Preventing Overdose and Suicide Through Housing Reform

October 27, 2021

Evidence suggests that ensuring access to healthy, safe, and affordable housing plays a vital role in preventing suicide and overdose. State and federal policies can be effective interventions to improve access to safe and affordable housing and improve health outcomes, such as by supporting Housing First and recovery housing programs. Although different types of housing provide different supports, some programs provide housing to all people experiencing homelessness, regardless of housing history or treatment status. While other programs provide alcohol-and-drug-free living environments for people recovering from substance use disorders (SUDs).

Federal law supports housing stability by forming programs that provide secure housing to people who have low incomes, SUDs, and mental illness. The United States Department of Housing and Urban Development and Substance Abuse and Mental Health Services Administration provide grant programs and services, often administered by state agencies and community organizations, to help eligible individuals access housing. The American Rescue Plan Act of 2021 (ARPA), passed in response to the COVID-19 pandemic, included nearly $43 billion in funding for housing-related programs. ARPA created new programs to prevent individuals from losing their homes, while enhancing existing homelessness prevention programs. Many of these programs are administered by state and local governments and provide states and territories the opportunity to braid and layer funding to support access to housing.

State Legislative Landscape

Enhancing Housing Opportunities During the 2021 state and territorial legislative sessions, at least 21 states considered bills that would enhance housing opportunities for people experiencing homelessness, SUDs, and/or mental illness.

One Colorado law aimed to improve overall coordination for behavioral health programs, including housing support. Colorado HB 21-1097 requires the Colorado Department of Human Services to establish a behavioral health administration by July 2022, which will be tasked with coordinating behavioral health efforts across agencies, improving collaboration, and driving accountability. The law is based on recommendations from the Colorado Behavioral Health Task Force to transform and streamline the state’s behavioral health system. Specifically, the BHA is tasked with leading the coordination of behavioral health efforts across agencies, creating shared goals, improving collaboration, and driving accountability and transparency. The new entity will promote an integrated approach to mental health and substance use treatment that includes coordinating supportive services related to the social determinates of health, including housing.

Furthering Housing Support

At least 15 states considered legislation to provide housing support for persons with SUDs or mental illness, with five states (California, Colorado, Illinois, New Jersey, and Oregon) enacting legislation.

Illinois enacted HB 449, the Housing is Recovery Pilot Program, which provides housing to people at high risk of unnecessary institutionalization for mental illness or at high risk of overdose due to lack of recovery supports or housing. The new law directs the Department of Humans Services Division of Mental Health and Substance Use Prevention and Recovery to develop a process to identify and refer eligible individuals for the program with input from the community and other interested parties. As a Housing First program, participants selected for the pilot program are not required to maintain sobriety, but must participate in continued mental health or substance use treatment provided by an approved supportive housing landlord or service provider.

Addressing Housing Needs for Vulnerable Populations

ASTHO identified 23 bills across 13 states that addressed housing needs for vulnerable populations, including, veterans, children, and recently incarcerated people.

Massachusetts is considering H 3838, which would create grant funding opportunities for third-party non-profits to provide housing support to children, youth, or families experiencing homelessness and complex medical conditions. Three states (Georgia, Illinois, and Tennessee) considered establishing a Veterans Bill of Rights to streamline veteran housing and direct veterans to behavioral health support. California is considering AB 328, which would direct at least 10% of funding allocated to its Reentry Housing and Workforce Development program to community-based organizations that employ previously incarcerated people.

States are also exploring opportunities to braid and layer funding to increase housing access among low- income communities. During the 2021 legislative session, at least seven states proposed legislation to explore leveraging Medicaid funds to support housing access. Utah enacted HB 34, which directs the Utah Department of Health to apply for Medicaid waivers to cover medical respite care services for adults experiencing homelessness. Meanwhile, states such as Massachusetts (H 3959) considered bills to study the potential effects of using Medicaid funding to provide housing support.

Key Takeaways

Across the country, states and territories are modeling innovative programs to prevent overdose and suicide by making key decisions that promote access to safe, healthy, and affordable housing. Some actions these agencies can take to drive meaningful change in their jurisdictions include:

• Partnering with housing authorities to identify opportunities to braid and layer funding to support broader access to housing.
• Assessing whether Medicaid funding can be used to further support access to housing.
• Advocating for using new funding streams, such as ARPA, to support housing policies that may prevent overdose and suicide.
• Advocating for sustainable federal funding to support housing programs enhanced by ARPA.