RJA

 Mental health and housing : joined up thinking for 21st Century  community mental health ....   
The Big Idea
Housing is central to community care.

It is, quite literally, where it’s at.

Some highly selective quotations
“Employment, housing and a strong social network are as important to people’s mental health as the treatment they receive………
"The next stage in the reconfiguration of mental health services will further strengthen care in the community - breaking down barriers in the way services are delivered.”
Prof Louis Appleby, (former) National Clinical Director, Mental Health.  
 Breaking down barriers: the clinical case for change, DH, 2007

 “Mental health problems require more than a medical solution; they require a positive response on the part of society to accommodate people’s individual needs and to promote mental well-being….
 ”Action will be needed across government to improve the current experiences of people with mental health problems. The problem… cannot be solved by any one department acting in isolation.”
Social Exclusion Unit
 Mental Health and Social Exclusion, ODPM, 2004

 “(These) are the broad set of outcomes across health and social care that organisations should be working towards for their populations.  This will require them to work in partnership with local authorities and other organisations.  It is this broader set of health and social care outcomes that we should hold commissioners accountable for.”
Introduction to:
Health and Social Care Outcomes and Accountability Framework
 (“The Outcomes Framework – an explanation”)

The public health budget will be “an agreed programme between the local authority and the primary care trust”. This budget, he stated, does not need to be restricted to health service activities and “can be spent on whatever looks to have the greatest potential in delivering health gain”. This, he suggested, could include adaptations and assisted technology in the home for older people, provision of counselling in occupation health schemes and even “things like gritting the roads in the county of Durham”.
Andrew Lansley MP,  
now UK Secretary of State for Health, interview
Health Service Journal & Local Government Chronicle
“We will look back on the last half of the 20th century as an aberration - a time when the natural unity of health, home, and community was fragmented and obscured, as an accidental by-product of government funding and     organisation.”
Giles Hilary
For a concise summary of the “Big Picture”, see the NIMHE (National Institute for Mental Health in England) position statement on mental health and housing from 2005 :  “What is to be done?” .

For our own recent and current work, see Development programme
For a broad overview of the development agenda - what can be done to ensure that  housing and mental health agendas are brought together - see our recent work on local action for achieving settled accommodation for those with major mental health problems (originally past of the previous government’s “PSA 16”.

For more specific examples of positive practice, see : ”Housing and mental health practice exchange”  

 For the research agenda to underpin developments in policy and practice,  see : “Knowledge review and critical gaps “, (prepared for the National Social Inclusion Programme in CSIP, 2007) Also  “An elusive interaction”  and “Making the links”

Top: The slums of the Victorian era were  physically unhealthy; but there seems little convincing evidence that they bred the depression and isolation that we see in today’s sub-standard housing.  Claims of a direct link between the physical condition of housing stock and the “common mental health problems” of depression, anxiety and substance abuse are unsubstantiated. It may be the social meaning of living in an unwanted area that has the most relevance to individual and community mental health.
Right: Despite the apparent severity of Le Corbusier’s modernist vision, his students [here] were not above gently mocking the idea of a home as simply a place to house people and activities.  Other examples of radically mis-conceived architecture appear through-put this site.
Centre Right: Catal Huyuk, the first known town, had no streets. Individual homes were entered via skylight in the roof. In her book “The economy of cities”, te influential US geographer Jane Jacobs used excavations of the Catal Huyuj site to illustrate her view that urban growth and regeneration is most effective when un-planned. We continue to experiment.
Centre Left: The modern city suburbs sometimes seem designed more for getting to and fro than for living in.
Left: The iconic image of the Earth - for all of us, our home - has become a symbol of our common humanity; our fragility; and a beauty we often forget to notice.

The US psychologist Abraham Maslow, in his now famous “hierarchy of needs”, identified housing - at least in the form of essential “shelter” - as lying at the very bedrock of our basic human needs.

In this, Maslow was not wrong.  Stable, secure, suitable housing is the necessary basis of our social being; and our social being is the very basis of our mental health. For too many in our society, even this is lacking.

Yet still, Maslow - perhaps, dare we say, because he was an American? - saw individual self-actualisation as the pinnacle of human needs met. We do not.

 

Above and beyond the individual, there is a human need to belong, to be a participating member of a community - a need that has been too long ignored by social and economic policies that stress the singleton as the locus of creativity, productivity, or of neediness.

 

 

For many of us, our home is more than shelter; it is an expression of our identity, our sense of belonging. A home is not just, as the architect Le Corbusier said, “a machine for living in”. Simply compare the meaning of the word “home” with the word “house”…..

 

Good housing is not just necessary to personal security and personal identity. Housing is also one of the basic building blocks of community; and the role of social housing, in particular, is pivotal to the social regeneration of our inner-city areas of multiple deprivation.

 

It is the dual aspect of housing's role in individual and community well-being that puts housing at the centre of new concerns for public health. Turning this abstract potential into an actual, practical agenda, and with the evidence base to support it, for development, is RJA’s primary raison d’etre.