The role of housing in managing mental health
One in four people in the UK suffer from poor mental health, but just 25% of these individuals access any formal health and social care support. This gap is not just affecting people’s mental and physical health and wellbeing, it is expensive too: mental health related illness is estimated to generate an annual cost to the economy of £105bn.
These alarming statistics have drawn governmental focus in recent years: an independent task force was established and recently announced, with NHS England, a five year plan to improve and expand mental health, investing an extra £1bn by 2020-1. Current plans include placing mental health specialists within A&E units, placing young people closer to home, and boosting early intervention services, amongst other targeted interventions. While these initiatives promise to make a difference, significant gaps remain in prevention and intervention around housing for people with mental health challenges.
The lack of adequate housing supply has resulted in patients with the most severe and enduring mental health needs being the most neglected. Those individuals with a history of dual diagnosis and resultant chaotic lifestyles lack stable accommodation best suited to meet their needs and support recovery. It is not uncommon for a person to be discharged to a supported housing placement that is out of borough and some residents are even placed in a completely different part of the country. As a result many people:
- Lose their local support network, including friends, family and carers;
- Have to change key support workers regularly and, with every change, start again to build understanding and trust necessary for effective support; and
- Experience inconsistency with the trust that are responsible for organising and providing appropriate care resulting in broken / disjointed care plans.
So what can be done to improve services? How do we better accommodate vulnerable individuals within a home environment at a time of increasing cuts and financial pressures?
Since the 2014 Care Act much of the focus has centred around the need for housing, health, and social care agencies to work together to ensure delivery of maximum impact for minimal cost. However, the integration of health and social care is already proving a challenge, therefore adding additional housing agencies – with completely different governance, funding, regulatory regimes and ways of working – presents further layers of complexity.
There are examples of progress at a local level across the country however, ranging from neighbourhood support and prevention initiatives, such as handyperson services, through to reablement services and supporting hospital discharge. Some providers are developing specialist expertise and capacity in dementia care involving creating a mix of housing, digital technology and personal care.
How best do we learn from these local successes, spread good practice and mobilise the movement towards integrated mental health support to improve mental health and wellbeing?
This is the big challenge for policy makers, commissioners and providers alike and one which will require concerted efforts. As mentioned by Paul Corrigan at a recent roundtable on Mental Health and Wellbeing – co-hosted by PPL, the Social Care Institute for Excellence and Mind: “The moral and economic case for change is here, and there is plenty of knowledge about what works. But making it happen in practice is difficult and bringing it to scale is even harder”. As a starting point we need to recognise that by working together, mental health and housing providers can help reduce overall demand for health and social care services. They can also develop better and more cost effective services which connect the NHS to community support. And, most importantly of all, integration between mental health services and housing providers can ensure patients have the basis to continue their recovery, receive the necessary levels of support to improve wellbeing and lead fulfilling and active lives.