Bridging Gaps in Implementing the Olmstead Mandate and Ending Chronic Homelessness

As someone who has worked on ending homelessness for many years, the growing national momentum to end homelessness is inspiring and energizing. Communities are helping people obtain permanent housing and achieve housing stability at a pace and rate previously unthinkable. At the same time, while stable housing with appropriate supports is the primary solution to homelessness, to truly end homelessness we must also engage in efforts to address the systems issues that lead to homelessness in the first place.

Homelessness is, and always has been, a problem stemming from the cracks between systems of care and public policy failures to seal those cracks. The roots of the problem of chronic homelessness in particular is, in large part, due to the de-institutionalization of the mental health system during the 1970s and 1980s, leading to a mass release of people from state psychiatric hospitals nationwide and the failure to create an effective community-based system of care for people with psychiatric disabilities. The result of this failure was that people with psychiatric disabilities wound up homeless or in jails and prisons, while others remained in state hospitals or other segregated settings, like nursing homes.

What emerged in response was not a single movement to establish a community-based mental health system, but rather three separate policy movements and efforts, namely, the effort to end chronic homelessness, the effort to ensure the community integration of people with disabilities, and more recently, efforts to reduce incarceration among people with mental illness. The fragmentation between these separate policy responses persists today. States typically are pursing one set of efforts to address the needs of individuals experiencing chronic homelessness and another focused on the community integration of people with disabilities, leading to inconsistent policies and competing priorities.

In the landmark decision Olmstead v. LC, the Supreme Court recognized that the problems of homelessness and the institutionalization of people with disabilities are inextricably linked, such that one cannot be solved without solving the other: “[It is not] the Americans with Disabilities Act (ADA) mission to drive states to move institutionalized patients into an inappropriate setting, such as a homeless shelter.”

The time has come for us to rejoin these efforts, redress the root cause of policy failures, and pursue a housing and community integration strategy that both ends homelessness and ends unnecessary institutionalization and incarceration among people with disabilities. Today, USICH is releasing Fulfilling the Dream: Aligning State Efforts to Implement Olmstead and End Chronic Homelessness. In it, we call on states to rejoin their efforts to implement the Olmstead community integration mandate and efforts to end chronic homelessness. 

We outline some concrete steps states can take to do so, including:

• Engaging in a collaborative planning process.
• Developing a broader plan to increase supportive housing opportunities by committing and coordinating affordable housing resources and ensuring the coverage of housing-related and supportive services under Medicaid.
• Developing a shared definition and measures of quality and community integration.
• Building the capacity of community-based housing and services providers.

The opportunities that come from tearing down walls and bridging gaps between homelessness and Olmstead policies are enormous. Together, let’s fully realize the potential of supportive housing as a tool for solving complex social problems that affect our most vulnerable citizens who need housing and services to achieve stability, dignity, and independence.