems using these funds which will not duplicate services, but rather provide necessary enhancements to existing community service networks to accomplish Supported Housing goals.

The intent of these Guidelines is to facilitate the development of Supported Housing in New York State for people with serious mental illness by:

  1. Providing an overview of the Supported Housing concept, including principles and goals. This overview should prove useful for Field Offices, local government and organizations in the design and/or understanding of specific Supported Housing initiatives.
  2. Providing specific information on the implementation of Supported Housing, including funding levels, implementation strategies, target population, contracting approaches and allowable costs.

II. The Supported Housing Approach and Principles to Guide Implementation

The following section provides a brief overview of the Supported Housing concept and presents three primary principles to guide Supported Housing implementation. Governments and organizations that will be designing Supported Housing initiatives are referred to a more detailed outline of principles and goals (see Appendix I). This document outlines the Supported Housing approach and offers recommendations which should be incorporated into local Supported Housing proposals.

  1. The Supported Housing Approach

    The intent of Supported Housing is to ensure that individuals who are seriously and persistently mentally ill (SPMI) may exercise their right to choose where they are going to live, taking into consideration the recipient’s functional skills, the range of affordable housing options available in the area under consideration, and the type and extent of services and resources that recipients require to maintain their residence with the community. The Supported Housing initiative should not be considered a “program” which is designed to develop a specific number of beds; rather, it is an approach which will create housing opportunities for people through development of a range of housing options, community support services, rental stipends, and recipient specific advocacy and brokering. As such, this initiative encompasses community support and psychiatric rehabilitation approaches.

  2. Principles to Guide Supported Housing Implementation

    The following should be used to guide the development of Supported Housing:

    The unifying principle of Supported Housing is that individual options in choosing preferred long term housing must be enhanced through:

    1. Increasing the number of affordable options available to recipients;
    2. Ensuring the provision of community supports necessary to assist recipients in succeeding in their preferred housing and to meaningfully integrate recipients into the community; and
    3. Separating housing from support services by assisting the resident to remain in the housing of his choice while the type and intensity of services vary to meet the changing needs of the individual.

III Guidelines for the Development of Supported Housing Initiatives

  1. Appropriation of Funds

    An appropriation will be requested annually for the Supported Housing initiative to fund housing development costs, housing support services and rental stipends. As noted above, these funds should be used to enhance existing community based service systems to enable people with mental illness to live in generic, permanent housing.

  2. Target Populations

    For the initial years of Supported Housing implementation, the program will be targeted to three populations: individuals ready to leave certified community residences; individuals discharge ready from psychiatric centers; and individuals who are currently homeless, living in shelters, depots or on the streets. Additionally, individuals served by this program must meet the eligibility criteria for a serious and persistent mental illness. (see Appendix II) Agencies participating in his program are required to meet these eligibility criteria.

    Statewide, at least 50% of the units made available through this initiative are to be reserved for individuals ready to leave licensed community residences. This approach will free capacity in the community residence program for individuals in need of that level of care and will provide permanent housing opportunities for people ready to leave transitional residential programs.

  3. Implementation Approaches

    The Supported Housing implementation approach has two main components, the Housing Access Strategy, which is intended to locate and secure decent affordable housing in the community and the Housing Support Strategy, which includes housing support services, including contingency funds. The following sections detail these strategies and provide suggestions for Supported Housing program designs.

    1. Housing Access Strategy

      The housing access strategy will focus on gaining access to affordable housing for people with serious mental illness. This goal will be facilitated by the following:

      1. negotiating access to publicly or privately funded affordable housing, using OMH rental stipends and capital funding to leverage other public funds where necessary and appropriate;
      2. assisting recipients in accessing Federal Section 8 and other available housing subsidies;
      3. assisting recipients in locating and securing affording housing on the open market;
      4. assisting the recipient with the cost of establishing a household; and
      5. providing rent stipends funded through the Supported Housing appropriation where necessary.

      Accessed housing should be in housing stock considered normal for the community. In most cases set aside units should be mixed with units available to the general population. Wherever possible, in instances where two or more Supported Housing recipients share a housing unit, each recipient should have a private bedroom.

      1. Negotiating Access to Affordable Housing

        First priority should be given to negotiating access to housing developed using public capital funds (e.g., Department of Social Services (DSS), Division of Housing and Community Renewal (DHCR) which is, therefore, rented below the market rate and should not experience significant rental increases in the future. The OMH Central Office will facilitate contacts between Field Offices/ local government and DHCR-funded not-for-profit housing agencies to encourage interagency cooperation in Supported Housing development. Where necessary, OMH may provide Local Capital funds to be used either solely or in conjunction with DHCR, DSS or other available funding to develop housing units for Supported Housing recipients.

        In instances where OMH Local Capital funds are accessed to develop housing, rents are approved by OMH through a cost-based methodology based on approved property operating costs. Agencies seeking such funding should contact the OMH Field Office for information regarding Local Capital Grant application procedures.

        Once access to a project has been negotiated, a contact will be developed between the Field Office or county and the housing agency which will specify the terms of the agreement.

        Recipient-held leases are strongly encouraged.

      2. Facilitating Recipient Access to HUD Section 8 Subsidies

        Many localities throughout the state receive direct Federal funding through the US Housing and Urban Development (HUD) Section 8 program to provide rent subsidies for eligible residents. Most Supported Housing recipients will be eligible to receive such assistance, and agencies must ensure that recipients apply for the required certification and that the Section 8 application has been filed. Additionally, the Field Office, the county, and/or the service or housing provider should assume an advocacy role with local Section 8 agencies to facilitate Supported Housing recipients’ access to such assistance.

      3. Locating and Securing Affordable Housing on the Open Market

        In areas of the state where affordable housing is readily available, access to units on the open market can be negotiated with landlords or property management agencies. It is expected that such housing may often be secured using the guarantee of support services but without the need for rent stipends.

      4. Household Establishment

        Funds may be provided under the Supported Housing program to assist recipients or housing agencies in meeting initial expenses incurred in establishing residences. These grants may be administered by the Supported Housing service provider, as discussed in the Housing Support Strategy section of these guidelines, or by the housing agency under contract to the Field Office or county.

        Wherever possible, recipients should be involved in selecting furnishings for the unit they will occupy. Agencies should address their plans for disposition of the furnishings in the event the recipient moves.
        See the Supported Housing Contract and Budgeting Guidelines (Start-up) for eligible costs.

      5. Rent Stipends

        Whether housing is accessed in publicly-funded developments or in the open market, it is expected that the provision of a rent subsidy will be necessary in many cases where a subsidy is not available through Section 8 or other sources, and where the rent for a unit is beyond the recipient’s means. Rent stipends paid through the Supported Housing appropriation will generally be paid to the housing agency through a contract with the Field Office or county. Under no circumstances should the stipend be paid directly to the recipient. Direct payment could jeopardize other client entitlement, (e.g., Supplemental Social Security Income/SSI).

        Individual stipend amounts must be calculated based upon the difference between what the tenant can pay and the rent for the unit. Please refer to the “Recipient Rental Stipend Worksheet”. (Appendix III) These worksheets should be completed annually with all individuals who are eligible for rent stipends under this service. Where possible, the not-for-profit housing provider should be responsible for completing these forms.) The recipient must contribute 30% of his/her adjusted income toward the total cost of cost of his/her rent and utilities.

        Rents for housing developed with public capital funds are determined via a cost-based methodology. For open market rentals, reimbursement to any individual contract agency will not exceed an average based on a per person rent allocation. Agencies should, therefore, avoid high-rent units. Additionally, agencies should obtain documentation to demonstrate that the rents paid by Supported Housing Tenants are consistent with the low to moderate rental market in the area.

        In no instance should the leases entered under this initiative obligate the contract agency for funds beyond the negotiated rent stipend. This applies to leases with both private and not-for-profit landlords.

        When two or more Supported Housing recipients elect to share an apartment, the rental obligation should be divided between the tenants on a percentage basis, according to the number of individuals that will share the apartment or by the relative size of the bedrooms, if applicable.

        Each individual would then be eligible for a stipend, if necessary, according to the methodology detailed in the “Recipient Rental Stipend Payment Worksheet.”

        If a Supported Housing recipient elects to live with individuals who do not receive services under this program (e.g. the children or personal friends of the recipient), the rental obligation should likewise be determined on a percentage basis, unless the other individuals receive some form of public assistance. In this latter case, the rent to be paid by the Supported Housing recipient should be determined by subtracting the amount the other individuals receive as a shelter allowance from the total rent, then calculating the necessary stipend according to the “Recipient Rental Stipend Payment Worksheet” methodology.

        Agencies administering rent stipend payments on behalf of Supported Housing recipients are required to verify on a monthly basis, and retain documentation, that the recipient is still occupying the unit for which the stipend is being paid. This verification can be either face-to- face contact or, in cases where the agency administering the stipend is not the Supported Housing service agency, through contact with the recipient’s case manager.

    2. Housing Support Strategy

      All individuals enrolled in Supported Housing programs must have access to housing related case management services. These services may be funded through the Supported Housing initiative can be absorbed by existing program capacity.

      Due to the varying stages of development of community support systems in different areas throughout the state, the support services listed below may all be provided by the Supported Housing service provider, or in coordination with existing case managers to include:

      1. Identification of Referral Sources - Field Offices and local government will identify providers to serve specific target populations based on regional priorities. Supported Housing service providers will identify referral sources which will reflect target population priorities (e.g., specific community residence providers in a defined geographic area).

      2. Outreach - Supported Housing service providers will provide aggressive outreach to referral sources to assure all potential recipients are aware of the service and housing availability.

      3. Eligibility Determination - evaluate individuals according to the SPMI eligibility criteria.

      4. Facilitate Recipient Choice - housing type and location should be matched with the recipient’s preference and goals, taking into consideration available housing options and support services and the recipient’s functional skills.

      5. Provide a Housing Related Psychiatric Rehabilitation Assessment - the psychiatric rehabilitation approach to assessment solicits recipient preference and aspirations and evaluates the person’s strengths and need for support and/or training necessary to succeed in the housing setting under consideration. This approach should be used to develop an individual support plan.

        The necessary supports which have been identified through this assessment must be available before the recipient moves into the housing unit.

      6. Implementation of the Support Plan - based on the psychiatric rehabilitation assessment, the Supported Housing service agency must provide a description of the proposed process for development and implementation of a recipient-specific support plan. The plan should be consistent with the Supported Housing principles contained in these Guidelines and should adequately address recipient access to preventive, ongoing and emergency services, as well as the frequency of planned contact with the recipient, and the interval at which the support plan will be reviewed. The support plan must be based on recipient preference and must be approved by the recipient.

      7. Assistance in Housing Negotiations - assistance to recipients will be provided around lease negotiation and review, including explanation of lease terms. Housing support staff should assure that recipients are afforded the same rights and responsibilities as other tenants.

      8. Help in Establishing a Household - Supported Housing service providers will help in the establishment of the household including, if roommates are involved, facilitating cooperative roommate agreements on bill payments, division of household responsibility, etc. These agencies may also be responsible for managing the Household Establishment process as described earlier in these Guidelines.

      9. Supported Housing Case Management - such services are generally subsumed under the definition of case management as contained in the Consolidated Fiscal Report (CFR) Manual, with special emphasis given to services that enable recipients to remain in permanent housing. Such services include: negotiating leases; assistance in resolving issues between the landlord and the recipient, or between roommates; financial consultations; and assistance in daily living skill development when appropriate. These services must be flexible and made available on an as needed basis.

      10. Contingency Fund Management - These are funds available to the Supported Housing service provider to resolve situations that place the recipient at risk of losing his/her housing. These funds are not intended to replace emergency funds available through the Department of Social Services or other sources, and Supported Housing service providers should make every effort to access such funds before contingency funds are used. Please refer to the Supported Housing Contract and Budgeting Guidelines for a listing of eligible expenses.

        In addition to the above recipient-specific services, Supported Housing service providers will be asked to address the following:

      11. Support to Landlords - to succeed in gaining access to housing for recipients, landlords must feel confident that, should a problem arise, assistance is available to the tenant and to them if necessary. Accordingly, the Supported Housing service provider must play a dual role in maintaining an amicable tenant/landlord relationship.  As an advocate for the recipient, the provider must assure that tenant rights as guaranteed by the lease and under law are upheld and that the recipient receives treatment equivalent to other tenants. However, the provider must also be aware of the rights and concerns of the landlord and should work with the recipient to avoid behavior which may be considered a nuisance to other tenants, or which may result in damage. Prompt responsiveness to emergency situations arising in tenant/landlord relationships will ultimately promote the success of this program through increasing its attractiveness to property managers and landlords.

      12. Hiring Recipients (Consumers) - Supported Housing service providers should actively seek qualified recipients to employ as housing support staff, consistent with equal opportunity and affirmative action principles and law.

      13. Access Generic Subsidies - Supported Housing service providers should approach local housing authorities to negotiate Section 8 rent vouchers to expand their resources so that the provider will be able to assist additional recipients in accessing housing.

        In most cases the service agreement (contracts) for these support services will be between local government and mental health, social services, or housing assistance service providers. The agreements should specify how the above services and functions will be made available. For those services that the Supported Housing service agency will provide directly, a budget must be supplied following the Consolidated Fiscal Report procedures. For ongoing support services which will be provided by other than Supported Housing resources (e.g., existing services), providers must be listed in the written agreement. The Field Office has discretion to approve proposed plans based on an evaluation of the provider’s service plan, target population, staff qualifications, service frequency, administration and overhead, and the funding requested.

  4. Coordination of Housing Access and Housing Support Services

    Separate written agreements for housing and housing supports will facilitate the separation of these two needs. People will be treated as tenants by their landlords and as recipients by Supported Housing service providers. For recipients to succeed in housing, however, and for the mental health system to gain access to housing on behalf of recipients, there must be coordination between the housing and the service provider.

    Field Offices and/or county governments will be responsible for facilitating written agreements between these two parties. The agreements should cover referrals, services available from both parties, a sample lease agreed to by both parties, contact person and phone numbers including after hours emergency access, as well as other issues felt relevant by either party or the Field Office/county.

    To summarize, in most cases the housing and support strategy in a given area will consist of three written agreements:

    • between the Field Office and the housing agency for access to a number of units;
    • between the county and Supported Housing service provider for housing support services; and
    • between the housing agency and the Supported Housing service provider to detail mutual responsibilities. This agreement will be facilitated by the Field Office/local government.

    In addition, there will be two recipient specific agreements; the lease and the recipient approved support plan.

    Note: In certain areas of the state, where affordable housing is available without subsidies, the housing agreement may not be necessary.

  5. Program Proposal

    Program Proposals should address the following issues:

    Target Populations

    Section III. B.

    Housing Access Strategy (a-e)

    Section III. C. 1.

    Housing Support Strategy (a-m)

    Section III. C. 2.

    Coordination of Housing Access and Housing Support Services

    Section III. D.

    If some proposal elements are to be provided by another agency, that agency should be identified and a companion proposal should be submitted. Additionally, if not incorporated into the above issues, the following specific program elements should be addressed:

    • Total persons to be served
    • After hours emergency plan
    • Responsibility for annual recipient income and rent stipend determination
    • Lease Terms
    • Responsibility for Reporting Requirements
    • A summary of proposed Start-Up, Rent/Property, and Case Management funding proposals.

    A brief summary of the Program Proposal should be contained within the Program Description as a contract appendix.

    Appendix I  

    Principles to Guide Supported Housing Implementation

    The unifying principle of Supported Housing is that individual options in choosing preferred long term housing must be enhanced through:

    1. increasing the number of affordable options available to recipients;
    2. assuring the provision of community supports necessary to assist the recipient in succeeding in his/her preferred housing and to meaningfully integrate recipients into their community; and
    3. separating housing from support services by assisting the resident to remain in the housing of his choice while the type and intensity of services vary to meet the changing needs of the individual.

    Subsumed under this principle are the following basic principles and goals.

    Principle I

    Recipient Participation - The recipient must play an integral role in the Supported Housing approach including active involvement in the choice of housing, type, frequency and intensity of services, and in the exercise of their rights as tenants and individuals.

    Goal 1

    To the extent that options permit, the recipient will play an active role in the choice of setting and living arrangement.

    Goal 2

    Housing needs assessment and rehabilitation services will be available to help the recipient make choices and develop the skills necessary to succeed in their housing.

    Goal 3

    Outreach will be provided to the target population to assure their awareness of the program and encourage participation.

    Goal 4

    Recipients should have formal input into program and policy decisions.

    Goal 5

    Tenants rights and grievance procedures should be explicit.

    Goal 6

    All tenants should be granted a lease for Supported Housing preferably directly between the recipient and landlord.

    Goal 7

    Recipients’ opportunity for privacy will be maximized by providing access to separate bedrooms where feasible.

    Goal 8

    Recipients should be given equal opportunity to obtain employment as Supported Housing staff when appropriate.

    Principle II

    System Development and Access - Efforts will be made on a systemic basic to increase the development, availability and accessibility of permanent housing for recipients who are seriously and persistently mentally ill.

    Goal 1

    OMH will negotiate set asides for people with serious mental illness in housing developed by state and local not-for-profit and for profit housing developers. Where appropriate, OMH will use rent stipends and capital funds to stimulate housing development and to gain access to housing.

    Goal 2

    OMH will provide a rent stipend when necessary to guarantee that recipients can afford decent housing at fair rentals and to encourage landlords to accept people with serious mental illness as a low financial risk tenant.

    Goal 3

    Funds will be available to assist recipients with initial costs associated with setting up a home, i.e., security deposits, utility deposits, furniture, household supplies, etc.

    Goal 4

    Efforts to educate landlords/managers regarding the support, staff services and resources available to support this population in their housing will be undertaken.

    Goal 5

    Landlords/managers will be provided access to support staff, should the need arise, to assist in addressing landlord/tenant issues.

    Goal 6

    Housing staff will provide outreach, assessment and referral services to the target population to assure access to appropriate housing option.

    Principle III

    Support, Maintenance and Rehabilitative Services - Supported Housing is permanent housing. Once obtained, efforts will be made to assist the individual to maintain the residence through the provision of funds, setting of reasonable expectations, rehabilitation services and support services.

    Goal 1

    Rental stipends will be available to supplement recipients own income when necessary and appropriate.

    Goal 2

    Requirements usually associated with housing programs are not appropriate.

    • no length of stay restrictions
    • no program attendance requirements
    • housing is not lost during hospitalization
    • no requirement to move from housing as the need for services change

    Goal 3

    Supported Housing staff will work with recipients/tenants and landlords/managers as a broker to negotiate problems often related to the loss of housing.

    Individual Supported Housing programs must ensure access to a full range of supports, but in most cases these services will be provided through the overall community support system in the area, and not directly by the Supported Housing program.

    Goal 4

    Encourage and assist the recipient to develop natural community support and use community resources to strengthen bond to neighborhood and encourage integration into community.

    Goal 5

    In-home and community-based psychiatric rehabilitation services addressing all of the skills needed to successfully live in the chosen housing environment will be available on an as needed basis.

    Goal 6

    A full range of Community Support Services will be available to the recipient, including:

    • employment opportunities (e.g., supported work)
    • transportation
    • mental health treatment
    • case management
    • assistance with obtaining entitlements
    • 24 hour crisis outreach services
    • medical/dental care

    Appendix II

    Serious and Persistent Mental Illness

    In order to be considered an adult with a serious and persistent mental illness, "1" below must be met, in addition to either "2", "3", or "4".

    1. Designated Mental Illness

      The individual is 18 years of age or older and currently meets the criteria for a DSM-IV psychiatric diagnosis other than alcohol or drug disorders, organic brain syndromes, developmental disabilities or social conditions. ICD-CM categories and codes that do not have an equivalent in DSM-IV are also included mental illness diagnoses.

      And

    2. Social Security Supplemental Income or Supplemental Social Security Disability Income due to Mental Illness

      The individual is currently enrolled in SSI/SSDI due to a designated mental illness.

      Or

    3. Extended Impairment in Functioning due to Mental Illness

      1. Documentation that the individual has experienced two of the following four functional limitations due to a designated mental illness over the past 12 months on a continuous or intermittent basis:
        1. Marked difficulties in self care (personal hygiene, diet, clothing avoiding injuries, securing health care or complying with medical advice).
        2. Marked restriction of activities of daily living (maintaining a residence, using transportation, day to day money management, accessing community services).
        3. Marked difficulties in maintaining social functioning (establishing and maintaining social relationships, interpersonal interactions with primary partner, children or other family members, friends, neighbors, social skills, compliance with social norms, appropriate use of leisure time).
        4. Frequent deficiencies of concentration, persistence or pace resulting in failure to complete tasks in a timely manner (ability to complete tasks commonly found in work settings or in structured activities that take place in home or school settings, individuals may exhibit limitations in these areas when they repeatedly are unable to complete errors in tasks, or require assistance in the completion of tasks).

        Or

      2. Reliance on Psychiatric Treatment, Rehabilitation and Supports

      A documented history shows that the individual at some prior time met the threshold for 3 (above), but the symptoms and/or functioning problems are currently attenuated by medication or psychiatric rehabilitation and supports. Medication refers to psychotropic medications which may control certain primary manifestations of mental disorder; e.g. hallucinations, but may or may not affect functional limitations imposed by the mental disorder. Psychiatric rehabilitation and supports refer to highly structured and supportive settings (e.g. Congregate or Apartment Treatment Programs) which may greatly reduce the demands placed on the individual and thereby, minimize overt symptoms and signs of the underlying mental disorder.

    Appendix III

     

           

               
    Recipient Rental Stipend Worksheet
    (To be completed annually)

     

         
       

     

       

     

    Recipient Name  

    Date

       

     

               
    Recipient SS #  

     

       

     

               

    Monthly Income and Adjustments

           
               
    Income  

     

    Adjustments    
        (Include Support of Minors, Child Care Expenses, or Court Expenses)
               
          Source   Amount
               
    1. Net Wages  

     

       

     

               
    2. SSD  

     

       

     

               
    3. SSI Source Amount  

     

       

     

               
    4. Pension  

     

    Total (B)  

     

               
    5. Alimony  

     

       

     

               

    6. Other

     

     

       

     

               
    7. Total (A)  

     

       

     

               
    Recipient Rental Payment

     

         

     

               
    8. Monthly Net Income  

    (Line 7 Above, A minus B)

       
               
    9. Recipient Rent Payment  

    Monthly Net Income X 30%

       
    (Inclusive of Utility Heat and Electric Costs)        

    Certification

    1. The above information is accurate to the best of my knowledge and documentation of income and expenses is attached to this form.
    2. The recipient agrees to inform the contract agency of any changes in income or adjustments at the time they occur.
    3. Application for federal Section 8 rental assistance has been made and will be diligently pursued.

    Recipient Name

     

     

     

     

     (Print)

     

    (Signature)

     

     

     

     

    Staff Name

     

     

     

     

    (Print)

     

     (Signature)

           

    Agency Name

     

     

     

     

     

     

     

    Agency Address