Housing and mental health

Sheffield Institute for …, 2005

2007

Psychiatric Bulletin, 1997

2021

Strong leadership: Ministers and civil servants across GB showed unprecedented leadership on the issue of homelessness in the early stages of the pandemic. Particularly in England and Wales, the government response was notable for its speed, clarity of direction, an injection of funding and a desire to work in partnership. The Scottish Government crisis response was characterised by a less sudden policy and practice shift because, we would contend, the pre-pandemic context was more inclusive, particularly in relation to the accommodation provided to single person households, and so there was less necessity for a large-scale emergency response. The direction handed down to local authorities at the outset (March 2020) was unambiguous that everyone should be accommodated and accommodation was expected to be single room wherever possible, and to allow for social distancing in all cases. In England specifically, while there was much praise for the early response from central government, as early as May 2020 key informants were flagging what they viewed as 'mixed messages' from MHCLG and this resulted in growing variation in local authority practice. Partnership working: Collaboration between sectors and organisations became a defining characteristic of the crisis response, particularly at local level. Strikingly, too, homelessness during the pandemic appeared to be addressed as a cross-sectoral priority in all three GB nations, rather than just a 'housing issue'. Yet, there were also examples of persistent SILOS and failures to effectively collaborate, for example in competition between Health and Housing to secure emergency accommodation. Funding patterns and limitations: The significant and unprecedented injection of funding into homelessness services during the crisis, particularly in England and Wales, was unanimously welcomed and enabled local authorities and their partners in the third sector to deliver the achievements outlined in this report. However, there were specific issues raised in England and Wales, where new crisis investment was highest and needed the most. Concerns focused on short-term funding pots, which limited opportunity for investment in longer-term staffing and in England very fast turnaround bidding windows were challenging and focused overwhelmingly on rough sleeping. Access to accommodation-new temporary provision but a stymied system: The commitment to get everyone in prompted an unprecedented response by the homelessness sector to secure sufficient, mostly temporary, accommodation, particularly in England and Wales where the gap between need and existing provision was greatest. Local authorities and their partners in national government, the third sector, RSLs, and the private sector took swift action to commission a very wide range of new temporary accommodation, including; hotels, B&Bs, holiday lets, university accommodation, and RSL properties. Whilst the major challenge was sourcing additional emergency accommodation, to a lesser extent some existing temporary accommodation also had to be decommissioned or adapted. While more common in larger cities in England, in Scotland and Wales too there were examples of accommodation with shared sleeping space in the immediate pre-COVID period. Changes introduced in this provision during the pandemic included shared rooms becoming single occupancy rooms, whilst some shelters were closed and people were moved into alternative accommodation. Following the initial focus on sourcing temporary accommodation, one of the most pressing issues to emerge was access to 'move on' or settled accommodation; a process stymied by a lengthy interruption of social housing allocations and moves within the PRS. Challenges in accommodating people with complex support needs: Across much of England and Wales a lack of existing suitable accommodation and support services created particular challenges in accommodating people with complex support needs. For example, people with significant substance misuse, mental health and behavioural support needs were placed into B&B/hotel accommodation with limited support. Consequently, there were cases of antisocial and criminal behaviour in these accommodation settings and ultimately people's health and well-being were put at risk. There were also challenges associated with hotel staff struggling to cope with complex needs for which they had no training. Meeting people's basic needs, such as access to decent food, was also a major logistical challenge for local authorities and they responded effectively and at speed. In some accommodation settings, such as hotels, this meant paying the hotel to deliver three meals a day, whilst in other contexts, such as across B&Bs and some independent accommodation, volunteers were mobilised to deliver food parcels and basic cooking facilities. Other support, included providing mobiles phones and 'boredom buster packs'. COVID-related welfare and labour market measures: Measures such as the 'furlough' job retention and support scheme, the uplift in the standard allowance of Universal Credit and Working tax Credits by £20 per week until April 2021, and the increase in Local Housing Allowance rates to cover the bottom 30 per cent of private rents, were cited as beneficial in mitigating the impacts of COVID-19 on employment, incomes and housing options. Other COVID-related measures that most English local authorities considered important in preventing or minimising homelessness in their area included the temporary suspension of benefit sanctions (cited by 74%), the pausing of (most) debt-related benefit deductions (67%), and the provision of additional Local Welfare Assistance funding (66%). Workforce and working practices: Frontline homelessness service staff played a crucial role in the pandemic response; often going beyond their usual duties, adapting their working practices and facing personal risks. A very early change in everyday support services involved the shift to remote working wherever possible on the part of both local authorities and Third Sector organisations. Perceptions were generally very positive about the shift to remote/ online working, believing it was more efficient, though some service users reported acute problems getting in touch with local authority services (albeit not necessarily homelessness services). Retaining opportunities for face-to-face support, especially for more vulnerable groups, was felt to be important. The positive accounts of a committed and agile workforce were accompanied by two main concerns. First, many services faced considerable difficulties accessing appropriate PPE at the very start of the pandemic. Second, the pandemic response had a notable impact on staff wellbeing. Frontline staff faced the fear of working in environments where they might contract the virus and there was potential for heightened vicarious trauma, whereby support staff continued to hear about and witness people's life ordeals but previous mechanisms for supporting staff to reflect upon these experiences were disrupted. The role of pre-crisis policy and legislation: Whilst there were similarities in the crisis responses of GB nations, there were also fundamental differences, particularly between Scotland and the rest of GB. The study highlights the central influence of the pre-COVID-19 context on the form of the emergency response. The distinctive position in Scotland, where the legislative framework confers rights to accommodation on all homeless households, meant far fewer additional households had to be temporarily accommodated and so there was less necessity for a large-scale emergency response of the form witnessed in England and Wales. Yet, according to key informants, relatively recent developments in England, particularly the HRA and RSI, laid the foundation of a more effective response to the COVID-19 crisis than would have been the case in the more hands-off 'localist' era under the Coalition Government. In both Scotland and Wales the pandemic also prompted moves to bring forward existing plans to end use of certain kinds of unsuitable temporary accommodation and to build upon rapid rehousing commitments.

Housing, Care and Support, 2010

This article describes the development of the Supported to Independent Living project (SIL), which is for the support and care for people with mental health needs in Oxfordshire to live as independently as possible in ordinary housing in the community. The project is a partnership between NHS Oxfordshire (Primary Care Trust), the Oxfordshire Supporting People programme and Oxfordshire County Council Social and Community Services. Although there was a very vigorous development of community living for people with longstanding mental health needs through the provision of group homes, particularly in Oxford City that started in 1963, there has not been an overall strategy for the development of mental health services for the County as a whole. The needs of a diverse, younger, often more mobile and potentially more challenging group of service users for housing with appropriate care and support have not been met. A joint strategy between the County Council and the Primary Care Trust (PCT) to meet these needs has therefore been developed that introduces a pathway of linked accommodation and support arrangements. These range from intensive support through to floating support in the community, and are intended to offer individuals a guided pathway away from specialist services to more mainstream provision. The services are based on the principles of recovery, personalisation and ordinary housing. As well as achieving significantly reconfigured services the strategy has to deliver savings to meet the cuts imposed on the Supporting People programme grant by Central Government. The project has involved the PCT and the County Council in close partnership working, and important and significant involvement of and engagement with service users and carers. A framework agreement has been agreed by all of the organisations involved. It sets out the roles and responsibilities of each and covers local government, the NHS, housing and support.

Ministry of Social …, 2002

Psychiatric Bulletin, 1998

2000

2002