Network Success Story

Embedding Mental Health Care in Affordable Housing Sites

The social stigma around mental health care, coupled with a lack of access to mental health providers, can create barriers to treatment, especially among older adults and adults with disabilities. To address both mental health care stigma and access, Support and Services at Home (SASH), HowardCenter, and OneCare began a pilot in November 2017 to embed a full-time mental health clinician (referred to as the Embedded Mental Health Clinician, or EMHC) in two SASH housing sites in the Burlington area. The pilot also uses language, such as “emotional wellness”, to open a conversation with the residents who may have been hesitant to talk about mental health. The pilot aims to meet residents where they are, both in their homes and in their readiness to talk about mental health.

Sash and Howard Center Pilot Program

Key Drivers

  • EMHC given flexible, full-time hours across both sites.

  • EMHC integrated as a full member of SASH staff team.

  • Residents had access to the EMHC in a variety of formats.

Group sessions were offered on participant-driven topics including: grief and loss, suicide prevention, end-of-life planning, emotional wellness, and age-related changes.

Individual, customizable sessions range from short-term social wellness check-ins to longer, formal sessions with treatment plans and goal-setting.

Action Taken

  • SASH staff identified need for additional, flexible and expedited mental health supports for SASH participants.
  • Pilot sites selected for the complexity and variety of mental health and substance abuse service needs present.
  • Existing inter-professional SASH teams in place at both sites conducting regular care coordination meetings.
  • Multi-agency consent for sharing of participant health information already in place due to SASH program requirements.
  • Pilot payments were driven by quarterly outcomes achieved, not quantity of sessions delivered.


Reducing Stigma

Surveyed residents at pilot sites indicate reduced stigma:

83% agree or strongly agree: “Over the past year, I have noticed an improvement in the culture of my building”.

79% agree or strongly agree: “I feel like there is less stigma with seeking support for emotional issues”.

Increase in Unique Participants Per Quarter (Cumulative)

Increasing Access

Surveyed residents at pilot sites indicate improved access:

85% agree or strongly agree: “My access to needed services increased”.

94% agree or strongly agree: “I feel like these are people here in the building who I can go to for support”.

Short referral window:

79% of participants had an encounter with the EMHC within a day from referral.

SASH staff see improved access and knowledge:

100% of pilot SASH staff agree or strongly agree: “Residents gained increased access to needed services as a result of [EMHC] services”.

90% of pilot SASH staff agree or strongly agree: “As a professional, I have gained an increased awareness of resources as a result of working with the [EMHC]”.

Lessons Learned


Empowering residents is key: they suggest group discussion topics, and direct their individual care plans


Flexibility in the pilot design and payment system allowed EMHC to provide participant-driven services without traditional barriers, such as submitting claims, which led to increased access and utilization of mental health supports by wide variety of participants


Pilot program messaging focused on “emotional health and wellness” instead of “mental illness” to encourage broad participation, reduce stigma and increase access to mental health support