When Supportive Housing Isn’t

The rationale behind supportive housing for people with mental disabilities is that pairing individualized services with permanent housing will help them live independently. But one San Francisco advocate sees more neglect than support.

It’s a scene reminiscent of a madhouse in another century: a tenant suffering pain from untreated physical illness, malnourished, mentally frozen by anxiety, sits in a room heaped with third-hand possessions and garbage. A property manager stands in the doorway, grimacing at the smell, demanding a cleanup, and threatening penalties. The tenant feels like a prisoner. The manager acts like a warden.

This scene plays out regularly in supportive-housing projects for recently homeless people in present-day San Francisco. The tenants are not prisoners, but instead are threatened with eviction, which almost guarantees a return to homelessness. They are not physically threatened, but instead suffer from neglect, which managers often attribute to the tenants’ failure to use available services.

Supportive housing for homeless people is meant to prevent just these kinds of crises. Properly run supportive housing provides individualized services to help disabled people live independently. Possible services include case management, medical and psychiatric care, housekeeping, home health assistance, medication and appointment reminders, addiction treatment, meal programs, and life coaching. The idea is to stabilize tenants, both for their own sake and to save public dollars by avoiding the more expensive institutions such as jails, hospitals, and homeless shelters.

Many supportive-housing programs I know well don’t make these services accessible enough to people with serious mental disabilities. In the 15-odd years I’ve been an advocate for very poor people in San Francisco, I have been through several eviction-threat scenes with clients, and have heard of many, many more from colleagues and clients, and clients’ friends and neighbors. It seems accepted as normal that some mentally disabled supportive-housing tenants are neglected and allowed to fail.

I have handled some of my clients’ case management and home care myself to prevent their eviction because their assigned “case managers” didn’t. I have cleaned and decluttered rooms, negotiated with property managers, advocated with public and nonprofit service providers, coaxed tenants to accept state-paid home-care workers, made reminder calls before medical appointments, and more. This tells me that supportive services do help. It also tells me supportive housing typically fails any tenant needing careful follow-up.

Most supportive-housing programs in San Francisco provide services primarily by employing case managers to connect tenants with outside nonprofit and government service providers, though sometimes there is a visiting nurse or other medical professional on site. Medical staff, when available, can be godsends, and case managers are often good-hearted. However, case managers face frequent crises—fights, suicide threats, health inspectors, cops, paramedics, and coroners. And there’s always paperwork. They have very little time to engage with each tenant.

Disconnects result. Instead of having a therapist visit a depressed tenant, a case manager gives the tenant a phone number for a mental-health office that the tenant might never call. A case manager arranges for a home-care worker to clean a tenant’s room, without realizing the tenant feels too ashamed of her untidiness and is too fearful of management spying to let the worker inside. Such failures are easily blamed on the severity of the tenant’s disability or the tenant’s exercise of the right to refuse services. It’s easy to say that the tenant rejected the home-care worker, rather than that the counselor failed to persuade her to open the door.

Supportive staff sometimes can be culpably indifferent. Volunteer social worker Judi Iranyi works with a bipolar, speed-addicted client who for years has been homeless and in declining health. The client was evicted from a supportive-housing building after missing a rent payment because an unexpected deduction from her disability check left her short of funds. The building’s case manager never asked why the rent was unpaid. When Iranyi questioned the case manager later, the response was, “Well, I’m here. She didn’t come.” That is, the bipolar addict bore the burden of approaching the case manager, whose duty was merely to sit behind a desk.

San Francisco programs are no worse than most others around the country; in fact, some are likely better. I’ve spoken with advocates for the homeless and mentally ill around the country who find my stories match their experiences, and some national studies suggest the problems I describe are widespread. Any nationwide figure is imperfect, but the supportive-housing industry’s cheerful claims about retention rates — percentages of tenants who stay — suggest too many are leaving. In a recent newsletter published by the federal Interagency Council on Homelessness, director Phil Mangano commented that, “Permanent supportive housing works for vulnerable and disabled populations�. Today communities across the country are targeting this technology to those experiencing chronic homelessness and achieving 80 to 85 percent retention rates on average.” The unanswered question is: Why do 15 to 20 percent leave?

Martha Bridegam is an attorney and journalist who has represented tenants of supportive-housing properties in San Francisco.


  1. And you say there are too many rules but the opposite is true here. This building is a mix of housing for those with mental health issues and “affordable” housing, but it’s a bag mix. The property manager doesn’t care what the affordable tenants do. They blast loud bass all day and all night, smoke weed on the premises and I’ve been harassed here. I’d feel safer in a regular apartment building because they’d probably do more to crack down on disruptive residents.

  2. Damn informative!! This is a great article, and something I think needs to be communicated more often. Thanks for sharing this great post. Mostly the people with developmental disabilities want to live on their own terms and there are only a few good communities to help them. I suggest everyone to collect proper details before sending your loved one in such kind of community. Hope this information will help!!

  3. Im getting depressed ,i don’t eat , sleep anymore… I left the family shelter on oct 2016 thinking that supportive housing was going to be helpfull… Since day one there’s been problem after problem, many case workers left, they have been failing to help me through my son’s & myself issues, i have done it everything myself but I was ok the 1st yr…but things got worse, i got at my limit when on oct 2017 my case worker didn’t answer me for 5 months, when she finally did, gave me my new lease (it was supposed to be on oct 2017 & she gave it on march 2018) told me that my rent increased cause my income did, but the amount didn’t make sense at all for my 49 dlls of my income increased, it was almost 4 x more! She didn’t listen & left for another 4 months cause she was pregnant… The new case worker didn’t do nothing when i told him there was a mistake, neither the supervisor back then, now she is also gone… They added up numbers in front of me so it could add up & told me the mistake was made on HRA if therevwas any …i was going back & forward for 4 months until my case worker came back from her pregnancy time off, i told her to pls do the math again , my rent was reaching 2000 already, even though i was paying from 180 to 230 a month( the 5 months my case wk disappear oct 2017- march 2018, my supposed increased started, i realized until march 2018 when signing the new lease ,that i was suppose to signed on oct 2017, my rent debt was reaching 1000 )she said they had a system to calculate my rent & can’t failed but she was going to check… She never did it , of course.. I was in HRA office every wk almost, my anxiety got worst as i knew i could get evicted & dealing with my every days problems by myself too…my son started to have school problems & nobody cared , it took my over a yr to get him back on therapy/psychiatry after a paper transfer was lost, but i did it by myself…finally my case wk agreed to go with me to HRA when she realized they were not paying their part of the rent when I asked where were all the copies of my money orders & to show me that they were been subtracted too !I signed my new contract on feb 2019 instead Oct 2018, after ,once gain been after my case worker to do it once again, now my rent decreased!(the amount that it was supposed to be since Oct 2017!!) Really? & my debt is already 2000 & today told me they want to take me to legal eviction… The good thing is that i just recivied a letter from HRA saying they re paying for HRA’s mistake, im glad about that, but what about the ” increased of my “supportive program” rent for over a yr? Im at my worst , i was sooo stress for over a yr for a mistake that nobody cared & listen , they owe me now!! What can I do? I was many times about to relapse , give up…isn’t fair that supported housing becomes unsupportive & makes you feel like crap, to be ignored! I haven’t get any services for my kid that ive asked for sooo long , sometimes she just gives me numbers only… Really? I’ d like to report this & do something about it, ive never broke any rule, ive never disrepect or fight no one, ive never relapse even though I felt they were pushing me to it…. We r humans not a check & a number , im extremely depressed, dissapointed. I just lost a family member & another is not doing fine, this can’t happened to another person or family! its inhuman & there’s many other things about our bldg & apt…I hope there is really someone who really cares,


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