Joshua Parry explores the problems people with mental health conditions have in negotiating the housing and social care labyrinth
According to Gofal, people with mental health issues face a ‘double whammy’ of setbacks when accessing housing services. They find it more difficult to access suitable housing or to manage the running of their home when they do. The Welsh Government, social landlords and local authorities are not doing enough to help such people maintain a tenancy or live more independently.
There is an immense chasm between the experience of people with mental health problems accessing housing and the rest of us. This is partly due to the stigma attached to mental health. For example, in January 2013 a proposed development by United Welsh Housing Association, to build eight flats in Caerphilly to house mental health patients was obstructed, after local residents barricaded themselves onto the construction site in protest.
In 2010 a Wales Audit Report found significant gaps in community based services that could provide an alternative to hospital admission. Representations made by several mental health organisations to the Welsh Affairs Select Committee in 2009 agreed with the lack of alternative accommodation for people with mental health needs to move on from hospital, They identified an urgent need for improved provision of specialized, supported accommodation.
It is not that many social landlords are unable to provide accommodation for those with mental health issues. Indeed, a study commissioned by the Community Housing Cymru Group found that they felt ‘competent’ to provide specialist mental health services. However, there is no sense that social landlords are queuing up to provide these types of services.
If a person experiencing mental health issues is sick and has to spend time in hospital, then one of their biggest concerns is about where they will live when they come out. However, for many arrangements are not made for them during their time in hospital. In a Wales Audit Office survey in 2009 more than a quarter of 310 respondents said they had not received enough support with their accommodation needs during the previous 12 months.
To remedy these problems, the Welsh Government’s Mental Health Wales Measure in 2010 provided patients with the right to an individual Care and Treatment Plan to assist their recovery. This considers eight areas of a person’s life, including accommodation, which should encourage partnership working with housing services.
The Measure also gives the right for service users to a Care Coordinator appointed to work with them to manage their care. Yet Care Co-ordinators rarely have housing expertise. Gofal recommends that all mental health wards should have access to someone with a specialist housing knowledge, to ensure patients have appropriate accommodation to go to when they are discharged from hospital.
The Adult Mental Health National Service Framework requires Local Authorities to plan services to meet the needs of homeless people with mental health problems. This requirement has been devastatingly critiqued by Wales Audit Office which found a widespread use of bed and breakfast for homeless people with mental health needs. Not only that, Local Authorities often use out of county placements tens of miles away from a homeless persons’ home area.
This leads to instances such as an example in 2011 when Cardiff Council homelessness services were hauled over the coals by the Public Services Ombudsman in their handling of a case of a young woman with mental health issues. She was evicted from her home just months after being diagnosed with schizophrenia, and was not found suitable accommodation by the council. He housing application was stopped by council workers who deemed she didn’t have the “capacity to make an application”.
Local authorities is also often fail to take armed forces veterans into account within allocation policies. At a Welsh Affair’s Select Committee inquiry into support for veterans, witnesses spoke of their problems accessing social housing, stating that many local authorities apply a ‘local connection’ rule to determine priority. Anglesey and Pembrokeshire Councils had turned away several ex-army personnel, as they had not lived in the local area for more than three or five years respectively.
The Welsh Government has put partnership at the heart of its aim to improve housing services for those with mental health issues. Within the 2010 White Paper for Better Lives and Communities is a commitment to explore placing a duty of co-operation on housing associations and other organisations to improve collaboration. They are urged to design shared models to deliver mental health outreach to homeless people and to prevent the discharge of people from inpatient psychiatry services into homelessness.
A key question is the ability of front line staff to support those with mental health problems. It is only since the beginning of welfare reform, that housing providers are raising awareness of mental health problems with staff.
However, the welfare reform changes have also meant housing providers are unable to concentrate on improving mental health services. Due to the bureaucracy and form writing surrounding ‘Work Capability Assessments’ for those on Employment Support Allowance, staff are spending less time with those with mental health problems. As a result they tend to suffer delays in discharge from hospital, unfair housing allocation policies, and sometimes negative treatment by front line staff.
The Welsh Government is encouraging more collaboration between housing and mental health providers, seeking a more holistic approach in service delivery. In general, however, housing providers are still unsure of their role in providing specialist mental health services.