Mental health, housing and social inclusion

 

This statement of principles first appeared on the website of NIMHE North East, Yorkshire and Humber – now CSIP-  RDC. It now also appears on the NSIP website, under Social Inclusion Principles in the Housing section.

 

What is to be done?

 

“Social inclusion must come down to somewhere to live, something to do and someone to love.  It’s as simple – and as complicated – as that”

Charles Fraser, in evidence to the MIND Enquiry “Creating Accepting Communities”.

 

Housing is central to mental health in three key areas:- firstly, in the importance of ordinary homes; secondly, in specialist or supported accommodation; and thirdly, in the neighbourhoods and social networks that our homes locate us in.

 

 

Ordinary houses.

 

The vast majority of us, including those with minor and major mental health problems, are living in our own homes, and would wish to continue to. But the quality of accommodation can have a major and pervasive effect on our lives, our quality of life, and on our mental health.  Worries about our accommodation feature heavily in the common mental health problems of anxiety or depression that many may at times feel. It takes little imagination then to appreciate how difficult life would be without somewhere to call home.

 

Yet finding and keeping a safe, comfortable and convenient home is fraught with difficulty for many people who have severe mental health problems.  

“Housing-related” support can have a very significant role in helping an individual manage a tenancy. But, nation-wide, the development of housing support services has been rather erratic over the past few years. Some parts of the country still have no supported accommodation or floating support services for individuals with mental health needs.

 

Also, for many with major mental health difficulties struggling to find somewhere suitable to live, the housing options available may not be helpful, particularly where the only accommodation for single people may be concentrated in inner city areas, in multi-occupancy housing, or in high-rise accommodation.

 

We do know that poor housing can have marked and lasting effects on anyone’s mental health. Some studies now suggest that this effect is even more marked on those already in poor mental health. There is a clear need for research to assess the full extent of this effect, and the hidden cost of leaving the housing needs of those with mental health needs to the vagaries of the market, where the evidence suggests that they are at a disadvantage.         

 

 

Special needs accommodation

 

There will probably always be some individuals – especially those with the most severe problems and/or the most challenging behaviour – who need considerable extra support to live in the community. For some, at least for a period, living with others with similar needs can be beneficial, particularly where individuals need support, company, or the “critical mass” for peer support and accelerated social learning in dedicated social environments.

 

We have coined the term “housing-based solutions” to refer to social support and social networking initiatives or approaches that are pro-active in their use of housing, seeking suitable stock as an essential feature of the support model. Rehabilitation hostels, therapeutic communities, foyers, core-and-cluster or Keyring household networks, group homes, and warden-aided complexes are all examples of support models where use of, or access to, suitable housing stock is central to the support provided.

 

But housing based solutions do not always need a specially built or adapted building. In “special needs housing”, it is the needs, and the support to meet those needs, that are “special”. Thoughtful earmarking of properties for their peer- and neighbour support value can turn ordinary, isolated housing stock into a social support resource. Note that all the examples above of “housing-based solutions” typically accentuate community and social networking and peer support.

 

 

Neighbourhoods and communities

 

It is widely accepted that housing is one of the key elements in the building and re-building of local communities. We all have neighbours, and we are all neighbours to somebody else. Research has indicated that individuals who feel supported and integrated within the neighbourhood will tend to like where they live, even where the housing itself is not of a high standard. But where individuals are isolated, feeling marginalized or excluded, then poor physical housing in addition is particularly hard to bear.

 

Whilst community care has been the ambition of successive governments since the mid-20th century, for most mental health services, pre-occupied with the demands of casework, this community dimension has often been missing. But unless mental health services play their part in the developing sustainable communities agenda, current efforts by government to promote neighbourhood renewal risk failing to engage with a significant part of the needs of the residents in their midst.

 

From Local Strategic Partnerships to Tenants’ Associations and Tenancy Compacts, mental health services need to engage with neighbourhood renewal strategies, to ensure that the sustainable communities vision positively includes those at most risk of marginalisation. We will need to be tackling stigma and mis-information, advocating on behalf of those with common and more severe mental health problems, learning difficulties, substance abuse problems or personality disorder – but listening, too, to the realities of life in our more disadvantaged areas.

 

 

An inter-agency vision

 

It is clear that any Mental Health service that is focussed upon personal recovery and social inclusion must learn to address the housing needs of its clients. Equally, any housing agency that is focussed upon individual and community well-being must recognise the mental health needs of tenants. Any strategy for neighbourhood renewal which neglects the most vulnerable and the most challenging, is bound to fail. All three sectors must learn to see people with mental health needs, first and foremost, as citizens.

 

More work needs to be done, both locally and nationally, to ensure that we can identify the housing needs of those with mental health problems, and have these needs factored in to community care strategies, and to the housing strategies of local authorities and their voluntary sector partners.  All this will require a degree of co-ordination, discussion and co-operation between mental health and housing services that we have not previously seen, over the needs of those with more severe mental health problems.

 

So how is this to be achieved?  The housing and mental health sectors are not natural partners.  A whole range of factors set them apart:  indeed they often seem to have conflicting objectives.  So, how can this divide be crossed?  Who should take responsibility for building the bridges?  What might good practice look like?  Is anybody doing it already?  If so, how can we learn from them?

 

These and many other issues concerning housing and mental health are now being taken up through the Housing and Mental Health National Project Team, developed by NIMHE as lead agency for the implementation of the Social Exclusion Unit report on Mental Health and Social Inclusion.

 

 

For more details of the SEU’s report, and the Factsheet on housing, see:- 

 http://www.socialexclusion.gov.uk/page.asp?id=257

 

For more detail on NIMHE’s social inclusion programme and housing, see: -

 http://www.nimhe.org.uk/priorities/socialinclusion.asp