DiNapoli: One in four homeless shelter clients with serious mental health issues were not placed in a mental health shelter

DiNapoli: One in four homeless shelter clients with serious mental health issues were not placed in a mental health shelter

According to an audit released today by State Comptroller Thomas P. DiNapoli, the New York Department of Homeless Services (DHS) is failing to meet the needs of homeless New Yorkers, especially those who have mental health and addiction issues.

The audit looked at DHS’s assessment and placement of clients and found that too often assessments were insufficient to determine when they had mental health or addiction issues and people were placed in a shelter that did not couldn’t give them the help they needed. Although the audit did not establish a causal link between the placement of people in shelters and outcomes, it found that appropriate placement in a specialized facility can reduce the risk to people inside. and outside the refuge system.

“The Department of Social Services needs to do a better job helping some of the city’s most vulnerable people,” DiNapoli said. “My latest audit shows that too often the ministry has failed to properly place homeless people with specialized needs into appropriate shelters where they could receive the support they need to get back on their feet and on the path to life. stable housing. DHS shortcomings can have serious consequences. I hope DHS will use the audit findings and recommendations to improve its operations. »

As part of DHS’s admissions process, clients are assessed to help determine which of its five shelter types best suits their needs: general, mental health, substance abuse, employment, and senior. General shelters do not offer specialized staff or services, while other options offer specialized staff and services or amenities.

DiNapoli’s audit revealed problems with DHS’ complex evaluation process:

  • Dependence on Self-Reporting Mental Health and Substance Abuse Problems: The DHS does not use all available data, and self-reported customer responses do not always reveal the true situation. Therefore, social worker judgment plays an important role in screening and assessment outcomes.
  • Lack of standardization in the evaluation process: Auditors found instances where clients were assessed and placed in shelters that did not match information documented by social workers. There were also insufficient records to document the rationale for placing clients in general shelters rather than specialized facilities.
  • Delays in placement of clients: Informal DHS policy states that clients must be placed within 21 days of their assessment. Auditors found that in fall 2021, 83 of 359 clients staying in assessment shelters had waited more than three weeks to be placed.

To try to understand the impact that shelter placements may have on client outcomes, auditors reviewed baseline information for the 17,244 homeless people who were listed in the DHS Client Demographic Report and examined their current assignment. shelter/program, length of stay at current facility. , screening assessment results (e.g. mental health, drug addiction, alcoholism) and medical diagnosis. Of these, auditors found 3,022 people diagnosed with serious mental illnesses that should have qualified them for a mental health shelter. However, 26% (795) were not placed in a mental health shelter.

In several cases, some people with known mental health diagnoses who have been placed in a general population shelter rather than a specialized shelter have injured themselves or died or caused the death of others. In one case, a client was diagnosed with schizophrenia and bipolar disorder. Although referred for a mental health shelter, the client was placed in a general health shelter and then transferred to three other non-mental shelters following violent incidents. After multiple psychotic and violent incidents, the client left a shelter and was charged with the murder of a person during a robbery approximately six weeks later.

Another client, who was diagnosed with schizophrenia, was found dead of probable suicide months after being placed in a general shelter. Prior to his death, he suffered from several psychotic episodes and was found not to have taken his medication, but there was no change in his placement in a shelter.

Auditors also found that clients with known substance abuse issues were routinely placed in shelters that lacked specialized staff and services. Of the 1,061 clients identified as having substance abuse problems, 90% (956 of 1,061) were not placed in a drug shelter. In one case, a client assessed with alcohol dependence had 60 separate drug and alcohol-related incidents while in general shelters in 2021, including one in which he threatened a roommate with a box cutter while intoxicated. Despite the incident, the client remained in a general shelter.

Placement in a specialized shelter may not eliminate the risk of a client harming themselves or others, but the presence of qualified and licensed staff and specialized services on site can reduce the risk. Especially in the case of clients with serious mental illness, placements should be in sites that offer the highest level of mental health supervision, services and staff, including psychiatrists and social workers, but too often this is not the case, according to the DiNapoli audit. found.

Placements were also an issue in seniors’ shelters. A large percentage of homeless seniors, 43%, were placed in general non-senior shelters. DHS officials attributed this, in part, to the small number of beds available at seniors’ shelters. However, auditors found that beds in seniors’ shelters were not just for seniors – 103 of 368 beds (28%) were assigned to clients under the age of 65.

Auditors also found weaknesses in DHS’s monitoring of clients once they are placed in a shelter and the agency does not use its option to remove clients who pose a threat to themselves and/or or for others.

DiNapoli’s recommendations included that DHS:

  • Create and implement standard operating procedures to ensure people are diagnosed, placed and/or transferred to the most appropriate shelter.
  • Analyze client data to help identify clients who may benefit from services that could be better provided in specialized shelters, helping to reduce the risk of clients harming themselves and others.
  • Review clients’ current investments; consider transferring clients to shelters that better meet their needs, as needed.
  • Consider what steps to take for clients who may put themselves or others at risk and may significantly affect the health, safety, welfare, care or comfort of other residents.

In its response, DHS officials generally disagreed with the report’s findings, attributed some negative impacts to the precautions implemented during the pandemic, and asserted that there was no causal factor between shelter placement and client outcomes. The full answer is available in the audit.


New York City Department of Human Services: Oversight of Shelter Placements

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