With New York City in Worst Homelessness Crisis Since Great Depression, Legal Aid Focuses on Medical and Mental Health Service Shortfalls

As record numbers of men, women and children sleep in New York City shelters, testimony from The Legal Aid Society detailed for city lawmakers the systemic shortfalls connected to medical and mental health services for the homeless.

The testimony—delving into the issues and offering recommendations on paths forward—took place over two days in a hearing held by the New York City Council Committee on General Welfare and the Committee on Health. Thursday’s testimony focused on the problem of hospitals and nursing homes often turning to the shelter system “as a last resort referral source” for patient discharges. Monday’s testimony called for improved shelter staff training on interactions with mentally ill individuals and emphasized the critical need for supportive housing, among other things.

In both instances, Legal Aid’s testimony with the Coalition for the Homeless stated the city is facing its worst homelessness crisis since the Great Depression.

In September, 61,931 men, women and children slept in shelters each night; this was an all-time record, according to the testimony. Homelessness has nearly doubled for single adults in the past 10 years and family homelessness has grown by more than 80 percent in that same period.

Beth Hofmeister, Staff Attorney in the Society’s Homeless Rights Project, testified on Thursday and Joshua Goldfein, also a Staff Attorney in the Homeless Rights Project, testified on Monday. Both Hofmeister and Goldfein testified with Giselle Routhier, Policy Director at the Coalition for the Homeless.

Homeless individuals have higher rates of chronic and acute health problems, compared with the general population, the testimony said. Likewise, homeless individuals have increased rates of severe mental illness.

Hofmeister and Routhier explained the shelter system is not equipped to offer medical care and should not be seen as an extension of the city’s public health system. Even still, it often gets discharged patients because of a wider absence of housing for extremely low-income people. Yet shelters “are not optimal settings” for those being discharged. Additionally, these referrals can put others living in shelters at risk of exposure to communicable diseases, opportunistic infections, or unsafe behavior if a someone is discharged too soon.

Hofmeister and Routhier’s recommendations included “a thorough analysis of hospital and nursing home discharges to shelters and the policies underlying them and the establishment of protocols for medically safe discharge planning.” They also called for a “strong policy prioritizing permanent housing options for those with the most acute medical needs.”

Goldfein and Routhier also underscored the need for housing in the context of mental health services. “Of particular value for the long term is the proven solution of supportive housing, which provides stable, permanent housing with onsite support services for individuals and families in need of extra support such as those with serious mental illness and other disabilities. Supportive housing is the solution to the problem of chronic homelessness among those with mental illness,” they said.

Advocacy with hundreds of partners in the Campaign 4 NY/NY Housing has resulted in promises from New York City Mayor Bill de Blasio and Governor Andrew Cuomo for the creation of 35,000 supportive housing units during the next 15 years, the pair said.

“The City is on track to open the first 500 units of supportive housing under the Mayor’s 15,000-unit commitment this year,” they testified. At the state level, while some conditional awards for some units have been made, Goldfein and Routhier said there was a “stalemate in Albany” regarding the release of the full $2 billion for the first 6,000 units of Governor Cuomo’s 20,000-unit commitment.

“We continue to urge the Governor and legislative leaders to make good on this crucial promise,” they said.