article Case Study: Northwest Michigan Supportive Housing

Case Study: Northwest Michigan Supportive Housing 

A Harm Reduction Approach to Stability and Recovery 

Challenges and Interventions

Coordination of Care in Rural Communities

In rural settings, the trust-building process between providers and individuals who have experienced trauma and are hesitant to engage in services is even more difficult because resources are limited and cross-provider collaboration is often weak or nonexistent. NMSH notes that it takes considerably more time and effort to establish and maintain trust, and individuals may not already be connected to any supportive networks, making it difficult for staff to provide seamless referrals or continuity of care. The scarcity of services, such as shelters and behavioral health support, leaves individuals with fewer familiar safe points of contact. Additionally, mental health services in many rural communities are rigid, poorly integrated, and prone to turning individuals away for reasons such as missed appointments due to the lack of transportation or narrowly defined eligibility criteria that individuals are unable to understand. 

Flexible Partnerships

NMSH has sought to address these gaps by partnering with providers to offer more flexible, low-barrier options. Their community-based support network includes healthcare clinics, harm reduction organizations, and crisis services tailored to each tenant’s needs. This approach can be difficult to sustain, as staff often find themselves stepping in to help individuals navigate complex systems, including coaching them on self-advocacy. When individuals encounter gatekeeping or feel dismissed by outside agencies, this can further erode their willingness to engage—not just with those systems, but also with NMSH itself.

Staff Training

To build and maintain trust, staff training emphasizes leading with empathy by incorporating motivational interviewing skills, giving individuals space to guide the conversation, and utilizing “warm handoffs” between outreach, housing, and clinical services. This ensures individuals feel safe, respected, and empowered in their journey to thriving, defined by themselves. Staff are intentional about spending time with individuals, showing up consistently, and building relationships even when individuals initially decline services. Training also emphasizes recognizing that every behavior is a clue to underlying trauma and encourages staff to ask, “What is at the root of this experience?” before jumping to solutions or conclusions about their experiences.

Mobile Support

To provide additional flexible support, NMSH offers onsite therapeutic services that allow therapists to meet individuals where they are through funding and partnership with the Department of Health and Human Services (DHS). Additionally, mobile outreach vans and partnerships with behavioral and physical health clinics allow for consistent, accessible, wraparound services. 

Housing Retention

Housing retention presents its own set of challenges as tenants navigate new lease requirements. Additionally, NMSH is seeing a shift in the tenant population, with more individuals between the ages of 20–40 experiencing substance use disorders. This shift demands greater emphasis on harm reduction and peer-based engagement strategies.

NMSH employs a harm reduction framework in all housing programs, offering nonjudgmental, flexible, and individual-centered support. The organization ensures tenants have access to life-saving supplies such as Narcan, fentanyl testing strips, and “Never Use Alone” protocols in communal areas and through their care coordinators. On-site syringe disposal bins are available, accompanied by resident training to ensure their safe use. NMSH staff engage in open, honest conversations with residents about their use, such as encouraging individuals with alcohol dependence to consider reducing consumption from hard liquor to beer to prevent blackouts. NMSH also utilizes partnerships with outside agencies to offer therapy, medication-assisted treatment, and medical care.

To balance support with housing stability, NMSH works to avoid punitive responses. For instance, when smoking indoors violates lease terms, staff explore alternatives with tenants to prevent eviction while honoring lease agreements. 

This tenant-centered, harm reduction approach reflects NMSH’s broader case management strategy: to support housing retention by meeting individuals where they are, using creative and compassionate methods to address behaviors that might otherwise lead to housing loss.

NMSH also employs a strategic housing placement model that aligns support intensity with individual needs and supports landlord engagement and retention. Individuals who are newer to housing or require more intensive services often live in agency-owned units, where staff can deliver support more readily. In contrast, individuals who have been in their programs for a while and have demonstrated greater stability and self-sufficiency often choose scattered-site housing. This approach helps preserve and strengthen relationships with private landlords and minimizes potential disruptions for tenants.

Positive Outcomes and Other Benefits

NMSH’s success is grounded in:

• collaborative partnerships and
• trauma-informed practices. 

As a result, over the last year, the organization has seen a 96% housing retention rate with residents in their program. Housing provides stability that enables individuals to address underlying trauma and unmet healthcare needs. Residents have reported reduced substance use, increased ability to access services, and improved daily functioning.

Once individuals feel safe, they can shift their focus from survival toward long-term goals such as reunifying with family, pursuing education or employment, and improving their mental and physical health. For example, according to the latest annual report, 57% of individuals were able to increase their income in 2023. One resident, Autum, shared that once she was in the program, she finally felt like she was taking care of her family and able to take care of herself, too.

Beyond individual benefits, NMSH’s model has contributed to greater community well-being, reducing the strain on emergency services and fostering a more inclusive approach to behavioral health and housing. Their commitment to ending homelessness through supportive housing is reshaping perceptions about people with SMI/SUD in rural Michigan and showing what is possible when stability, respect, and community-based care intersect.

Lessons Learned

Building Trust Takes Time: NMSH has learned that establishing trust with individuals, especially those who have experienced trauma, requires patience, consistency, and a willingness to progress at the individual's pace. Seeking quick results can harm engagement. Through intentional relationship building, individuals are better able to understand their options and manage their expectations.

Peer Support Builds Connections: Peers with lived experience often serve as the most effective connectors. When individuals feel disconnected from traditional case management and services, peer support offers a trusted pathway to healing and access to resources.

Flexibility Enhances Engagement: Authentic engagement means meeting individuals on their terms. Each person’s needs and levels of engagement are unique and should be treated accordingly, rather than with a one-size-fits-all mentality. NMSH provides mobile and in-home services, asks people how they prefer to connect, and ensures they show up consistently even when individuals are not ready to engage. Mental health professionals continue to reschedule appointments and create intentional space for program participants.

Systems Must Evolve: Many individuals fall through the cracks due to fragmented mental health systems and restrictive eligibility policies. NMSH has recognized that integration between housing and behavioral health services is essential for long-term stability.

Storytelling as a Tool for Access: Helping people articulate their needs and experiences has proven to be a powerful strategy for navigating complex systems. Coaching and advocacy empower residents to access the services they deserve.

Compassionate Accountability is Effective: Instead of relying on punitive measures, NMSH employs harm reduction and creative problem-solving to support housing retention.

This case study was written in partnership with the Corporation for Supportive Housing (CSH).