Homelessness and mental health issues often go hand-in-hand, making it hard for behavioral health providers to successfully solve one of those problems without also addressing the other. And now, COVID-19 has complicated things even further.

In Harris County, Texas, where Houston is located, stakeholders have taken aim at both issues with the creation of a trailblazing new facility. It’s called the COVID-19 Homeless Respite and Rehabilitation Center.

The center boasts a unique model and multipronged approach to the rehabilitation of homeless individuals with serious mental health issues, with the goal being to stabilize those people so they can one day have a home and live independently. The center and its services could one day serve as a prototype for other communities.

“There’s not anybody [else] that’s got this comprehensive of a vision to fill the gaps we identified … in our community,” Wayne Young — CEO of the Harris Center for Mental Health and IDD — told Behavioral Health Business. “We think it’s very innovative.”

The Harris Center — the largest behavioral and developmental disability care center in Texas — will operate the new center, which was created with conceptual and financial help from state, county and city stakeholders.

Based in Houston, the Harris Center is a nonprofit safety net provider that serves more than 88,000 patients each year, many of whom are under- or uninsured. With 86 care locations, the Harris Center has an annual operating budget of about $280 million, with funding coming from state, county and third party sources, as well as from various grants.

Origin story

Despite its name, the COVID-19 Homeless Respite and Rehab Center was born out of conversations that started back in January, before the coronavirus took the U.S. by storm.

Harris County had created a task force to look for ways to reduce homelessness in the area. Around the same time, the Houston Downtown Management District set out on a similar mission, convening stakeholders to identify strategies to reduce the impact of homelessness on the community and local economy.

Both groups came to a similar realization, Young said.

“It became clear from both conversations that mental health was a key component of trying to address homelessness, at least in our community,” Young, who was involved in the conversations, said.

In Harris County, as much as 25% of the homeless population is estimated to have a severe mental health condition. Some of those incluse bipolar disorder, substance use disorder (SUD) and severe depression, among others.

To address homelessness in the Houston area, stakeholders realized they’d have to address those issues, too. To start, they looked at cities such as Miami, San Antonio and Seattle for best practices and inspiration before ultimately landing on a model unique to Harris County.

“We identified the gaps in our community, and then collectively, as a group of stakeholders and interested parties, we began to identify what we thought the necessary interventions were,” Young said. “We tried to add in some literature review, so we could come up with evidence-based practices. … Then we formulated this [new model].”

The framework is based on a SAMHSA model for rehabilitating homeless individuals with behavioral health conditions. The model involves engaging those people, transitioning them to intensive care and then providing them with ongoing rehab and community support.

The center, which will implement recommendations from the Harris County Homeless Task Force, aims to do all that. It consists of 108 beds and a broad array of services. 

Those services include step-down residential care for people discharging from hospitals, outpatient competency restoration programing, jail re-entry services and mental health housing, as well as the Harris Center’s well-known jail diversion program.

Additionally, there’s still room for the development of future services, and all living spaces will include supportive and wraparound services.

While development began pre-coronavirus, the new center has become especially important in light of COVID-19, as social distancing requirements have reduced homeless shelter capacity. Plus, the homeless population has a higher chance of getting COVID-19, and frequent emergency intervention puts them and first responders at risk of exposure. 

Those are just a few reasons Houston Mayor Sylvester Turner praised the new facility in a press release announcing its creation. Specifically, he lauded the impact it would have on the area’s homeless population.

“This groundbreaking facility will enable mental health experts to connect with them, so they are permanently housed and out of harm’s way,” Turner said. “The public health threats and challenges of COVID-19 require that we move beyond programs that will create only incremental change, and instead focus collectively on projects, like this needed facility, that will produce a significant change for all Houston and Harris County residents.”

Center financing, features

Financially, the creation of the COVID-19 Homeless Respite and Rehab Center has been a community effort.

Harris County and the city of Houston each invested $5 million dollars for the acquisition of the center’s building and various renovation and furnishing costs.

Meanwhile, a $3 million grant from the state will help with the construction of long-term apartments for homeless people with mental health conditions.

Plus, the Harris Center also has $1.6 million set aside for the operation of the 24 bed step-down unit, as well as $5.8 million in state grants for the already existent jail diversion program, among other funding.

“The commitment of our city and county [in] helping us achieve this model is innovative and ahead of the curve,” Young said. “We think [the center is] a nod towards where communities are wanting to go — and oftentimes, because of resources and other challenges, haven’t been able to get there.”

The center should begin delivering services on November 2, Young said.

In addition to providing housing for homeless individuals with mental health conditions, the facility and its programming will help those people address their psychological and physical health, in addition to providing other resources designed to help them function in society.

One of the most important components of the COVID-19 Homeless Respite and Rehab Center is its 24-bed behavioral step down unit. It’s meant for homeless individuals with psychiatric conditions who are transitioning out of the hospital.

“Our vision for those beds is that people may stay there for up to six months, going through a traditional rehabilitation process and developing the skills and the recovery they need to sustain themselves as they transition out into housing,” Young said.

In the same vein, the center’s 20-bed jail re-entry program will give people a place to stay after being released from jail, with typical stays meant to last three to five days.

Meanwhile, the outpatient competency restoration program is designed to provide housing for homeless people with a behavioral health consitions who are found incompetent to stand trial but likely to regain competency. It will have eight beds and house individuals for 60 to 120 days.

“Most of the people who participate in outpatient competency restoration have misdemeanors,” Young said. “So this is about trying to provide them restoration while they’re in the community without them having to go to hospitals or wait in jail. … As you can imagine, the criminal justice system is hesitant to do outpatient competency restoration if [people] don’t have a stable living arrangement.”

The Harris Center will also move its jail diversion program into the center. The pre-charge diversion effort allows law enforcement to drop off nonviolent offenders who commit crimes associated with mental illness, such as indecent exposure.

The diversion center will have 36 beds, with the average length of stay ranging from 4 to 10 days.

“[Our jail diversion program] isn’t going to look different; we’re just going to pick it up and move it into this location,” Young said. “We think the continuity of this campus will provide us a great opportunity because between 65% and 85% of the people who go to jail diversion are homeless.”

Finally, the center will have 20 beds available for future programming and growth, bringing the total number of beds up to 108. Long-term, however, the Harris Center and its community partners are thinking even bigger.

“We’re braiding some funding … to build apartments for individuals with serious mental health issues,” Young said, noting that the apartments will serve as a permanent, long-term housing option. “We are taking those funds and intending to develop a 25- to 30-unit apartment building on this campus.”

The apartments will be operated using Harris Center funding, as well as city and county housing vouchers. Young says the project should be completed in about a year.

The idea is to build a robust continuum of services in one location, with each program aiming to rehabilitate and stabilize homeless people with serious mental health issues. 

“At the end of the day, if we have one overarching goal, it’s to reduce the experiences of homelessness for those individuals who have a mental health issue, with particular emphasis those they keep coming in contact with criminal justice system,” Young said. “Because those homeless folks are at a high risk of crossing into the criminal justice system just because of the nature of their circumstances.”