· Information for housing providers on local mental health services
· Mental health awareness training for housing staff
· An agreed inter-agency policy on disclosure and confidentiality
· Liaison/ link workers
· Housing needs assessments and CPA reviews.
· Advance notification procedures between in-patient and homelessness services
Accurate and up-to-date information for housing providers on the structure and operations of local mental health services can help to clarify who housing staff should contact, if concerned about a tenant’s welfare, so that appropriate action can be taken, before a problem builds into a crisis.
Local information –whether in the form of a booklet, or via a website - should include addresses and catchment areas of locality area offices, the range of specialist services available, including for example Assertive Outreach and STAR services, emergency contacts numbers and procedures, and might also include current policy statements on service delivery.
Mental health awareness training, combined with an opportunity to up-date information on the configuration of mental health services ( see above ) and the workings of any confidentiality/disclosure policy, should be a regular part of staff training for housing services.
Awareness training that involves mental health service users as part of the training team has been found to be particularly effective in dispelling myths and misunderstandings and promoting better practice.
Both housing and mental health services may sign up to an agreed policy identifying the circumstances in which housing staff may legitimately need to know certain agreed information on tenants. The weblink here will take you to an example of a confidentiality/disclosure policy statement that was drawn up in Bradford, after extensive discussions with housing and mental health services.
This kind of policy, and any agreed procedures, can be included in basic induction for new staff in both housing and mental health services. The policy should be formally reviewed approx. annually, and should also be discussed more informally in inter-agency venues; joint training ( see below) is an ideal opportunity.
Each housing office, service or agency can identify one or more members of staff who will be knowledgeable on mental health issues and the structure of mental health services; this worker then acts as an adviser to other housing staff, and also as a link with mental health staff for the locality, able to raise general or specific concerns with the CMHT.
[ NB: such a link worker arrangement is especially useful when in conjunction with an agreed confidentiality/disclosure policy that involves designated housing staff as being within the confidentiality “loop”, and bound by its requirements. ]
One local authority that has moved its housing allocations service to a “Choice-Based Lettings” or “CBL” model, has developed a generic housing support service, which can offer additional assistance as needed to any prospective tenants, or any tenant wishing to re-locate, to help them manage the CBL process. Where there are other health or social services workers already known to be involved with a prospective tenant, the tenancy sustainment team can work alongside the care staff, to ensure that all due sensitivities are respected.
Where the tenant has not given any indication of mental health problems, and may not wish perhaps to reveal any involvement with mental health services, the team can still take them on for support, without needing to know the nature of their vulnerability. Where, having perhaps gained the tenant’s trust through the medium of offering very practical help, it becomes apparent that the individual has other problems that could be helped, the generic workers may then encourage and advise them over engaging with other support or care services in the future.
This would appear then to be a model of socially inclusive practice, that recognises that people may have needs for assistance, without requiring them to accept a “mental health” label, in order to receive support. It would be valuable to know if other CBL schemes find this appropriate; it would also be valuable to hear if service users themselves have found this welcome.
Housing needs assessments and CPA reviews.
Housing needs, and the possible need for housing-related support, should be regularly considered in the course of all mental health assessments, and in CPA reviews. There should be procedures for un-met housing-related support needs to be communicated to the local commissioners of housing related support services.
More information may need to be available to mental health staff, to assist them in appreciating the role of housing staff and support staff, and keeping up to date on referrals procedures, vacancies and other such issues in supported accommodation services. Some services give one staff member the task of keeping this overview of available resources, and also collating measures of un-met need ( from CPA reviews as well as from direct referrals ) to assist in identifying shortfalls and the planning of new services.
We would be particularly keen to hear of examples of different ways this may be done in other parts of the country.
A common complaint of housing services in the past, and particularly homelessness resettlement services, has been that they have been unable to access mental health support for tenants with a diagnosis of personality disorder. In the past, mental health services have been reluctant to take on individuals with this diagnosis.
However, the recent NIMHE document “Personality Disorder – no longer a diagnosis of exclusion” has indicated a significant shift in perceptions and policy towards this client group. This document stresses the need for constructive inter-agency linkages at local level, to meet a range of needs that were previously un-met.
Housing services have typically developed some expertise in working with this client group. If they are not in prison or in hospital, individuals with personality disorder will be in ordinary housing, and many homeless persons resettlement services are dealing with individuals with mild to severe personality problems. Psychiatric services that now attempt to be more inclusive need to be aware of, and to work with, the expertise that some housing support services have developed for this client group.
Many studies have indicated a strong link between mental health and homelessness. Establishing specialist services and/or linkworker roles ( whether in CMHTs or in voluntary sector services, or both ) helps to ensure assessment, engagement and treatment and support for homeless persons.
NIMHE has been gathering information from LITs on the extent to which the needs of homeless persons are explicitly included in mental health strategies, and vice versa. We will also be promoting a new study, to look at emerging good practice in the way that homeless persons services can best manage mental health issues amongst their tenants, and the links they have established with mental health services.
Homelessness services may sometimes complain that they are informed of homeless in-patients only at the point of discharge. It is not unknown for an individual to be taken to the homeless persons service by ward staff, and simply left there, to be re-housed as homeless, with no further information being given. This is not the best way to ensure that the individual will be suitably re-housed.
Homeless in-patients who will be seeking re-housing on the grounds of vulnerability have a considerable vested interest in having information on the grounds for their vulnerability communicated to housing services ( see also “An agreed policy on disclosure and confidentiality” above). In-patient services can therefore be more pro-active in establishing patients’ consent to share information.
(NB: the confidentiality policy explains when and where housing staff need to know information on a patient, in order to meet their housing needs appropriately.)
To suggest further examples in your area of good practice in the interface of housing and mental health services, please contact :-
RJA : c/o 48, Church Drive, Carrington, Nottingham, NG5 2BA
Telephone: (0115 ) 9603111 or email to: Robin@rjaconsultancy.org.uk
Or see the RJA consultancy website, at www.rjaconsultancy.org.uk
NB: All items linked with this overall inter-agency partnership programme are identified on this site by the phrase “housing+”. Once the Knowledge Community is established, this discussion will migrate there, using the term “housing+” again to denote all items in this field.