Magazine article Developments in Mental Health Law

Permanent Supportive Housing: Virginia Investment and Estimated State Cost Avoidance

Magazine article Developments in Mental Health Law

Permanent Supportive Housing: Virginia Investment and Estimated State Cost Avoidance

Article excerpt

In order to inform the deliberations of the Housing Work Group of the SJ 47 Joint Subcommittee to Study Mental Health Services in the 21st Century, the Virginia Department of Behavioral Health and Developmental Services conducted analyses utilizing multiple agency administrative databases. The following results were prepared to share with the Work Group in answer to particular questions posed by its members about estimating potential state cost avoidance through investment in permanent supportive housing (PSH). The cost avoidance estimates described below were limited by the scope of the request as well as time and data-sharing constraints. As a result, it is important to note that the cost avoidance estimates attend to only two types of services: state psychiatric inpatient care and state-funded locally purchased psychiatric inpatient care. Nonetheless, the results speak to the great potential for cost savings via investment in permanent supportive housing.

Additional PSH Units Needed by SMI Sub-Population

Jail      1056
ALF        824
CSB       2684
Homeless   516

Data Sources: Jail: Mental Illness in Jails Report (Virginia
Compensation Board, 2015); ALF: Auxiliary Grant payments to localities
(Virginia DARS, 2016); CSB: CSB CCS3 data submissions (DBHDS, 2016);
Homeless: The State of Permanent Supportive Housing in Virginia, 2015
(Virginia Housing Alliance)

Note: Table made from bar graph.

Available data indicate that approximately 5,080 individuals living with serious mental illness are in need of permanent supportive housing. Over 1,000 of those individuals are currently incarcerated in local jails, 824 are currently in assisted living facilities, and 516 are currently living on the streets or in homeless shelters. The majority of people identified as likely candidates for PSH were CSB clients. Those individuals were unstably housed, receiving mental health case management or assertive community treatment from CSBs, and were among the top 20% of crisis and emergency services utilizers across the state.

Because client-level data is available for the identified CSB sub-population, more precise cost avoidance estimates can be provided for this group. A $10 million investment in PSH could house about 660 of those unstably housed consumers with serious mental illness who are high utilizers of CSB and state hospital services. Such an investment would address a quarter of that sub-population, which represents the largest share of statewide PSH need.

Using only state psychiatric facility and state-purchased local inpatient psychiatric bed days, the 660 PSH-eligible consumers' one year use of inpatient treatment costs approximately $24,702,759. Cost avoidance per client, per year estimates ranged from $4,433 to $14,684, which in turn suggested total state cost avoidance estimates ranging from $2,056,973 to $6,813,462.

Cost avoidance estimates assume that PSH providers would house the most costly eligible consumers for the 660 PSH units, and that reductions in consumer inpatient utilization would be similar to those published in randomized control trials and quasi-experimental studies of high-fidelity PSH interventions with similar populations. Cost reductions are based on statewide average bed day costs per consumer. (Note that because this sub-population has been identified as high-utilizers crisis and emergency services, using state average bed day costs likely underestimates the actual inpatient costs for these clients. …

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