Fusing Fitness With Mental Health Treatment in Supportive Housing and Related Settings

The New Social Worker magazine published a piece I wrote last summer shortly after earning my MSW in their Summer 2017 issue [Available for Download here].

Here is an excerpt: 

Four Attributes of an Effective Program

During the past year, I have identified four core attributes of the programs that effectively foster an atmosphere of health within the community and that enable individuals to attain their physical health, mental health, and recovery goals.

First, the programs provide preventive, holistic healthcare by addressing chronic health problems proactively—a key to improving quality of life and reducing emergency room visits.

Second, the programs fuse fitness with mental health in a setting that contrasts the traditional seated, face-to-face counseling experience. The transference experience is quite different when a client and worker chat while pedaling stationary bicycles next to one another. Individuals often seem more comfortable talking while exercising and frequently share information with me that they have not yet talked about with their social workers or case managers. For example, a client recently disclosed to me how his family dynamics influence his substance use while he rested between sets of 10 push-ups. I am able to discuss such experiences with clients and encourage them to share these issues with their social workers.

Third, clinical evidence indicates that exercise serves as an effective tool in the substance abuse intervention toolkit by affecting the brain’s reward system and serving as a positive, non-drug reinforcer (Smith & Lynch, 2012). In a practical sense, exercise provides a structured alternative to substance use during the period in which one prepares for and engages in it.

Fourth, exercise programs build community among staff and tenants and promote egalitarianism in the client-worker relationship. Typical barriers disintegrate when a case manager and client try to complete one last squat or shoulder press together.

Improving safety without building a Shelter-to-Prison Pipeline

Department of Homeless Services security guards – called peace officers or special officers – earn a starting salary of $31,482/year to maintain order at shelters where many of the residents have severe mental illness and where everyone experiences the anxieties, agitations and heightened stress levels associated with poverty. At family shelters, young children mingle with teens and adults and domestic violence is common. So is substance use. 

Here is a list of special working conditions copy and pasted from the DHS Special Officer application:

"Some of the physical activities performed by Special Officers and environmental conditions experienced are: working outdoors in all kinds of weather; walking and/or standing in an assigned area during a tour; driving or sitting in a patrol car during a tour while remaining alert; running after a fleeing suspect; climbing up stairs; may assist in carrying an injured adult; gripping persons to prevent escape; restraining a suspect by use of handcuffs; may be required to detect odors such as those caused by smoke or gas leaks; engaging in hand to hand struggles to subdue a suspect resisting arrest; being physically active for prolonged periods of time; understanding verbal communication over a radio with background noise; reading and writing under low light conditions; carrying or wearing heavy equipment and wearing a bullet-resistant vest."

It's a demanding, physical job. As the face of authority and of the shelter itself, peace officers tend to bear the brunt of shelter residents' anger. Yet, they lack the de-escalation training of a social worker or the authority of a police officer. Social service staff and mental health workers do not spend nights at the shelters - the special officers are the only ones there. The officers deserve extensive social service training and support to better work with clients who experience emotional disturbances as well as those who need to save face and never back down from perceived challenges. Meanwhile, residents deserve compassion, patience and understanding of their day-to-day frustrations, including those that stem from discomfort, powerlessness and lack of solitude.

Two days ago, the City announced that the NYPD will broaden oversight at city shelters and assign additional cops to manage the whole force of 771 peace officers. This could be a positive development: NYPD will provide more training on working with emotionally disturbed persons (EDP) and victims of abuse. The move will likely foster more accountability.

Nevertheless, When the law enforcement presence increases, arrests increase. The new chain of command could lead to many unintended consequences.

For every 'bad apple' violent offender who makes the environment dangerous or unhealthy for everyone else, there are certainly many more low-level offenders whose minor misdeeds (open containers, sex work, marijuana use) ensnare them in the criminal justice system. That's what happens at public schools where the presence of police officers means the criminal justice system now punishes issues (like petty theft or hallway scuffles) previously handled in-house by the school. That has led to more children and young adults yoked with records that weigh them down for life, lead to more severe sentences after violations (accumulating offenses or 'strikes') and inhibit employment and housing opportunities. 

NYPD Deputy Chief Edward Thompson said the new oversight structure will promote collaboration between peace officers and police. Again, that is a mix of good and bad. 

Would police encourage peace officers to carry broken windows policing into shelters in order to make more arrests for minor quality of life violations? Would they impose a form of indiscriminate stop-and-frisk? Would police and collaborating peace officers safely and reasonably manage individuals with mental illness? Or would they try to overpower emotionally disturbed people rather than patiently work with them? 

Last year, NYPD officers, plus cops from New Jersey and Long Island, combed shelter rolls to hunt residents with outstanding warrants. Such warrants often relate to unpaid citations for quality of life violations like open containers or public urination, the violations that already disproportionately punish low-income people. Such fines also pose a more severe financial burden to the working poor or individuals on a fixed income.

Perhaps this is a smart structural change when we consider the sprawling, unsafe shelter system, but, we gotta remember, the move does not treat the core issues of an over-reliance on temporary shelters and the failure to prioritize and develop permanent supportive housing. It's just a different style of managing the warehouse.

Bottom line: However the City restructures the security system within shelters, we really, really need more supportive services to assist homeless individuals and to prevent homelessness. A smaller homeless population means fewer problems at overcrowded homeless shelters.  

 

2017 National Health Care for the Homeless Coalition Conference

In June, my supervisor and I will discuss our work integrating fitness and health counseling services at supportive housing and affordable housing sites at the NHCHC Conference and Policy Symposium in Washington, D.C. We have titled our presentation Move Toward Wellness: Integrating access to exercise in programs serving individuals impacted by homelessness.

People who have experienced homelessness die, on average, 15-20 years earlier than the general population. Individuals with severe mental illness–a significant proportion of the homeless population– die, on average, 25 years earlier than the general population. In order to most effectively implement preventive health programs for low-income individuals and people who have experienced or currently experience homelessness, we need to bring the programs to them - the places they live and frequent. 

In social work, we often say we need to "meet people where they're at." Usually, it's metaphorical. For example, if a woman uses heroin, we need to consider the physical, mental and social factors that influence her getting high and support her without expecting her to immediately cease abusing drugs. We also can't expect individuals from diverse backgrounds and complex experiences to conform to our standards of behavior and ways of thinking. 

But in the case of preventive health strategies, like fitness programs and health counseling, we need to literally meet people where they're at by doing the work in their buildings' community rooms, lobbies, patios or dining rooms. 

The presentation will share experiences and ideas for implementing such programs at sites with significant resources (like NYC's HIV/Aids Services Administration-funded supportive housing sites, which tend to receive more funding than most other supportive housing facilities) as well as the typical mixed-use supportive/affordable housing site that tends to operate with sparse funding and few frills. 

Come check us out if you plan to attend the conference in late-June. 

The Home Stability Support program would save people from becoming homeless

The HUD FY2016 fair market rent (FMR) for a 2-Bedroom apartment in New York City is $1,571. Yet, a 3-person family with children that earns Public Assistance only receives $400 in shelter allowance, about 1/4 of what they need. It's more or less impossible to rent an apartment for your family if you receive Public Assistance without some sort of additional (and rare) housing voucher like Section 8.

There are currently more than 80,000 people in New York State who receive PA and who pay rents 1.5x higher than their shelter allowance – including 21,000 who pay rents 2.5x higher. Home Stability Support is a statewide rental supplement that would enable New Yorkers at risk for homelessness to find an apartment and prevent eviction.

According to the Coalition for the Homeless, "HSS would cost $11,224 per year for a household of three in New York City – a mere fraction of the $43,880 it costs annually to provide temporary shelter to a homeless family."

New York State originally instituted the shelter allowance to pay the cost of housing for low-income individuals and families unable to otherwise afford rent, but the allowance has not kept up with rising rents in the past few decades since the law changed in 1975. 

Citywide, the rapid FMR increase has been significant for most people but crippling for low-income individuals. Consider Kings County (aka Brooklyn). In 1983, the FMR for a 2-BR apartment was $420 (the current shelter allowance wouldn't even cover that). Now it's $1571.  In 2008, 2-BR FMR increased by nearly 11%. In 1994, it increased by more than 20%. Last year, it rose by more than 6%. 

This problem isn't new. It's just exploding. An article in The New York Times  explored the very same issue more than 23 years ago:

Less than six weeks before Gov. Mario M. Cuomo must propose next year's state budget, his administration is considering pressing the Legislature for the first increase in rent subsidies for welfare recipients since 1988 . . .  The rent subsidy, which is known as the shelter allowance, is so low -- $286 a month for a family of three in New York City -- that many families on welfare have been forced into homelessness, lawyers and other advocates for the homeless say. The median rent in the city, according to a recent report on housing vacancies, was $475 in 1991.

Back in December 1993, when the article was written, there were  5,100 adults and 7,500 children in the city's family shelters. Today, the population has more than tripled.

Even if you typically oppose subsidies that lift low-income families with children out of homelessness and poverty, check your small-government impulses for one moment and use the other parts of your brain: New York City is already paying a billion dollars just to warehouse people in temporary, substandard municipal shelters. We would save hundreds of millions of dollars to subsidize permanent housing for families – and that's not including all the attending social benefits of housing, especially for homeless children who have zero power over or responsibility for their living situation.