Recently there was an informational session held by the Health and Human Services Committee in regards to the proposed eligibility changes for Section 17 services through Mainecare. In the Mainecare Benefits Manual the service is defined as follows:
Community Support Service means a rehabilitative service that is provided in the context of a supportive relationship, pursuant to an individual support plan that promotes a person’s recovery, and integration of the person into the community, and sustains the person in his or her current living situation or another living situation of his or her choice.
This is what is known as case management services. Consumers and social service workers are very concerned about these changes and are making their voices heard. As a shelter provider, I too am concerned about the changes. Of the individuals who utilize this shelter over 65% of them suffer from mental illness or are dual diagnosed with mental illness and substance abuse disorder. I understand that DHHS is making a case that we are creating over-dependence on the system by assisting those deemed less in need than others. In some instances, much to the chagrin of my colleagues, I agree this can be the case.
Folks make bad choices, do things they shouldn’t do, lose sight of priorities and end up in situations that cause them to feel depressed and anxious. More than likely these folks will endure and pull themselves up. I’ve been there, many of my friends have been there. I’m sure we all know people who have been there. The difference is when things get so overwhelming and symptoms persist that individuals become at risk of homelessness or literally homeless. We may be able to make a case for those staying in the Shelter to either keep or obtain section 17 services however I am unclear as to whether or not those services will be discontinued once someone becomes housed.
Maine State Housing Authority estimates that it costs approximately $68 per day to keep someone in shelter. We have estimated a bit higher at $74-$78 per day. Keeping someone in housing costs about $25 per day. We support numerous individuals who have been housed who currently receive section 17 services. Most of them receive case management through community mental health agencies. Here are a few examples of people who will probably end up back in the shelter without the ongoing support: “Benjamin” lived outside for three years before we were able to assist to obtain housing. He has now been housed for almost three years. Benjamin has some significant barriers but no diagnosis of schizophrenia or schizoaffective disorder. He has been at risk of losing his apartment no less than four times and without the support of his case management there is no doubt he would have been evicted. His case manager meets with him weekly to ensure he follows up with his medical providers and maintains the health and safety of his apartment. We have known Benjamin for many years and he is not someone who will maintain without the case management. Although there are some individuals who could benefit from short term case management and then maintain independently, he is not one of them.
“Adam” was homeless for a significant period of time. Although he has never been diagnosed with cognitive impairment he is definitely delayed and also has a diagnosis of bipolar. He has limited social skills and presents at around a 12 year old level of functioning. He needs help ongoing to navigate the system and maintain his apartment. The guidance he receives from his case manager prevents him from making impulsive decisions and disengaging from services.
This is not a situation that can be addressed by categorizing one diagnosis as more important than another. Individuals function at different levels regardless of what they are experiencing for mental health issues. This shelter will not be able to accommodate the need that will exist for shelter if these rule changes go through as suggested. It would be a complete failure of this system if someone like Benjamin ends up on the streets again.