Mental Health Reform Needs Supportive Housing

If we’re going to talk about changing our culture post-Newtown, we need to talk about supportive housing.

It shouldn’t be that difficult a conversation. Unlike the state’s heated discussions about potential gun legislation, we have consensus that something must be done about Connecticut’s mental health care system – which isn’t really a system at all.

While the public’s attention to mental health in the wake of the horrific Newtown school shooting is important, the irony is that we don’t know if the Newtown shooter was mentally ill.

What he did was horrific, but, as Kate Mattias, executive director of the National Alliance On Mental Illness-CT, said, “You don’t have to have a mental illness to do something sociopathic. You could just have no conscience. We just don’t know.”

We do know that we are attempting to roll a big rock up a steep hill. At a recent public hearing in Hartford, legislators listened to advocates, family members, and others talk about living with mental illness in Connecticut.

The most heart-breaking stories came from families who have exhausted every avenue looking for adequate treatment for their loved ones. How do they make their mother, brother, father, sister take their medication? What do they do when there are not enough psychiatrists to go around? And for how long should adolescents who need psychiatric care languish in hospital rooms?

We also know we are working against a powerful stigma.  At a hearing in Newtown, one young man said he was "terrified'' of people with mental illness who could do him harm -- though people with mental illness are far more likely to be victim than perpetrator.  That fear is repeated throughout the state when neighbors balk at supportive housing on their streets. In time, even the most vociferous opponents end up embracing them -- as much for their well-kept lawns as for their undeniable neighborliness.

Legislators intend to take what they’ve learned at the hearings and pass legislation by the end of February. As Don Williams, Senate president pro tempore, has said, the country is watching.

Careful consideration is important because some of the suggested fixes run the risk of treading on the civil rights of people with mental illness. There’s talk of passing an assisted outpatient commitment law, in which courts could order the medical treatment for people who won’t take their medication. Forty-four states – but not Connecticut -- have such laws, though the states’ specifics vary. Connecticut has civil commitment laws, said Mattias, though some critics say they leave families and loved ones with a high bar to clear.

“How wide a net are you casting?” Mattias said. “We don’t force people to take chemotherapy, and there’s definitely a question of civil rights if we’re forcing people to take medication.”

Some states require therapists to alert authorities if they suspect their clients are capable of doing harm, but even that raises tough questions, said Mattias. Such a mandate significantly alters the therapeutic relationship, and may deter some patients from speaking honestly to their therapists – or from seeking treatment in the first place.

And medication alone isn’t enough, said Mattias.

“They need community supports,” Mattias said. “They need to be in supportive housing where treatment can be given to them in a community setting.”

Whatever we learn about the Newtown shooter, we – all of us – need to talk more about permanent supportive housing, which effectively reintroduces people back into their communities, which costs just a fraction of hospital emergency rooms or inpatient psychiatric care.

We need to talk, and then we need to act. According to Partnership for Strong Communities, where I work part-time, the state needs 10,000 supportive housing units to meet the state’s current need. We’re not yet halfway there.