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.

A 2006 federal study commissioned by the Department of Housing and Urban Development (HUD) found that during 2004 a quarter of tenants nationwide left permanent supportive housing after less than two years of residency. Proof that San Francisco doesn’t have the worst record, the same study found low retention rates in Philadelphia, where 385 of 943 tenants, more than 40 percent, in supposedly “permanent” supportive housing left during the 3 1/2-year study period. Two-fifths of those who left were asked to leave for violating program rules or for being “incapable of maintaining themselves in the permanent supportive housing environment,” which, in my experience, simply means a tenant needs more help than a program wants to provide.

San Francisco’s Care Not Cash, which places indigent single adults in supportive housing, has received harsh criticism from tenant advocates who believe too many people housed through the program leave or are evicted. Care Not Cash ostensibly provides housing and supportive services to people with or without disabilities, but advocates complain that the program’s managers neglect tenants with disabilities and then threaten to evict them when disability-related lease violations arise.

In a November 2006 San Francisco Chronicle op-ed, Iranyi called for an audit of Care Not Cash’s evictions and coerced departures. Although Mayor Gavin Newsom claimed in his 2006 State of the City address that 95 percent of the 2,222 people in the program “remain housed,” Iranyi wrote that her own and others’ anecdotal experience made her “extremely concerned about the number of residents who are forced to move out of managed properties through evictions, threats of eviction, or failure to maintain residency for reasons directly or indirectly related to the resident’s disability/history.”

Local advocates have criticized the practices of the John Stewart Company, a large private property manager, and the Tenderloin Housing Clinic, a nonprofit with roots in tenant activism, although several advocates recognize that Tenderloin Housing has become more sensitive to tenants with disabilities in recent years. Deputy director Debbie Raucher says that Tenderloin Housing has established an eviction-prevention protocol that now calls for holding meetings, issuing warnings, and offering a last-chance opportunity in the form of a “housing retention contract” before it begins eviction. John Stewart Company president and CEO Jack Gardner rejected claims that evictions were excessive in the 10 buildings his company manages for the city of San Francisco. The average building, he says, “experiences only 2.6 evictions per year—80 percent of which are for nonpayment of rent and the balance for behavioral issues.” Nevertheless, he acknowledges that mismatches do exist between tenants’ needs and a building’s available services. He says this happens because managers accept tenants who are a bad fit because of the shortage of supportive housing and the urgency of getting people indoors.

Some San Francisco programs have been successful at keeping seriously disabled tenants housed. The city-operated Direct Access to Housing (DAH) — which houses nearly 900 tenants, all frequent users of city medical or mental-health services — does so by providing one case manager for every 15 to 20 tenants. It also provides exceptional access to medical and psychiatric staff. Marc Trotz, DAH’s manager, says eviction is rare, generally related to health and safety concerns, and pursued only after “pretty extraordinary attempts” have been made to rectify problems.

There is no national standard to define supportive housing. It can take the form of small buildings with on-site services or scattered-site housing with visiting service providers, but the more commonplace type is the “big box,” a large residential hotel or apartment building that houses 50 to 100 tenants and has on-site services. Almost all of San Francisco’s programs are big boxes.

Much of the funding for the nation’s supportive-housing programs comes from federal McKinney-Vento grants, frequently serving people the federal government calls “chronically homeless”: those who are mentally disabled or suffer from addiction. A 2001 paper by the Technical Assistance Collaborative suggested that the McKinney-Vento criteria favor big boxes to the detriment of disabled tenants: “To a certain extent, the complexities of aggregating sufficient capital, operating, and supportive-services resources, and the efficiencies that can be achieved with larger site-based models, have driven the most common models of supportive housing for homeless people. However, these high-density approaches are not favored by most housing advocates for people with significant disabilities.”

Paul Boden, executive director of the Western Regional Advocacy Project (a coalition of homelessness organizations), says neglect of serious mental disability is “more common than not” in a big box. Managers often fill buildings with people who share similar disabilities and assume tenants all have the same needs. Such segregation is still legally defensible, even though the 1999 Supreme Court decision in Olmstead v. L.C. held that people should not have to live in segregated places in order to receive treatment. In this environment, it becomes particularly easy to skimp on service spending and to neglect individual needs. If one tenant needs more help than others, the response is not “What else does X need?” but “Does X belong here?”

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,


Please enter your comment!
Please enter your name here

This site uses Akismet to reduce spam. Learn how your comment data is processed.