Pathways to Housing: Moving People with Psychiatric Disabilities Directly from Streets into Apartments of Their Own

About The Housing: Pathways provides housing first for individuals who have psychiatric disabilities and substance use disorders who have been turned away from other agencies because they were not considered housing ready.  Pathways does not require participation in psychiatric treatment or sobriety as a condition for housing.  Pathways pursues its mission by providing these individuals with apartments of their own, and then offers extensive ongoing treatment and support services through interdisciplinary Assertive Community Treatment (ACT) Teams.  The ACT Teams, comprised of social workers, service coordinators, nurse, psychiatrist, peer counselors, and an employment specialist, are located at four New York City sites:  East Harlem, West Harlem, Brooklyn, and South Jamaica, Queens.    ACT Teams conduct outreach to homeless people on the streets, in parks, subway stations, abandoned buildings, and other public places l and moves them directly into permanent housing. Pathways’ pioneering approach has produced an impressive housing retention rate of 85%. 

Type of Housing: Independent scatter site apartments, rented from private landlords, consumers have rights and responsibilities outlined in a standard lease.  Number of Units:  450 Sponsor(s) of the Project: Pathways to Housing

How it came about: Pathways to Housing was incorporated in 1992, to serve one of the most disenfranchised populations in New York City-people who are homeless, living on the streets and who have psychiatric disabilities and substance abuse disorders. Founded to fill a gap for people who could not meet the requirements of other housing programs, Pathways began renting apartments in the private market for the homeless clients served by its outreach and ACT team services.

Goals and Philosophy: The program is founded on the belief that housing is a basic right for all people and that people with psychiatric disabilities should be fully integrated into our communities.  The program is intensively client-driven, that is participants are respected as individuals who can make an informed choice about what they want, the sequence they want it in, and for how long they want the service.  Typically, clients say that housing is what they want first. After clients are housed, the ACT team staff work in partnership with clients to develop service plans and learn the skills they need to maintain and apartment and develop a sense of community.

Tenancy Profile: People living in Pathway to Housing apartments are people with serious mental illness, 90% of who also have histories or current drug and alcohol use, and have been homeless for long periods of time.   The agency presently serves over 450 people who have come to Pathways from shelters, psychiatric hospitals, and jails as well as the streets. Most clients are SSI/SSDI recipients.

In order to be eligible for the program, an individual must be homeless, must have a psychiatric impairment that results in disability and must agree to meet with a case manager a minimum of twice a month during the first year of tenancy as well as pay 30% of their income towards their rent by participating in the agency’s money management program. Refusal to participate in sobriety or other treatment programs does not disqualify an individual, nor does a history of violence or prison time.

In 2001, Pathways formally extended its target population to include persons leaving New York City’s correctional facilities at Rikers Island who are living with mental illness.  For this initiative Pathways received a HUD award for 25 units of targeted housing for mentally ill individuals leaving detention or incarceration at Rikers Island.

Housing Description: Pathways to Housing seeks private market rental housing throughout New York City. Their housing department keeps logs of new vacancies and the over 200 landlords they work with, and works to negotiate leases or in some cases complete Section 8 applications.

Services Description: Assertive Community Treatment (ACT) Teams engage and provide treatment and support services. These interdisciplinary teams include a social worker, a nurse, a peer counselor, a vocational rehabilitation specialist, and a psychiatrist.  One team member is on-call 24 hours a day, seven days a week.  The Pathways ACT teams serve as the single point of contact for most clients and provide most services directly.  The teams work from agency field offices around the City.  In each site, Pathways has developed extensive linkages to local services, including primary care and housing referrals and placements. The staff team members to client ratio is approximately 1:10.

Employment Services: Through Pathways vocational program clients can be employed at minimum wage or higher within the agency as clerical workers, messengers, maintenance workers, painters, movers, and “buddies” who make apartment visits to new tenants and help them adjust to the program and their new homes. Vocational planning is a part of the service plan developed with each client. Recently, Pathways to Housing opened a thrift shop in Queens as a social purpose business affording clients jobs while producing revenue for the agency. 

Property Management: Pathways currently manages numerous scattered site apartments including rent collection and completing minor repairs. Larger repairs and maintenance are the responsibility of the private landlord.

Staffing Description: Pathways to Housing employs 4 staff responsible for housing services, 40 service coordinators, 6 team leaders, 3 psychiatrists, 3 nurse practitioners, 3 nurses, 2 vocational specialists, and and 2 clinical directors.   The staff make-up is culturally and racially similar to the population the program serves. Program success is attributed in part to staff composition that includes 30% consumer representation (i.e. people in recovery) that serve as role models.

Eligibility Criteria/Lease/Occupancy Agreement/Rent:  The units are regular apartments rented from private landlords and tenants have full tenants rights and responsibilities as outlined in a standard lease.    Housing is permanent or as long as the clients want it.  Tere is no length of stay limitation.  Tenant rent payments are based on income, with tenants generally paying either 30% of income. 

Project Financing:

• Development type:   Scattered site apartments in the private real estate market. 
• Operating Sources:

  HUD Shelter Plus Care

  Housing Choice Vouchers (Section 8)

  NY State Office of Mental Health Supported Housing

  NYC DOHMH Supported Housing

  OMH and DMH ACT Teams

• Services Sources:

  New York State Office of Mental Health

• Cost per unit: Each unit costs approximately $20,000 - $22,000 per year.
• 2001 CSH provided $100,00 to fund clinical services that included a nurse practitioner for primary health care and in 2002, a loan of $50,000 to open a social enterprise business (thrift store).

Role of the Corporation for Supportive Housing: As a Pathways to Housing partner, CSH has provided the agency technical assistance and project specific assistance through three funding actions that support the activities of Pathways to Housing including acquisition and business venture loans.

Lessons Learned/Advice for Others:

In a recent SAMHSA study, 225 individuals with psychiatric disabilities who were also homeless were randomly assigned to either the Pathways program or to traditional New York City services. At the end of 12 months, 80% of the clients assigned to Pathways to Housing were stably housed compared to 23% for the comparison group.  Once housed, the self-reported quality of life improved at comparable levels in both groups, and noteworthy is that there were no differences in the levels of substance abuse or psychiatric symptoms between the two samples.

The study concludes that housing first without pretreatment requirements is very effective in ending homelessness and does not does not adversely affect substance abuse or psychiatric symptoms. 

“It's an enormous and futile effort if you try and get people into treatment, clean and sober before you house them. For this particular group that we're focused on, the ones that stay on the street, it's not working. And if you offer the person what they want, a choice, they will make the best choice and then, also, own it.”

-SAM TSEMBERIS

12/30/02 Online News Hour Interview

Photograph by Margaret Morton

For More Information Contact:
Sam Tsemberis, Ph.D.
Executive Director
Pathways to Housing
55 West 125th Street
New York, N.Y. 10027
Voice: (212) 289-0000
Fax: (212) 289-7594
Email: pathman101@aol.com