Housing
The Government report No health without mental health recognised that education, social care, housing, employment and welfare are as important in tackling mental health as health services.
Poor housing has strong connections with deprivation, poor education, unemployment, ill health, loneliness, social isolation and a lack of neighbourhood safety. Homelessness is therefore a huge concern with studies showing that poor health (and hospital admission) causes homelessness, poor health is caused by homelessness, and poor health is exacerbated by homelessness.
Supporting the national social inclusion agenda, we ensure that specialist housing support and advice is available to mental health service users in London who fall under the care programme approach.
To achieve this, we plan and manage specialist projects, collating and analysing information, and working across a range of services and agencies which contribute to their implementation. These include London’s PCTs, local authorities, registered social landlords and voluntary sector organisations.
Delayed transfer of care
The delayed transfer of care project recognises that housing has a key role in mental health recovery; re-integration and preventing delayed transfer of care in hospitals by ensuring that patients have a safe, settled and appropriate home to go to when they are fit for discharge.
On average across the NHS, the transfer of care for seven percent of adult mental health inpatients is delayed but this rises to twenty five percent for some trusts. Delays like these cost at least £19 million per year.
The consequences and additional indirect costs of being stuck on a ward when a patient is ready to be discharged are seriously damaging to wellbeing and can result in many patients becoming institutionalised, stressed, bored and aggressive.
Staff morale, retention and recruitment also suffers as staff have to work on overcrowded wards where there is little room for staff to engage with patients.
To avoid health and financial costs to staff, patients and NHS as a whole, the delayed transfer of care project aims to ensure that community and inpatient services ally with local authority housing departments and housing providers to achieve the best and most suitable care holistically.
NHS QIPP agenda
Housing is an essential part of a person-centred ‘care programme approach’ in mental health, and high quality housing and flexible and innovative housing-related support is crucial for alignment with the government’s preventative and productive agenda.
To ensure this, inpatient assessments should include a thorough social needs checklist incorporating housing, employment, income and social networks.
As there is limited supportive and supported housing, our challenge is to increase choice, control, and shared decision making around housing options as well as the level of housing-related practical support.
Peer support
Evidenced-based studies show that additional support on discharge can be provided by a peer support worker who has personal experience of similar difficulties. This worker can relate to the service user in an enabling and empowering way, assisting them to access services such as advocacy, housing advice, education, employment and training services.
Healthcare outcomes will improve if services are aware of a patient’s social exclusion and their combination of linked problems, and work in collaboration to develop solutions. To this end, we have been working with Skills for Health, and devised a new mental health advisor role to assist service users to navigate primary and secondary mental health services.
