Supermarket model: Individualizing support and housing options for veterans with serious mental illness and complex barriers to care

Background and issues: Adults living with serious mental illness die 25 years earlier than other Americans, largely due to treatable medical conditions. In order to plan effective care for the individual with serious mental illness, housing must be safe, and be designed to include access to medical and psychiatric care, adequate nutrition, and medication adherence. Description: The team of a Registered Nurse and Social Worker address the following: 1) Identification of barriers to care. 2) Assessment of medical, psychiatric, social, legal, and financial needs. 3) Referral for evaluation, treatment, and intervention by a multidisciplinary team of providers. 4) Collaboration with housing providers in the community to include emergency shelters, boarding homes, recovery houses, assisted living facilities and apartments which meet the individuals' needs. 5) Ongoing case management to offer support, monitor the effectiveness of the placement, and make adjustments as needed. Lessons Learned: Trust needs to be established with each individual. Each individual has a preference to the gender makeup and size of their housing option. There is an adjustment period which requires close follow up. Pharmacy support is crucial to success. Transportation is essential to an effective program. Recommendations: Both Registered Nurses and Social Workers be included on the case management teams. Psychiatric visits, preventive testing and immunizations be conducted in the community. Transportation be incorporated into all programs. Supportive apartments be developed as a housing option.