Photo Courtesy of Wikimedia/Thomas Good/NLN
“The Department of Social Services must do a better job helping some of the city’s most vulnerable people,” State Comptroller DiNapoli said.
By Michael V. Cusenza
The City Department of Homeless Services (DHS) is falling short in meeting the needs of homeless New Yorkers, particularly those with mental health and substance abuse issues, according to a scathing audit released Thursday by State Comptroller Tom DiNapoli.
DHS is the primary agency responsible for providing transitional housing and services for eligible homeless families and individuals in the City and for providing fiscal oversight of the homeless shelters. Governed by a “right to shelter” mandate, the City provides temporary emergency shelter to every eligible person who requests services. When a single adult arrives at an intake/assessment shelter, staff work to identify the individual’s needs and the type of shelter that would best facilitate their transition to more permanent housing. During the intake/assessment process, clinical providers conduct a comprehensive medical examination and obtain demographic information by interviewing clients. This is followed by a standardized mental health and substance abuse screening (psychosocial) assessment, which should be conducted within 48 hours of the client’s arrival, as well as a comprehensive psychiatric behavioral health assessment, as needed. The screening results are entered into DHS’ electronic case management system, Client Assistance and Rehousing Enterprise System (CARES), by the assigned caseworker. At the end of the process, the caseworker recommends the type of shelter in which the client should be placed, a case manager confirms the appropriateness of the proposed shelter assignment, and the client is generally placed into a general or specialized homeless shelter within 21 days of their initial assessment.
Specialized homeless shelters include mental health, substance abuse, employment, and elderly population shelters. On average, DHS provided emergency shelter to 18,000 single adults daily for City Fiscal Year 2021.
The audit examined DHS’ assessment and placement of clients and found that far too often the assessments were insufficient in assessing when they had mental illness or substance abuse issues and individuals were placed in a shelter that could not give them the help they needed. Although the audit did not establish a causal relationship between individuals’ shelter placements and outcomes, it found that appropriate placement in a specialized facility may lower the risk to individuals inside and outside of the shelter system.
As part of DHS’ intake process, clients are assessed to help determine which of its five types of shelter best meet their needs: General, Mental Health, Substance Abuse, Employment and Senior. General shelters do not offer specialized staffing or services, while the other options offer specialized staffing and services or amenities.
DiNapoli’s audit found issues with DHS’s complex assessment process:
- Reliance on self-reporting of mental health and substance abuse issues: DHS does not utilize all data available, and clients’ self-reported answers do not always reveal the true situation. As a result, caseworkers’ judgement factors heavily into screening and assessment results.
- Lack of standardization in the assessment process: Auditors found instances where clients were assessed and placed in shelters that did not match the information documented by caseworkers. There were also insufficient records documenting the rationale for placing clients in general shelters instead of specialized facilities.
- Delays in client placement: DHS’ informal policy says clients should be placed within 21 days of being assessed. Auditors found that in the fall of 2021, 83 of the 359 clients staying at assessment shelters had been waiting over three weeks for placement.
To try to understand the impact that shelter placements can have on clients’ outcomes, auditors looked at the background information of the 17,244 homeless individuals who were in DHS’ Client Demographic Report and examined their current shelter/program assignment, length of stay at current facility, assessment screening scores (e.g., mental health, substance abuse, alcohol abuse) and medical diagnosis. Of these, auditors found 3,022 who were diagnosed with serious mental illnesses that should have qualified them for a mental health shelter. However, 26 percent (795) were not placed in a mental health shelter.
In several cases, some individuals with known mental health diagnoses who were placed in a general population shelter rather than in a specialized shelter caused injury or death to themselves or others. In one instance, a client was diagnosed with schizophrenia and bipolar disorder. Despite being recommended for a mental health shelter, the client was placed in a general health shelter and subsequently transferred to three other non-mental health shelters following violent incidents. After multiple psychotic and violent incidents, the client left a shelter and was charged with murdering a person in a robbery about six weeks later.
Another client, who was diagnosed with schizophrenia, was found dead from probable suicide months after being placed in a general shelter. Prior to his death, he suffered multiple psychotic episodes and was found to not have taken his medication, but there was no change in his shelter placement.
Auditors also found that clients with known substance abuse issues were routinely placed in shelters that did not have specialized staffing and services. Out of the 1,061 clients identified as having alcohol or substance abuse issues, 90 percent (956 of 1,061) were not placed in a substance abuse 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, licensed staff on-site, and specialized services can lower the risk. Especially in the case of clients with serious mental illness, placements should be at sites that offer the highest level of supervision, services, and mental health staff, including psychiatrists and social workers, but too often this is not the case, DiNapoli’s audit found.
Placements were also an issue in senior shelters. A large percentage of homeless seniors, 43 percent, were placed in general, non-senior shelters. DHS officials attributed this, in part, to a small number of beds available in senior shelters. However, auditors found that beds in senior shelters were not being reserved for seniors — 103 of the 368 beds (28 percent) were given to clients who were younger than 65.
Auditors also found weaknesses in DHS’ oversight of clients once they are placed in a shelter and that the agency does not utilize its option to remove clients who pose a threat to themselves and/or others.
DiNapoli’s recommendations included that DHS:
- Create and implement standard operating procedures to ensure individuals are diagnosed, placed in, and/or transferred to the most suitable shelter.
- Analyze client data to help identify clients who potentially may benefit from services that could best be provided in specialized shelters, helping to reduce the risk of clients causing harm to themselves and others.
- Review current client placements; consider transferring clients into shelters that better serve their needs, as warranted.
- Consider what actions to take for clients who may cause danger to themselves or others and are likely to substantially interfere with the health, safety, welfare, care, or comfort of other residents.
In its response, DHS officials generally disagreed with the findings of the report, attributed some negative impacts to precautions implemented during the pandemic, and asserted that there is not a causal factor between shelter placement and client outcomes. The complete response is available in the audit.
“The Department of Social Services must do a better job helping some of the city’s most vulnerable people,” said DiNapoli. “My latest audit shows that too often the department did not properly place homeless individuals with specialized needs in appropriate shelters where they could receive the support they need to get back on their feet and on the path to stable housing. DHS’ shortcomings can have serious implications. It’s my hope that DHS uses the audit findings and recommendations to improve its operations.”
