circles of support: a floating support service for moving...
TRANSCRIPT
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Circles of support:A floating support service for moving people with
mental health problems to independent living
Richard Wynne, Work Research CentrePaula McNulty, HAIL Housing
Aoife Farrelly, HSE
NDA conference 2017
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A floating support service
• 2 Genio funded projects – Doras and Slan Abhaile
• Collaboration: HAIL Housing and HSE Mental Health Rehab team
– Housing
– Tenancy and personal support
– Clinical support
• 56 clients over 4 years
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Hostels /CommunityResidential
Floating Support(mental health oriented)
‘Recovery’ dimension
Tenancy-related support
PreparatoryPhase
Transition/Settling in
PhaseMaintenance &
Recovery Enhancement
Homeless InappropriateLiving Situation
LA Tenants
Other SocialHousing Tenants
HAIl Tenants
PsychiatricHospital
OtherHospital
Private RentalTenants
Prison
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Dublin North City Mental Health Services | CHO 9
CURRENT SERVICES
• DNC provides community and local and regional in-patient services to 337,000 people in north inner city Dublin.
• 13 CMHT’s
• Programme for the Homeless team
• 3 Community Rehabilitation Teams
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Dublin North City Mental Health Services | CHO 9
REHABILITATION AND RECOVERY MENTAL HEALTH SERVICES
• A Specialised Tertiary Service for people with complex needs that can’t be met by general adult MH services
• Individuals with severe and enduring mental health issues and complex needs aged 18-65.
• People with prominent symptoms and partial response to medication.
• Difficulties with communication and engagement and repeated hospitalisations / involuntary detentions. Some with difficult to manage behaviours and forensic issues.
• Some loss of self confidence, life purpose, institutionalisation, unemployment, social isolation and housing difficulties.
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HSE VISION FOR THE PROJECT
• Collaboration between HSE, Rehabilitation CMHT and HAIL i.e. Mental health professionals working with housing specialists.
• Implement Vision For Change - social housing responsibility of local authority.
• Provide secure independent housing in safe environments .
• Promote active community participation and meaningful social roles.
• A model of CMH rehabilitation based on community outreach and homecare.
• Reconfigure services - reduce places in hostels, close high support hostels and reassign staff to community teams.
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Process
• Develop personalised support plan and set goals (ICP)
• Housing Support Worker essential member of team, attends team meetings and ICP meetings.
• Meaningful engagement with families and service users.
• When client is housed – plan for reduced support, follow up by team, in some cases referral back to local CMHT.
• Joint training HSE and HAIL in SSDL (SRV)
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About HAIL
• Founded in 1985 – St Brendan’s, Grangegorman following the publication of the report “Let’s Look at Housing
• Approved Voluntary Housing Association
• HAIL provides exceptional quality social and affordable rented accommodation for people from local authority housing waiting lists, primarily those with mental health difficulties.
• Currently 340+ tenancies
• Individually tailored services (floating support) to support people with mental health difficulties to integrate and live independent lives in the community.
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Our Support Services
HAIL SUPPORT
Individual's needs
Partnership working
Holistic
Non- clinical
Towards Independence
PICCLS
Cloverhill Remand Prison
Referred by NFMHS
Homeless
Complex Needs
TENANT SUPPORT SERVICE
Permanent home with HAIL
Community Integration
Phased but open-ended
SLAN ABHAILE
From hostels to Independence
Low/med /high support
Working with Rehab teams
VISITING SUPPORT SERVICE
Tenancies at risk ( MH related)
Range of tenancies
Crisis Intervention
Time limited
PEER SUPPORT
One to one Peer Support
Social, Emotional, Practical
Recovery focused
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Move On
• Meet with MHRT, Client & Families to
discuss move on, and area of choice.
• Begin the “discovery process” to explore
interests, dreams, previous experiences of
clients in order to enhance or develop
new positive roles.
• Advocate with Local Authorities and
Housing Bodies in order to source suitable
housing.
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Moving In
• Familiar with locality of choice.
• Support them with interview & signing a tenancy.
• Social Welfare and Benefits.
• Shopping
• Assist with setting up utilities (Electric, Gas, & Water) in clients names.
• Encourage clients to pay utility bills and rent through direct debit.
• Rent payment system (An Post).
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Did the project work and the value case for continuing?
• Stakeholders perspectives
• Resources used on the project
• Value for money
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Doras and Slan Abhaile projects
Marker Doras Slan Abhaile
Number of clients 18 51
Client status69 people supported by the project; 56 had moved in; only one failed tenancy
Nature of MH issue 39 Schizophrenia, remainder mostly bipolar disorder
Length of time in previous accommodation
10.2 years (< 1 year to c. 40 years)
Previous accommodationHostel – 53; hospital ward – 6;Family friends – 6; others – 4.
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The sample
• 16 individual interviews
• 10 clients in focus groups
• 28 Hail key workers assessments
• 14 HSE key workers assessments
Data from 37 clients in all
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Quiet, good for studying, good
accommodation, subsidy is good
enough
Invaluable for recovery
Having my own place, feeling
secure, being in control of my life
87% say it is better than
previous accommodation
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19
I can manage better because my new home
allows me time and space to deal with issues
Because I am living on my own now
My accommodation and living conditions
are better now
HSE KW: 86% ‘OK’ or ‘very well’
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20
I have no problems in managing daily
activities
I am saving now and paying my bills
HAIL KW: 95% managing ‘OK’ or ‘Very well’
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21
I want to be better in my
studies
I am trying to get a job now and I am doing other
things
The other patients
annoyed me
Not having my own personal
space
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Value case
• Delivery on policy – the projects help realise policy on:
• Health
• Housing
• Employment
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Value case
• Value for clients with enduring mental health needs
Mental health & Wellbeing gains
Housing-related gains
Recovery-related gains
Social inclusion gains
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Value Case
• Enabling/enhancing service provision HSE service provision – Better throughput of clients,
potentially lower service usage
Housing sector – enabling clients to reside in housing, reduced problems associated with client group