In 1987, the Lucas County Mental Health Board in Toledo, Ohio, was one of nine urban areas to receive a five-year grant from the Robert Wood Johnson Foundation to refine and expand its service system for people with serious mental illness. The purpose of the resulting Lucas County Housing Services, an initiative of the Lucas County Mental Health Board, is to assist people who are seriously mentally ill to live successfully in affordable, permanent housing they choose themselves.
The foundation of Lucas County Housing Services is built on the value placed on the individual choices of potential residents during each step of the process, which includes housing selection, housing development, and housing support services. Choosing housing begins with a structured residential preference interview during which a person's housing values and goals are explored. Topics covered in the interview include the benefits and obligations associated with various types of housing, the type of housing arrangements the person prefers, neighborhoods in which they want to live, who they may want to share housing with, and the kinds of assistance and supports they believe they will need to be successful.
Several activities are involved in the next step: locating housing. First, Housing Services maintains an inventory of available housing that is owned, operated, or subsidized by the mental health system. In addition, they keep a listing of other housing that is available on the open market. Second, Housing Services aggregates interview data to direct development activities of Neighborhood Properties, Inc., the system housing corporation. This has resulted in 143 apartments in 19 buildings being purchased and renovated. Third, Housing Service staff assists clients to obtain their housing and, if necessary, arrange for subsidy support. Community mental health agencies are then responsible for assuring that residency is successful. A case manager from the mental health center works with the resident to obtain the necessary services and supports. The case manager also continually assesses and updates the plan as necessary.
Since 1988, over 500 people have obtained good housing through this program. This is over one-fifth of the 2,500 people who have serious mental illness in Toledo, Ohio. Most of these people are living in integrated apartment buildings located in good neighborhoods throughout the Toledo metropolitan area. A follow-up study of the first 20 people to obtain housing found that 16 were still living in apartments after approximately 21 months. Furthermore, only three of the 20 had been back to a state psychiatric hospital though all had substantial hospitalization histories and 17 had moved directly from the hospital to their apartments. As a group, they had averaged 22 days in state psychiatric hospitals during the 21 months after they moved into their apartments. In the two years prior to obtaining their homes they had averaged 245 days. Case managers rated their present quality of life as one excellent, nine good, five average, and one poor. This residential success indicates that responsiveness to residential preference is a critical factor in residential success for a person with serious mental illness.