A patient with severe mental illness has been living successfully in a group home and decided to get her own apartment

Question

The prospective landlord told her, "People like you would have trouble getting along and paying their rent," and he refused to meet with her. The patient and case manager meet with the nurse for a problem-solving session. Which options should the nurse endorse? Select all that apply. a. Coach the patient in ways to control her symptoms more effectively.
b. Seek out landlords less affected by the stigma associated with mental illness.
c. Threaten the landlord with legal action because of his discriminatory actions.
d. Encourage the patient to remain in the group home until her illness is less obvious.
e. Suggest that the patient list a false current address in her rental application.
f. Have the case manager meet with the landlord to educate him about mental illness.

Answer 1

A, B, F
Managing symptoms so that they are less obvious or socially disruptive can reduce negative reactions and reduce rejection due to stigma. Although stigma is a serious and pervasive problem, many persons are less affected by it thanks to public education and positive experiences with persons with SMI. Seeking a more receptive person might be the most expeditious route to housing for this patient. Educating the landlord to reduce stigma might make him more receptive and give the case manager an opportunity to address some of his concerns (e.g., the case manager could arrange a payee to assure that the rent is paid each month). However, threatening a lawsuit would increase the landlord's defensiveness and would likely be a long and expensive undertaking. Further, although it might benefit mentally ill persons as a group, it might not be a helpful solution for this individual patient. Even if successful and handled pro bono, the landlord would likely be inclined to maintain his negative bias against this patient, leading to other problems down the road. Delaying the patient's efforts to become more independent is not clinically necessary according to the data noted here; the problem is the landlord's bias and response, not the patient's illness. It would be unethical to encourage falsification and poor role modeling to do so; further, if falsification is discovered, it could permit the landlord to refuse or cancel her lease.