Housing and Support
Suitable housing is an essential component of community care for people with mental health
problems, with this accommodation linked to effective support based on individual needs. Housing
should be a priority when arrangements are being made for hospital discharge. This is a core
service element of the Framework for Mental Health Services in Scotland(1).
"A long-term strategic
approach to the planning and provision of a range of accommodation is needed. The needs of
people with mental health problems range from 24-hour staffed support to occasional support in
independent living. The Care Programme Approach and the general NHS discharge arrangements
require that accommodation, and associated support, appropriate to need is in place in the
community before any patient is discharged." This Paper gives more detail about the nature of
current housing provision, support services available, the processes which take place and funding.
Types of housing provision
The main forms of available accommodation are:
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shared supported housing
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individual supported tenancy
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core and cluster housing, with a centrally staffed base and a number of flats
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mainstream housing, both individual and shared
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transitional hostels and halfway houses
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staffed residential homes and hostels
The use of transitional halfway houses has much reduced since the mid '90s when studies such as
that of Carling(2) found that a series of time limited stays in a range of settings caused many
problems because of the number of moves involved and having to live with different groups of
people and different levels of support. The model of provision which is increasingly being
recognised as the preferred choice, as reported in an accommodation needs assessment report in
Fife(3), is the use of single tenancies. Special needs housing developments are also increasingly
being replaced by the provision of ordinary housing integrated into the community, as reported in
1998(4).
There are, however, a significant number of people with mental health problems who value
the company and support derived from sharing with other who have experienced similar problems
(McCollam, 1998)(5). It is necessary to enable choice and to have a range of options available.
Different and flexible arrangements for support services are also necessary to enable people to
make best use of the options available.
Forms of housing with support
Different types of arrangements can be put in place, each with their own merits and concerns:
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a housing provider supplies the premises and another agency provides the housing management
and support
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a housing provider provides housing management and another agency provides support
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a housing provider takes on the management services and also employs support staff
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personal support based on the person not the property
The combination of managing the accommodation and providing the support services has the
benefit for tenants of dealing with one agency, although generally the management and support
roles are separated into different departments. There is an increasing belief that housing
management should be separated from support management so that support workers are not
employed by the agencies who provide the housing (Fife Report 1996)(6). This report also
concluded that personal support attached to the person is preferable, with flexibility to match
individual's changing needs. Schemes offering this are sometimes called Floating Support, with a
person's needs assessed and suitable services accessed. The service is provided for as long as it is
needed and when no longer required, it 'floats' off to another person who needs it (Bennett
1998)(7).
Funding housing support
New arrangements for funding support services were set in place by the government following a
review in 1998, Supporting People(8). A transitional housing benefit scheme allows for tenants to
obtain housing benefit, covering accommodation and management, as well as support costs,
provided that housing benefit officers deem these 'reasonable'. From 2003 the proposal is to
transfer all government resources relating to housing support into a single budget to be
administered by local authorities.
This will shift payment of funding from individuals receiving
housing benefit to services being funded by block grants paid direct to service providers. The
Scottish Executive have given reassurance that existing service users will not lose out (Managing
the Changeover 2000)(9).
References
(1) Scottish Executive. Framework for Mental Health Services in Scotland (1997).
(2) Carling (1993). Housing and supports for persons with mental illness. Hospital and community
Psychiatry, 44.
(3) Accommodation Needs Assessment Sub-Group (1996). Report on Accommodation Needs for
people with mental health Problems in Fife.
(4) Scottish Development Centre for Mental Health Services (1998). Building Partnerships -
Conference Report.
(5) McCollam (1998). A Framework for the Development of Housing Services for People with Mental
Health Problems. The Mental Health Review Volume 3 Issue 3.
(6) Accommodation Needs Assessment Sub-Group (1996). Report on Accommodation Needs for
people with mental health Problems in Fife.
(7) Bennett (1998). Housing and Floating Support. The Mental Health Review Volume 3 Issue 3.
(8) Department of Social Security (1998). Supporting People.
(9) Scottish Executive (2000). Managing the Changeover.
www.scotland.gov.uk/housing/supporting people/managechange.asp
