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Tennessee Finds Ways To House People With Mental Health Disabilities

Clinton Toy in front of his Nashville home.
Rose Hoban

  Around the country, advocates have come to realize that one of the most important services for people with mental health disabilities is housing – and that most people with disabilities are able to live independently with some help. States have tried many strategies to create suitable housing options. Tennessee dedicates a small amount of state money every year to local groups that succeed pretty well.  


Nashville is a big sprawling city with some old neighborhoods near the center of town. Those older areas sit along the Cumberland River. It overflowed last year in a hundred-year flood. The water inundated Clinton Toy’s house at the bottom of a small incline near the river. 

Clinton Toy: "I looked up front and it was coming up, coming up over those steps, and so I barely made it out…"

Toy spent last fall wrangling with insurance adjusters and paperwork and contractors and tools. Now he’s home… and he’s pretty satisfied with the results. 

Hoban:"So… what color is this on the wall?"
Toy: "I forget what kind of green they call it. They can only paint one coat, according to the insurance, they can only put one coat of paint on. So I need to get me a brush and a roller, and get back behind that cabinet right there."

Toy didn’t get to start repainting his walls for a couple of months after the flood. In the rush to evacuate, he left his pills behind. Toy has a psychiatric disorder, and after a few days without medication, he landed in a state psychiatric institution. But he wanted out.

Toy: "I think that having this home has helped me want to stay out of the hospital because it's been responsibility, because when I was in there, you got behind, you know, and then… that's one of the things about homeownership it gives you motivation to want to stay out of the hospital. To try to make something of your life."

Before the flood, Clinton Toy had spent five straight years out of the hospital. It was the longest he’d stayed out of since he was diagnosed with psychosis at 17. Now he’s a 41-year-old guy with a job making sandwiches and a long “to-do” list of home repairs. He’s got plans to go fishing… and no plans to return to the state institution. 

Toy: "Even though sometimes it's sad and hard, sometimes I think it would be easy to lay in that hospital, you know, and get free food, or whatever, but what kind of life is that, you know?"

That’s the question Marie Williams started asking herself in the early 19-nineties. She was a case worker with homeless mental health patients in Memphis. Williams says she eventually realized that for most of her clients, not having a steady place to live was the biggest obstacle to getting their lives together. 

Marie Williams: "I would work with them at homeless shelters… and if you don't have a place to go back to, it really impacts your ability to recover. And move forward."

With that in mind, Williams earned a social work degree. Then she did a fellowship at the federal Department of Housing and Urban Development in Washington. When she returned to Nashville, she was on a mission – to help develop housing for people with mental health problems. She landed a job with the Tennessee mental health commission and got to work 

Williams: "We focused on Knoxville, Memphis, Nashville and Chattanooga… And we went across the state and those communities, one person working with four communities we brought in $4,920,000 and created 801 options."

That was in one year. In the subsequent decade, Williams and her team have developed a range of options - from private homes like Clinton Toy’s to clusters of apartments, to group homes. All told, the state of Tennessee has ponied up only about 25-million dollars. Williams and her people across the state use that money as leverage to raise more money so they can build and renovate more housing. 

Williams: "We have brought into the state 400 million dollars."

She says it came from all kinds of places... Federal home loan bank... the Tennessee Housing Development Agency,

Williams:" local foundations, local banks, local banks who said we want to do something about this, Housing and Urban Development, USDA, Rural Housing Development… there are all kinds of different places where our facilitators have coalesced funding to make housing affordable for people."

And in a decade, they’ve created 98-hundred housing opportunities, around the state. Urban, rural, you name it. 

Bob Kucab: "Which to me, it is a staggering number for a state the size of Tennessee."

Bob Kucab heads the North Carolina Housing Finance Agency. In the same spell that Marie Williams helped develop more than 9,000-plus housing opportunities in Tennessee – a smaller state than North Carolina – Kucab figures North Carolina’s created less than a third of that number targeted for folks with mental health problems. Kucab should know… he’s got his fingers in pretty much all of the low income housing and special needs housing in North Carolina.

Kucab: "I am determined to call Tennessee... and find a little more about it because we have made significant investments in this approach, and our numbers are what they are. So I would be interested to see how they could possibly produce 9,000 units. That… that’s a lot."

Tennessee is ahead on the number of units, the state is spending less to get them built – and Tennessee is seeing results. Bob Currie is Marie Williams’ right hand man. He also started out as a case worker with homeless mentally ill people and helped many of them move into independent housing. Framed photos of those houses line his office walls. 

Currie talks about one pair of brothers, both mentally ill, both in and out of state institutions and living in public housing. Five years ago, he helped them cobble together the money to buy a condo – the state chipped in enough so they could pay their mortgage with their Social Security disability money.

Bob Currie: "Over the course of their 30-year mortgage, the public will save $180,000 on the lack of rental subsidies being necessary for them... by investing a little bit, by investing about $30,000 to reduce their mortgage payment to where it was affordable… the public saved $180,000."

Currie says the brothers are doing really well and, for the most part, staying out of the hospital. Those kinds of successes are becoming apparent in the state’s mental health institutions. In the past two years, Tennessee has been able to close about a third of the beds in state institutions. That’s reduced costs. And in contrast to North Carolina, the beds in Tennessee’s mental health institutions are never full. That’s reduced waiting time for people who do need those beds… down to almost nothing. During the last fiscal year, Currie says about 13,500 people sought admission to a state hospital. 

Currie: "Of those, there were four people who had to wait more than two days. And those waited because they wanted to be admitted to the Institute, the hospital closest to their home. They could have been placed otherwise, sooner."
Hoban: "So 13,500 admissions... four of them waited more than two days."
Currie: That's correct. Four people waited two days because they wanted to be close to home "
Hoban: "If they had been willing to go to someplace else slightly further away... "
Currie: "Probably would have been within 12 hours they would have a hospital bed."

Bob Currie says that’s because when Tennessee closed beds in its state institutions, the local treatment – and the housing – were in place for people who needed them… people like Clinton Toy who’s happy to be home after last year’s flood

Toy: So, I 'm just thankful to have a life, you know, a little bit of a pretty good life and … and I try to be as normal as I can. I got… I had my fishing poles behind the door.
Hoban: I saw those… 
Toy: I like to fish. It always, like, cheers me up, especially if I can catch a fish… you know?

His story plays out in stark contrast to North Carolina, where psychiatric patients often wait days in local emergency rooms for a bed in one of the state institutions. And when they’re discharged from that state facility, they wind up in institutional places like adult care and family care homes…because often, that’s all there is.

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