supporting recovery in mental health through community living… · supporting recovery in mental...

Critical Social Thinking, Vol. 5, 2013

Critical Social Thinking | Applied Social Studies | University College Cork | http//:cst.ucc.ie 1

Supporting recovery in mental health through community living: A

case study of Slí Eile

Aoife Farrell, BSW

Abstract

Responses to mental health difficulties in Ireland still cleave mainly to the dominant

bio-medical model in terms of underpinning theory. ‘Treatment’ of ‘mental illness’ is,

for the most part, carried out in a medical setting incorporating a range of

interventions such as hospital admissions and the prescription of psychotropic

medication. As an alternative approach, Slí Eile Housing Association offers

supportive accommodation to people who experience mental health difficulties in a

therapeutic, non-medical environment.

Keywords: Mental health; community living; housing policy

Background

This paper is informed by primary research carried out by the author in 2012, which

was undertaken in order to evaluate Slí Eile Housing Association – a supportive, non-

medical, housing project for people who experience mental health difficulties.1 The

1 The researcher is aware of the contentious nature of terminology used in the lexicon of mental health. Labelling ‘patients’ with ‘mental illnesses’ and other such pathological terminology can have profoundly oppressive effects on people. Therefore, the use of the limited language of ‘illness’ will be avoided throughout this discussion. The terms madness and mental distress will be used in favour of medicalised jargon. Furthermore, the terms service user and person who experiences mental health will be used interchangeably throughout the discussion. Since some terms are seen as pejorative by some

Critical Social Thinking: Policy and Practice, Vol. 5, 2013 School of Applied Social Studies, University College Cork, Ireland



project was taken as a case study to exemplify the nature and form of a social,

community-based approached to supportive housing in mental health care. The

purpose of the research was to evaluate Slí Eile in terms of its effectiveness and to

inquire as to whether the project offers learning and examples of best practice in the

area.

Slí Eile provides supportive community-based accommodation for individuals who

experience, or who have in the past experienced, mental distress. According to its

mission statement, the aim is ‘to provide a safe living environment where structure,

routine and respect support a person experiencing mental distress in regaining control

of their lives’ (Slí Eile Mission Statement). The project’s philosophy is informed by a

social approach to mental health and its ethos is underpinned by the recovery model.

Fundamental to the approach is supporting tenants to regain control of their lives and

promoting and facilitating recovery through supportive, community living.

The Slí Eile approach is informed by Loren Mosher’s principles around therapeutic

communities and the Soteria project which he founded in California in the 1970s and

describes as follows:

[B]asically, the Soteria method can be characterized as the 24 hour a day application

of interpersonal phenomenologic interventions by a nonprofessional staff, usually

without neuroleptic drug treatment, in the context of a small, homelike, quiet,

supportive, protective, and tolerant social environment (Mosher, 1999; 144-145).

In addition, the Slí Eile approach is firmly rooted in Recovery Model values and

principles as well as William Glasser’s choice theories which will be explored further

in the findings section.

At the time of the research, in Spring 2012, the Slí Eile project was operating out of

Villa Maria2– a five bedroomed bungalow just outside of Charleville in North Cork.

Having evolved over the six years since its inception in 2006, the house provided individuals, it is hoped that a mixture of terminologies will reflect this diversity. The term tenant will be adopted from Slí Eile and used in reference to people who are living there for the sake of brevity. 2 since then, Slí Eile has expanded its operations and is now based at a 50 acre farm at Burton Park, Churchtown Mallow. The Slí Eile Farm Project was launched in May 2013 and can provide accommodation for 12 tenants.



accommodation for six tenants (the use of psychiatric labels is deliberately avoided)

and included a kitchen, living room, purpose-built bakery and garden.

In terms of organisational structure, Slí Eile is managed by a 6 member Board of

Directors. The CEO and founder, alongside a recently appointed manager, is

responsible for the management and development of the project on the ground. The

day-to-day running of the project is facilitated by a team of five support workers. The

organisational structure is non-hierarchical, allowing for good communications

between management, staff and tenants.

Methodology

In terms of methodology, the research was informed by the principles of Participatory

Action Research. A model of participatory research, as Truman et al. point out, takes

a phenomenological model further in research practice ‘in the attempt to share power

and aim for equality at every stage of the research process’ (1999; 4) and these

attempts were fundamental to this study. It is a democratic and non-coercive approach

to research whereby the research is carried out with rather than on the participants

(Pratt 2000; Wadsworth 1998). In practice that meant collaboration with the Slí Eile

community at all stages of the research process. Initially, during the forming stage,

discussions were had with tenants, staff and management in an open and democratic

manner in order to formulate a research plan. The proposal was then written up and

presented again to the community as well as the Board of Directors. Feedback was

sought and given during the storming stage and the proposal was adapted accordingly.

Lee et al. point out how ‘this community-driven approach to research begins with the

goals and questions of the community, is participatory at every level...and uses a

diversity of communication tools and languages’ (in Minker & Wallerstein, 2008;

336). This certainly resonates with the research methodology since a ‘diversity of

communication tools and languages’, as referred to by Lee et al. (2008), were

employed as part of the data collection methods, discussed in further detail below.

Furthermore, a community-driven approach was applied since the research objectives

were conceived of through collaboration with the community in question. Not only

was the research community-driven, the field work was (as far as was practicable)

community-based.



Irish social science has been particularly dominated by positivist and post-positivist

paradigms and critics have pointed out the limitations of these approaches, especially

in terms of addressing issues of oppression of marginalised groups (Byrne & Lentin,

2000). Therefore, in an attempt to avoid perpetuating the social injustices inherent in

society (and conceptualised in much mainstream mental health research), the

theoretical perspective which underpinned this study was emancipatory by design. As

an alternative to positivism, emancipatory research seeks to empower participants.

Therefore, rather than adopting a ‘top-down’ expert approach, the hope was for this

research to be collaborative and participatory, thereby embracing an emancipatory

theoretical perspective. Furthermore, and of particular note in terms of mental health

research, this process emphasises the knowledge of people with lived experience as a

vital source of expertise.

Ethical Considerations

It is well established that people who experience or have experienced mental distress

are also likely to face stigmatisation, discrimination and marginalisation (Johnstone,

2001; Pilgrim & Rogers, 2003). Maintaining an ethical stance, therefore, is imperative

in mental health research. As a basic tenet of ethical research, informed consent was

required from all participants. At the outset, the research was explained thoroughly to

the Slí Eile community - initially through the provision of a draft proposal and

subsequently through discussions at a community meeting. The right to refuse to

participate or to withdraw at any stage was outlined and, following on from that,

written consent was sought.

Furthermore, another fundamental consideration of ethical research is the protection

of participants through maintaining anonymity and confidentiality (Aita & Richer,

2005). Anonymity has been maintained since names of participants have not been

used in the analysis of data. In addition, due to relatively small number of

participants, some narrative detail has been changed where necessary to disguise

circumstances. Confidentiality was therefore maintained and the identification of

specific individuals was avoided.



Data Collection Methods

The bulk of the fieldwork was carried out in March and April 2012 at Villa Maria,

with the researcher making a number of visits to the project, working on site and

collecting data through various methods. In keeping with the principles of

participatory action research, the community's input was fundamental to the research

design. Therefore, in terms of data collection methods, in-depth discussions took

place around how best to capture the most meaningful expression of the tenants’

experiences. Following collaborative examination of various research methods

introduced and explained by the researcher including interviews, focus groups and

other more creative methods, the tenants decided that photovoice was the most

effective means through which to convey their experiences.

Photovoice

Photovoice was developed by Caroline Wang and Mary Ann Burris and first applied

as part of their participatory research with a group of women in rural China (1997).

Photovoice is a method most commonly used in community development and public

health research and is underpinned by notions of empowerment and raising critical

consciousness. It borrows from Freire’s (1970) ideas about the power of visual images

in facilitating critical thinking about forces that influence people’s lives. The process

involves providing participants with cameras and asking them to photograph their

everyday realities. Subsequently, the photographs are used as the basis of group

discussion and action. In addition, participants are encouraged to use collage,

captioning and creative story-telling to further express what the photographs mean to

them. The result is a collection of narrative audio, written and visual data.

The photovoice approach to community-based participatory research has been used

with many marginalised communities as a tool for empowerment and raising critical

consciousness. For example, the approach has been used with black and Latino youths

(May, 2001), people with mental health difficulties (Bowers, 1999) and people who

are homeless (Wang, Cash & Powers, 2000). According to Ruby, photovoice offers

the possibility of perceiving the world from the viewpoint of the people who

live lives that are different from those traditionally in control of the means of

imagining the world’ (1991; 50).



In that sense, it ties in with the emancipatory design of this inquiry, empowering

participants and giving them a sense of control as to how their experiences are

documented. Of particular note here in terms of mental health research is the contrast

between this research design and more traditional methodologies. The limited scope

of positivism in social scientific research has been outlined already and, in terms of

service user input into mental health research, questions have been raised over the

extent to which participation and involvement have been realised (Bell, 2000; Fudge

et al., 2008). Therefore, through incorporation of participatory methods and an

emancipatory research design, it was hoped that dominant, conventional research

methods were challenged.

In addition to the photovoice methods, as well as observation of the project’s

operations, a number of interviews were carried out. For the purposes of triangulation

and in order to glean data from multiple perspectives (O’ Donoghue & Punch, 2003),

members of the staff and management teams were recruited to partake in semi-

structured interviews.

Table 1 - Sampling of participants and data collection methods used

Interview Photovoice Total

Tenants 2 4 6

Staff 3 - 3

Management 3 - 3

Total 8 4 12

Findings and Analysis

Environment

The importance of psychosocial environment and atmosphere for persons who

experience mental distress was recognised in the work of Stanton & Schwartz (1954),

Goffman (1961) and Mosher (1999). The climate and culture of Villa Maria is

positive, welcoming and relaxed and all tenants spoke of how this was a marked

contrast to previous experiences of hospitals and residential settings. Furthermore,



tenants commented on how the home-like environment was central to their recovery

and gave them a sense of wellbeing and independence.

‘Bramley Apples - sending exquisite welcoming aroma as you’re entering Slí Eile.

Very attractive, memorable smell of home baking, most pleasantly intoxicating,

extremely uplifting for your mood’

‘This bed means that I have a bed with a duvet. The beds I had [in hospital] only had

fireproof blankets. When I came to Slí Eile, it was so good to have a comfortable bed

even though I nearly went crazy when I tried to put the cover on the duvet!’



Management and Support

In terms of the project structure, the recent appointment of a manager in April 2012

has changed the organisational framework somewhat. The manager is present in the

house every weekday (08:15 - 17:30) which is seen as positive in terms of supporting

staff members:

all along there was just one staff member on any shift but now there’s

two...it’s nice actually to have him around. He can deal with things there and

then’ (support worker).

Furthermore, the availability of the CEO to staff was seen as a cornerstone in terms of

support. One support worker stated that:

I’ve always found the support [of CEO] very useful. There’s no judgement.

[CEO’s name] has listened to tears and frustration and the whole

lot...sometimes you need to vent and [CEO’s name] is the one that gets all the

venting [laughs], but to know that’s there [is reassuring].

However, some challenges were identified by support workers, especially in terms of

working longer shifts without additional staff support;

it’s difficult to be there but not be too there for one particular person. To keep

everyone included [when you are the only staff working] is a bit of a

balancing act

The project’s staff have a high degree of autonomy in their work and the relationship

between management and staff is reported to be good, with communication on-going

all of the time.

I think we are all very equal and we are all very heard. I don’t think there is

actually a huge difference between management and staff’ (Support worker).

Support Workers

Slí Eile has a team of 5 support workers who, in collaboration with the manager and

CEO, facilitate the day-to-day running of the project. A high value is placed on

support staff by both management and tenants:



you can see by every one of them that their hearts are so much in their jobs.

They’re so eager, so helpful, caring, supportive’ (Member of management)

The image above is of a collage made by a tenant as part of the photovoice project

and represents her relationship with a support worker. The tenant described what the

piece means to her;

It’s like a cracked egg - like we are in the same life. Like the support worker is

in my life and I am in part of her life.

An excess of care in conventional community residences in Ireland was flagged as a

cause for concern by Tedstone Doherty et al. (2007) in terms of compromising

residents’ autonomy and independence. In Slí Eile, however, the approach of the

support workers to their practice is very much underpinned by values of

empowerment. All support workers identified themselves as facilitators in terms of

supporting individual tenants’ recovery.

I would be very much always aware of trying to put the ball back in the girls’

court. I’m not the mammy at all when sometimes it can be easier to be’

(Support worker)



In addition, support workers adopt a person-centred approach. One support worker

highlighted the contrast with the medical model where, as she saw it,‘everyone is

treated the same, they are all medicated and they are kept in hospital’.

In contrast,

every day in Slí Eile we consider a learning day. What works for one does not

work for another so we keep it very individual. [The approach] is adapted

around the person. It’s not like we are pushing our agenda on the person. That

person needs to tell us what their hopes, dreams and wishes are and then we’ll

work with them.

The approach, therefore, is very much informed by principles of recovery insofar as

support is offered in terms of facilitating tenants to meet their own self-defined goals.

The non-medical, person-centred support and validation of the individual’s subjective

experience was highly regarded by all tenants:

’This is a photo of glass I pass in the park walking. When I was in hospital I was self-

harming every chance I got but since I have come here, I have learned how not to let

myself harm with the support of staff and support workers’ (Tenant).



Communication

Communication within the house is open and on-going and takes place in a

democratic, non-hierarchical manner. There are various channels of communication

and, in keeping with the ethos of community living, communication is inclusive of all

community members.

It’s all community - I think it has to be. If somebody has an idea or a

suggestion to look at something differently it is discussed, it’s planned, it’s

tried and if it’s ok, then it’s applied (Member of management).

There are a number of forums for open communication within the house, the primary

one being the community meeting which takes place every Monday. Mental health

service users describe ‘being listened to’ as critical elements of their recovery process

(Brown & Kandirikirira, 2007) and, through participatory community meetings, this

process is manifested in the Slí Eile approach. One tenant highlighted the benefits of

the community meeting in spite of its challenges:

I used to dread that, being called to the table [for community meetings]. But I

suppose when you think about it, it’s the only way. You get everything out

then so I suppose it’s the only way. It can be pretty gruelling though (Tenant).

Challenges for tenants centred around adapting to community living. They reported a

marked difference in terms of participation as a member of a community in

comparison to previous experiences of psychiatric settings. Support workers

acknowledged this too, stressing the importance of creating a safe environment in

order to overcome the challenges:

It takes a while for someone to feel safe because for years maybe these women

have not felt safe maybe or not spoke their mind. It’s for us then to create that

safe environment and we are succeeding’ (Support worker).



My communication skills have improved. I wasn’t going to meetings at the

other hostel where I was in [name of town] even though they had meetings

too. It’s good to be going to meetings now (Tenant).

Dunne’s (2006) study into services users’ views of mental health services found that

users of public mental health services found communicative channels and hierarchical

structures particularly oppressive. For example, one service user described a meeting;

They brought me into a room with about eight other people...I think I knew

two of them and they were just sitting around in a circle and I felt

so...stupid...I didn’t even know their names. I don’t know who they are but

they know about me! That gets to me...they were all talking amongst

themselves (2006; 62).

The difference of approach in terms of communication was highlighted by support

workers who noted contrasts between their attitudes and those of other professionals.

Their thought is very different to ours...she [HSE mental health service

provider] would be inclined to talk to me about [tenant’s name] when she is

not there and I would have to say to her then ‘sorry, [tenant’s name] actually



needs to be here or we need to stop the conversation’...very different

perspective (Support worker).

In terms of communication, openness and honesty are fundamental features of the Slí

Eile approach and all members of the community spoke of how this fostered a culture

of respect within the house.

Underpinning Principles of the Project

As outlined, principles of community living are central to the Slí Eile approach. In

addition, in terms of a theoretical framework, elements of William Glasser’s theories

are integrated into practice. Of particular note are Glasser’s, Reality Therapy (1990)

and Choice Theory (1999) which focus on behaviour as central to our existence and

suggest that we have considerable choice and control over our behaviour. As support

workers described the theoretical underpinnings of their practice, Glasser’s principles

emerged as recurring themes;

personal responsibility is huge in the house - taking responsibility for your

behaviour and understanding that nobody can change your behaviour only you

(Support worker)

On being asked what theory informs her practice, another support worker replied;

Glasser. [Do you find it effective?] I do, yeah. You are empowering the person

to have the freedom of choice and this is huge in itself.

The basic thing with Glasser is ‘what do you want?’ It’s that simple. It’s not

easy but it’s simple’ (Member of management)

Mancini et al., (2005) identified not being allowed to make decisions as a barrier to

service users’ recovery. However, tenants spoke of how, through taking responsibility

and making choices, they have become empowered to make decisions and take back

control in their lives. The process of regaining control for one tenant was represented

in the following photograph and caption;



This photo shows food that I treated as my enemy. I suffered from an eating

disorder for the past 22 years. In hospital the doctor told me to get over it but

by coming to Slí Eile my eating has improved so much. I have it under control

for the first time.

Goal-setting and Evaluation of Progress

In accordance with the recovery model principle of user-defined outcomes, each

tenant will self-evaluate, on a daily basis, and link this evaluation to their own

personal goals. As one member of management put it,‘evaluation of the progress of

the tenants is mainly done by the tenant themselves’.



‘Sprouting seeds symbolising innate potential’

Goals and evaluations are recorded on file and staff will consult these accordingly in

order to support a tenant as much as possible in achieving their goals. The goals are,

in turn, linked to the ‘Steps of Slí Eile’ – a four step process that tenants follow while

living in the house. Staff members were clear that this is not a dogmatic formula and

reiterated the individualised approach as they work with tenants towards these

outcomes.

In addition to user-defined outcomes, more traditional methods of evaluation such as

reduction of hospital admissions can also examined in an attempt to appraise the

effectiveness of the Slí Eile approach.

There’s absolutely a reduction in admissions - [tenant’s name] had had 70

admissions before she came here. [another tenant] has had 2 short admissions

since she’s been here but that’s tapering off. [A third tenant] hasn’t had any,

neither had [fourth tenant] (Member of management).

In addition to the quality of life benefits identified by tenants, the cost-effectiveness

of Slí Eile as an alternative to hospital admission cannot be understated. The cost per



bed per annum in a public psychiatric hospital was estimated at €158, 410 in 2006 (O’

Shea & Kennelly, 2008). The cost of a bed in Slí Eile is currently estimated at around

€40, 000 and it is envisaged that this will drop considerably when the planned

expansion of services is carried out.

Organisation and Running of the House

In terms of organisation and day-to-day running of the house, structure and routine

are essential elements of the Slí Eile approach and have developed as the project has

evolved. High levels of dependency are noted in conventional high-support and group

homes (O’Mahoney, 2010) and high levels of boredom are reported in inpatient

psychiatric settings (Warner et al., 2000), sentiments echoed in this tenant’s

experience;

In hospital you don’t do much - they have art and pottery but, yerra...you

wouldn’t do much, no. In Slí Eile you’d be busy all day like (Tenant)

A rota is used in the house to delegate chores and assign tasks to the tenants for each

week; household duties such as shopping, cooking, washing, cleaning etc. are the

responsibility of the tenants who voiced an appreciation of the need of such routine

and responsibility. For example,

I hated the rota thing at first! I hated being called out of the bed. But even

now, I don’t go into the bed that much...I’m doing my shopping now, getting

the routine back.

The house helped me to get back the housekeeping skills and the bakery

especially helped.



‘Rota’ – ‘preparing organising, planning, structure, something to get up in the

morning for, giving purpose/meaning to the day, breaking the day down,

managing time, coping strategy

According to Mosher (1999) all activities are viewed as potentially therapeutic and

this philosophy is incorporated into the Slí Eile approach. As well as traditionally

defined, formal therapy, tenants appreciate the benefits of gardening, art, outings,

shopping, cooking, baking, classes etc. Activities featured prominently in the

photovoice project results;



‘This bus means a lot to me. It means freedom which I have not had in the past 22

years. It’s great because we can go on outings every weekend and it helped me to

socialise with people which before I would have kept to myself in my own little world’

‘Some Fabric’ – ‘building collection for patchwork making. I’m attending patchwork

class in Limerick one night per month. [Volunteer’s name] calls each Saturday

evening to do patchwork with us’



The Bakery Project - ‘Cuisine Slí Eile’

As a key feature of the running of the house, Slí Eile’s bakery project - Cuisine Slí

Eile - is a growing enterprise in which all of the tenants are involved. The idea was

conceived of in response to a need, described here by a member of management;

[Following the first 18 months of the project] tenants started to...look for more

and more meaning than just routine...and that’s where the idea of the bakery

project came in...now, again there are arguments around it - as tenants, you

have to buy into it. It relies on the tenants buying into it.

Since all tenants are involved in the bakery, teamwork skills were identified as an

essential component in terms of its functioning as well as for the personal

development of each individual tenant.

This photo is my favourite. I never had the chance to cook when I was young because

we could never afford the ingredients. So when I came here to Slí Eile, I am involved

in the bakery. I love making the bread, scones, apple pies and the fruit loaf, which I

feel very proud of. It gives me a reason to get up for and work together.

Integration into the Community

Integration into the community has been recognised in policy (A Vision for Change,

2006) and research (Mosher, 1999) as a fundamental element of recovery and as a

means to create a more meaningful life for people who have experienced periods of

mental distress. In terms of traditional psychiatric settings in Ireland, lack of social



integration has been well documented (Dunne, 2006; Tedstone Doherty, 2007) and

identified as a barrier for service users’ recovery. For Slí Eile, integration and

involvement in the local community has been a gradual process and staff and

management identify considerable progress over the years:

When we started out first we were a small community within a community -

we weren’t really IN the community but now we are fully part of the

community (Support worker)

Slí Eile’s bakery project - Cuisine Slí Eile - has been identified as an integral aspect of

tenants’ interactions - and hence the project’s integration - with the local community

in Charleville:

[the local people are] really supportive and it’s the tenants that are doing that.

[Tenant’s name] is a natural at it - she is a PR person! (Member of

management).

‘Line Up of Tarts’ - ‘I was looking forward to seeing the line-up of grannies in

Supervalu ready for purchase of tarts!’ (tenant)

Furthermore, the integration into the local community and especially the tenants’

interactions in their roles as part of Cuisine Slí Eile, serve important functions in

reducing the stigma associated with mental health;



It [integration] happened very quickly and it was to do with getting out there

and losing the label of mental illness. With Slí Eile of course there is an

association with mental health issues but not carrying that. You’re with the

bakery and that is your role. Mental health is left somewhere behind (Support

worker)

You are going down town as a delivery person, that’s how you are seen in the

community’ (Support worker)

Furthermore, the deliveries present to opportunity for tenants to meet local people and

have meaningful relationships with them, as well as providing an important social

outlet:

My social life would be in the morning. I would go up to Charleville with the

deliveries and I would meet [lists about 5 local people] and we would go into

[name of local pub] and have the chat and a cup of coffee in the morning. I

think they knew that I was in Slí Eile alright but it didn’t worry them. It didn’t

bother them y’know (Tenant).



Interpersonal Relationships

As outlined above, tenants identified the support of staff as crucial in terms of their

recovery and general wellbeing. In addition, however, peer support - as a feature of

community living, is of paramount importance to most tenants.

‘I called it ‘The Chalice of Friendship’....peer support is very good here. I had loads

of friends before I came here but they weren’t all in recovery. It’s nice to be in a place

now that I am getting my life sorted and I am around people [who are] like-minded.

We are all in it together - in it together, does it better!’ (tenant).



In addition, one tenant outlined a personal goal of being able to offer peer support to

the other tenants in the house;

I want to come to a point now next when a tenant can come to me and say

‘look, can you help me with this?’ I don’t think I’ve quite got there yet but all

at my own pace...

Concerns and Opportunities for Development

While tenants spoke of how the structure and routine were, for the most part,

beneficial to them in supporting their recovery, the dangers of the development of

institution-like patterns were not overlooked especially in light of the recent

expansion opening house number two;

There is, of course, the danger that it may become institutionalised – one

house, two houses, is there going to be a third house next to it? Before you

know it, you may have a small institution (Member of management).

Management and staff’s alertness to the dangers of institutionalisation is seen as a

protective factor in preventing this from happening. In addition, the multitude and

frequency of meetings and the on-going collaborative processes characteristic of the

Slí Eile approach were seen as positive in terms of identifying institutionalised

behaviours and patterns of working.

The farm project is very much in the planning stage at the moment and, needless to

say, funding is an issue.

I do see lots of opportunities for development but the one thing that would

hold that back would be funding, which is a pity. If you look at the value of

what is being done with so little funding then you think, if there was more

funding, what could you do?!’ (Member of management).

Regardless of funding and other possible challenges, the ambition and drive to expand

is palpable in Slí Eile.

I just want this beautiful place...I want someplace beautiful because these

people deserve something beautiful...I hope it [the farm] can materialise

(Support worker).



Recommendations and Conclusions:

It has been found that Slí Eile housing is successfully implementing a social model of

mental health care and the success of the project can be ascribed to a number of

interrelated factors;

• Staff - through a combination of skills, personal attributes and values, the support

staff are found to be capable, dedicated and motivated to respond in a creative

way in order to facilitate tenants recovery.

• Management - a non-hierarchical structure allows for good relations and

communications between management, staff and tenants. The service

development has been organic and needs-driven which is seen as effective in

terms of meeting the needs of service users.

• Communication methods are a defining characteristic of Slí Eile’s modus

operandi. The project is structured in such a way which facilitates and

encourages open and honest communication and collaboration with all members

of the Slí Eile community. In this way it extracts maximum input and value from

all stakeholders and fosters a sense of respect within the project.

• Conceptual clarity - the project is firmly rooted in a social approach to mental

health care. A high degree of clarity around the project’s purpose and its

conceptual basis was found amongst all research participants - tenants, staff and

management.

• The organisational structure of the house was found to facilitate tenants in taking

responsibility and control over their day-to-day lives. The provision of structure

and opportunities for skill development and participation were found to be

appropriate and conducive to tenants’ recovery.

• Relations with the local community were found to be positive. Integration and

participation in the community have come about mainly due to tenants’

interactions in the town in their roles as part of the bakery. These networks are

seen as very beneficial in terms of accessing social capital and developing

meaningful social roles.

In addition to the key findings outlined above, a number of recommendations for

practice emerged over the course of the research.



• While the recent appointment of a manager is seen as positive in terms of support

for staff, some concerns were raised around staffing arrangements. In the instance

of a support worker working a longer shift alone, challenges were identified in

relation to providing adequate support to a number of tenants simultaneously.

• By acknowledgement of management, issues surrounding tenants ‘moving on’

require attention. The opportunities and possibilities for support of tenants

following their departure from Slí Eile need to be examined in more detail.

• In terms of empirical data, there is a need for the collation of information in terms

of reduction of hospital admissions, reduction of medication etc.

• Furthermore, at this juncture, especially in terms of planning for future

development of the project, there is a need for a full evaluation of the Slí Eile

housing project. With the current growing emphasis on evidence based practice,

it is necessary for the full complexities of the Slí Eile approach to be

uncovered. Further research is recommended in order to guide Slí Eile’s practice

and development as well as to detail this particular conceptual model and assess

the feasibility of transfer to other locales.

From the findings of this study it can be concluded that a social approach to working

with people who experience mental distress in a supportive non-medical environment

is effective. Counter to the current provision of mental health services, the Slí Eile

approach incorporates elements of the new social paradigm in mental health and

represents changing attitudes and values in terms of how understandings of and

responses to mental distress are conceptualised. Moreover, and especially in relation

to the current global economic climate, it must be stressed that the Slí Eile approach

represents excellent value for money. Despite the fact that a cost-benefit analysis was

beyond the scope of this particular study, the cost per head per annum is strikingly

less than traditional psychiatric services. Quality of life indicators speak for

themselves and tenants’ satisfaction with the project has been restated throughout the

research. This is without factoring the myriad of wider benefits such as stigma-

reduction, awareness-raising of mental health issues and, in particular, highlighting

alternative approaches to working with mental distress. These benefits, while

arguably less tangible, are invaluable, not alone to the service users and the local

community, but to civil society as a whole.



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