Residential Settings

Residential Settings

Persons with mental illness may live in community residen-tial treatment settings that vary according to structure, level of supervision, and services provided. Some settings are designed as transitional housing with the expec-tation that residents will progress to more independentliving. Other residential programs serve clients for as long as the need exists, sometimes years. Board and care homes often provide a room, bathroom, laundry facilities, and one common meal each day. Adult foster homes may care for one to three clients in a family-like atmosphere, including meals and social activities with the family. Halfway houses usually serve as temporary placements that provide support as the clients prepare for independence. Group homes house 6 to 10 residents, who take turns cooking meals and sharing household chores under the supervision of one or two staff persons. Independent living programs are often housed in apartment complexes, where clients share apartments. Staff members are available for crisis intervention, transporta-tion, assistance with daily living tasks, and, sometimes, drug monitoring. In addition to on-site staff, many residential settings provide case management services for clients and put them in touch with other programs (e.g., vocational rehabilitation; medical, dental, and psychiatric care; and psychosocial rehabilitation programs or services) as needed.

Some agencies provide respite housing, or crisis housing services, for clients in need of short-term temporary shelter. These clients may live in group homes or independently most of the time but have a need for “respite” from their usual residences. This usually occurs when clients experi-ence a crisis, feel overwhelmed, or cannot cope with prob-lems or emotions. Respite services often provide increased emotional support and assistance with problem-solving in a setting away from the source of the clients’ distress.

A client’s living environment affects his or her level of functioning, rate of reinstitutionalization, and duration of remaining in the community setting. In fact, the living environment is often more predictive of the client’s success than the characteristics of his or her illness. A client with a poor living environment often leaves the community or is readmitted to the hospital. Finding quality living situa-tions for clients is a difficult task. Many clients live in crime-ridden or commercial, rather than residential, areas (Forchuk, Nelson, & Hall, 2006).

The evolving consumer household is a group-living situation in which the residents make the transition from a traditional group home to a residence where they fulfill their own responsibilities and function without on-site supervision from paid staff. One of the problems with housing for people with mental illness is that they may have to move many times, from one type of setting to another, as their independence increases. This continual moving necessitates readjustment in each setting, making it difficult for clients to sustain their gains in indepen-dence. Because the evolving consumer household is a per-manent living arrangement, it eliminates the problem of relocation.

Frequently, residents oppose plans to establish a group home or residential facility in their neighborhood. They argue that having a group home will decrease their prop-erty values, and they may believe that people with mental illness are violent, will act bizarrely in public, or will be a menace to their children. These people have strongly ingrained stereotypes and a great deal of misinformation. Local residents must be given the facts so that safe, afford-able, and desirable housing can be established for persons needing residential care. Nurses are in a position to advo-cate for clients by educating members of the community.