Building blocks

Sitting alone in a flat in the middle of an urban “sink estate”
is unlikely to make someone with mental health problems feel any
better. Housing has a profound effect on our well-being and
research shows that being trapped in poor accommodation or becoming
homeless can be both a cause and a result of mental illness. For
those with mental health problems, suitable housing can make the
difference between living a stable, fulfilling life and one spent
lurching from one crisis to another.

Ministers have long recognised that securing a decent home is a key
component of mental health support. It has been mentioned in a raft
of policy documents, from the original community care legislation
and the 1990 Homeless Mentally Ill initiative, to the joint
guidance from health and environment ministries, Housing and
Community Care, which in 1997 set out priorities for local and
health authorities on developing a mental health strategy.

“But people with mental health problems still have difficulty
accessing good quality accommodation”, says Toby Williamson, head
of the Strategies for Living project at the Mental Health
Foundation.

A report published last month claimed a shortage of accommodation
for people leaving hospital after mental health treatment resulted
in delayed discharges and limited choice. Some patients had to wait
several months for appropriate homes while others had to accept
housing outside their home borough.¹

In general, provision is patchy. Like many other areas of health
and social care, the quality of support still depends on where you
live. There are plenty of examples of good practice and
multi-disciplinary working, as well as various projects which
target specific groups such as women or ethnic minorities.

But at the same time, clients’ needs are changing and there is
evidence that provision is failing to keep pace with demand. As a
result, some groups are falling through the net. Mental health
charity Mind says providers often face local opposition when it
comes to opening hostels or supported accommodation for people
leaving hospital, explains a spokesperson.

A King’s Fund report published in March, revealed there had been
little growth in supported housing.² In addition it
found that compared with five years ago, schemes were housing
people with more complex needs and that supported housing providers
were reluctant to accept the most difficult clients.

Professionals are coming across increasing numbers of people with
dual diagnosis – where a person has a drug or alcohol problem in
addition to a mental health problem. Often these clients fall
between two stools. “Some mental health accommodation providers
will insist clients address their drug or alcohol problems before
they can be allocated housing. But clients may refuse to address
their problems,” explains Williamson.

And while councils have a duty to house vulnerable people, these
clients sometimes end up living in isolated conditions on estates,
where their behaviour may lead to them being labelled a “problem”
neighbour, he adds. “Someone can end up being moved around several
times with never enough support. If the drug and alcohol problems
continue, the local authorities say that people can end up making
themselves intentionally homeless”.

Chris Jenkins, an independent consultant in housing and social care
and co-author of the King’s Fund report, agrees that there is a
large number of people in the homeless population who are not
picked up by mental health teams. “Providers of accommodation for
single homeless people estimate that 25-30 per cent of their
population have a mental health need, and many of these people are
just bumping around at the bottom of the system,” says
Jenkins.

People with mental health problems have a variety of needs but one
thing they do have in common is a desire for a home of their own as
well as something meaningful to do during the day. “Whatever the
type of housing it needs to give people self-respect”, adds
Jenkins.

Housing for people with mental health problems includes everything
from owner occupied, through supported shared accommodation,
self-contained flats, grouped together and supported by staff, to
hostels, both with and without specialist support. In addition
there are a growing number of crisis intervention projects and
assertive outreach teams that aim to prevent hospital
admission.

“Floating” services, where support is offered to people in their
own homes, are also growing in popularity. “Whatever the client
group, shared housing is unpopular but it’s still quite a large
proportion of provision,” adds Jenkins. Professionals are
cautiously hopeful that the Supporting People initiative, which
began in April, will be good news for many vulnerable people. It
aims to improve the funding, planning and monitoring of
housing-related support services via a new funding system. Cash for
housing related support, previously released through the housing
benefit system, the probation service or the Housing Corporation,
is being transferred to local authorities to spend according to
need. Under the new scheme people will be able to receive services
without being a resident of a particular project or scheme – a move
seen as a major improvement. It allows for the development of
“floating” services provided within clients’ own homes or to
homelessness schemes, and tailored to individual needs.

This concept is a popular one with clients, say professionals. The
King’s Fund report says it will take many years for the full
implications of Supporting People to become apparent. Meanwhile,
the authors argue, health, housing and social services must address
the housing needs of mentally ill people as a specific project
within service planning, along the lines of work undertaken in the
London boroughs of Islington, Tower Hamlets and Harrow, which are
reviewing provision and developing local mental health and housing
strategies. Other promising developments include the mental health
and social exclusion project launched by the government in
March.³ It’s hoped that the accompanying consultation
paper will provide an opportunity to highlight how fundamentally
important housing is to the participation of people with mental
health problems in wider society.

¹ Getting a Move On
from
www.london.gov.uk 

² King’s Fund, Housing for
Londoners with Mental Health Needs from

www.kingsfund.org.uk/pdf/Housing_for_Londoners_with_Mental_Health_Needs.pdf

³

www.socialexclusionunit.gov.uk/mental_health/mental_health.htm
  

Peckham partnership   

People with mental health problems who are unengaged with
statutory services are among the most needy but difficult groups to
help. However, in one London borough, health and housing
professionals have succeeded in significantly reducing hospital
admissions for people with psychosis who are caught up in a cycle
of repeated hospital admissions, homelessness, and contact with the
criminal justice system. 

Partnership in Peckham (PiP) is an assertive outreach project
which targets people who have drifted away from statutory services
with support that focuses on social needs, such as welfare rights
advice, as well as health. It is a joint venture between Opendoor
Housing Trust and the South London and Maudsley NHS Trust. 
Research into a pilot project found a 40 per cent reduction in the
number of NHS bed days and a 35 per cent reduction in the number of
hospital admissions that PiP clients needed compared with before
their involvement with the project. 

PiP currently works with 47 clients but is in the process of
expanding. New enlarged teams of housing trust, social care and
health staff will be launched in December.   Martin Butcher,
operations manager for Opendoor Housing Trust says the drive and
commitment of Eleanor Cole, a consultant psychiatrist at the
Maudsley, is a major factor behind the project’s success. Plus the
fact that PiP is based at Opendoor rather than in a health setting
means clients are more receptive to the service.  Clients with drug
and alcohol problems as well as mental distress shy away from
statutory services, he says. “We can make contact with them on the
street and engage with them in informal settings and in a flexible
way which allows us to build up trust”.