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Housing services for people with mental health problems in

EnglandMarya SaidiLondon School of Economics

Some background information

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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

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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)

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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)

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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?

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Housing and mental health

More likely 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)

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)

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The PhD

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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?

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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

Describing the sample

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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

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/run14

How do people in SHSs spend their

time?

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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

Are people in SHSs

discriminated against?

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DiscriminationStill 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

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Area of discrimination N Percent (%)

Limited places where clients can live 24 60

Poor quality housing services 8 20

Limited choice about who they live with 25 62.5

Public lack understanding and awareness of mental health 8 20

No hospital after care and support 13 32.5

Discrimination from private landlords 11 27.5

No gradation in support 12 30

Satisfaction and well-being

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Tenant well-being and satisfaction

N Min Max Mean SDSocial situation 83 10 100 73.9 19.

91Housing service 81 25 100 84.8 16.

71Community activities 68 0 100 74.4 22.

29Fellow tenants 75 0 100 74.3 20.

59Income 78 0 100 74.1 26.

33Amount of comfort 76 35 100 83 17.

06Amount of freedom 78 0 100 82.7 22.

06Amount of space 81 20 100 82.8 18.

54Job 14 20 100 76.8 23.

66Staff 76 20 100 86.5 16.

58Privacy 28 30 100 81.32 17.

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Predictors of general satisfaction

Factor B Standard error

Beta t Sig.

(Constant)

-.038 .291   -.130 .897

Living in hospital before

.766 .286 .334 2.679 .011

Want to move somewhere else

-.656 .267 -.311 -2.456 .020

Move was easy

-2.137 .495 -.554 -4.316 .000

Length of stay in SHS

.076 .025 .416 3.003 .005

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Social exclusion and social networks

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Social networks

Satisfaction rating

Chatted to someone

(SD/N)

Not chatted to anyone

(SD/N)

F P Total samples

(SD/N)

Social situation

77.2 (±17.9/63)

59 (±23.7/15)

10.999 .001 73.7 (±20.3/78

)Housing service

87.9 (±14.4/62)

76.1 (±20.3/15)

6.856 .011 85.6 (±16.2/77

)Fellow tenants

78.4 (±17.2/56)

60 (±27.8/15)

10.202 .002 74.5 (±21.1/71

)Amount of freedom

86.7 (±17.5/59)

67.7 (±32.8/15)

9.582 .003 82.9 (±22.5/74

)Average satisfaction

82.9 (±12.9/64)

71.4 (±16.7/15)

8.474 .005 80.7 (±14.4/79

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

Social networks (2) Cluster analysis revealed two distinct groups:

socially supported versus socially excluded

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  Cluster 1: Socially isolated (SD/N)

Cluster 2: Socially supported (SD/N)

F P Total samples (SD/N)

Problems with self-care (EQ-5D)

.53 (±.52/13)

.19 (±.39/48)

7.051 .010 .010

Home located in major urban area

.77 (±.44/13)

.14 (±.35/48)

28.304

.000  

.28 (±.45/61)

Go to daycentre regularly

.00 (±.0/13)

.25 (±.44/48)

4.191 .045 .19 (±.4/61)

Satisfaction with social situation

61.15 (±25.4/13)

74.8 (±19.7/48)

4.308 .042 71.9 (±21.6/61)

Satisfaction with housing situation

75.5 (±24/13)

86.4 (±12.9/48)

4.818 .032 84.1 (±16.3/61)

Want to move out .8 (±.42/10)

.46 (.5/46) 4.021 .050 .52 (±.5/56)

Moving in and out of SHSs

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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

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

Some conclusions…

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

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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

Thank you!

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