Housing services for people with mental health problems in England

1. Housing services for people with mental health problems in England MaryaSaidi London School of Economics

2. Some background information

3. Background information • In 1990, the National Health Service and Community Care Act • In 1997, the Department of the Environment and Department of Health publish the ‘Housing and Community Care: Establishing a Strategic Framework’ • In 1999, the National Service Framework • In 2003, the Supporting People Programme

4. Prevalence of MHPs • 1 in 4 British adults experience at least 1 mental health problem (MHP) in any 1 year (ONS, 2001) • Women more likely to be treated for a MHP than men (ONS, 2003). • Mixed anxiety and depression most common MHP in Britain (ONS, 2000)

5. Prevalence of MHPs in BME groups • Higher rates of MHPs (NIMHE, 2003) • High numbers in inpatient wards (Healthcare Commission, 2006) • Higher rates of involuntary admissions (Healthcare Commission, 2006) • Less likely to be offered psychotherapy (McKenzie et al., 2001)

6. Stigma and discrimination • 1 in 4 unemployed has a MHP (ONS, 2001) • 75% of people with MHPs are unemployed (Social Exclusion Unit, 2004) • Less than 4 in 10 employers would recruit someone with MHPs (Manning & White, 1995) • Concentrated in deprived areas (Sainsbury Centre for Mental Health 1998) • Stigma & discrimination from housing providers (ONS, 2000) BME groups : poor experience of MH services & have difficulty with access to community MH services (Raleigh et al., 2007) • Social exclusion within housing services?

7. Housing and mental health • Morelikely to rent home from LA or HA; less likely to own home (MIND, 2008). • Effect of poor housing on MH (Fakhoury et al., 2002) • Housing most important factor to achieving independence (Audit Commission, 1998)

8. Housing and mental health (2) Deinstitutionalisation No exact figures on number of people with MHPs in housing services Most people with MHPs live in community & mainstream housing (Social Exclusion Unit, 2004) Lack of information on housing situation, problems & preferences of people with MHPs (Knapp et al., 2007)

9. The PhD

10. Research questions • What are the factors and policies that contribute to the movement of individuals with mental health problems in and out of housing services and how do these individuals experience those movements? • Well-being and satisfaction: how do tenants with mental health problems feel about their housing experience? • How apparent are social exclusion and discrimination in the world of specialist housing services, in terms of accommodation, employment etc? • Structural social capital and social networks: are tenants fully entrenched in the social sphere and the community? What effect does that have on their well-being and satisfaction? • Do tenants from BME backgrounds have different experiences with regard to moving in and out of, as well living in, housing services?

11. Method • 9 areas in England • Up to 8 specialist housing services for mental health problems in each area • Manager & up to 4 tenants in each service to be interviewed • Visited 40 services • On average, about 2.2 service users per SHS were interviewed

12. Describing the sample

13. Description of the tenant sample • 86 service users • 57 of them male • Most of them were suffering from schizophrenia (64.5%) • Mean age: 51.7 (SD=15.22) • Majority were White British (N=71) • Most tenants described health as ‘very good’ “I used to work at a charity shop with normal people but I'm not sure if it's for me yet. I still don’t feel ready and I’m not confident enough to do it yet. But I'm building up the confidence now. I still feel a lot of stigma from people.”Jenny, Supported Housing, Very rural area

14. Description of tenant sample (2) 60 people in care homes – 18 in supported housing, 4 in shared lives and 4 in independent living Most living in small or medium-sized homes Mostly concentrated in rural areas Mostly privately owned/run

15. How do people in SHSs spend their time?

16. Tenant activities • 21 people were in some kind of employment; 1 in FT employment • Most time spent watching television • Minimal physical activity • Low to moderate involvement in community activities: religious (N=21) & hobby or interest group (N=36) • Poor relationships with family and friends “In this place you have to do things to entertain yourself. I really wish there were more things to do.” Kate, Care Home, Large Urban area “If there wasn't the café, I'd be really bored. I like it there, they call me by my name, everyone knows me.” Helen, Care Home, Large Urban area “I guess they are marginally involved in the community. It all depends on peoples' personalities. They do have acquaintances in the community, but not people they can call friends. They lack social skills, like for example the ability to empathise, to be able to maintain relationships.” Tim, Manager, Care home, Part rural area

17. Are people in SHSs discriminated against?

18. Discrimination Still pervasive in the world of mental health and housing – more felt by managers “The media plays a big role in discrimination and the stigmatisation of people with mental health problems. They are very badly portrayed. They’re depicted as murderers. There’s a complete lack of awareness of what mental health really is.” Shelly, Manager, Care home, Part rural area “There’s still a lot of ignorance in society regarding people with mental health problems. People still think that they’re dangerous. We really need to educate and train people. Some staff even discriminates against them!” Karl, Manager, Care home, Major urban area

19. Satisfaction and well-being

20. Tenant well-being and satisfaction

21. Predictors of general satisfaction

22. Social exclusion and social networks

23. Social networks Chatted to anyone in the last two weeks: means and significant relationships by satisfaction rating

24. Social networks (2) Cluster analysis revealed two distinct groups: socially supported versus socially excluded

25. Moving in and out of SHSs

26. Tenant movements • Most had wanted to come to this SHS • Referrals most often made through social worker or hospital • LOS varies with each tenant/service “I was in a care home before with *name of charity*. And I was homeless before that. I stayed there for 15months then moved here. Moving here was a good thing and it was quick and easy. At the end of the day, I’m happy because now I have a roof over my head.” Roberta, Care Home resident, Major Urban area “I suppose they all want to live in a flat on their own, and they aspire to have one but it's different to what they really want. They need company. They might get caught up in a cycle of their accommodation breaking down because of social isolation, they end up back in hospital and eventually lose the flat.” Olivia, Care home manager, Major Urban area

27. Tenant movements (2) • Most managers felt they pushed clients towards independence • Main reason to leave: want less support • More than half the people interviewed wanted to move somewhere else after this • Care home residents: 29 did not want to leave • Move on to independent flat or supported housing service

28. Some conclusions…

29. Future directions Policy implications Cost of non-accommodation services Personalisation Combining the two datasets? Submitting?!

30. Conclusions • Tenants generally did not have the desire; and managers acknowledged their lack of concern with employment • Lack of public mental health awareness • Poor relationships and community involvement • Social networks had a significant effect on different satisfaction ratings

31. Thank you!