The importance of housing to people’s mental health is widely recognised, yet remarkably poorly understood. We all instinctively know that having a home that is safe, warm, secure and affordable is a basic need for life, let alone good mental health. And yet the links between housing, homelessness and mental health services have been difficult, often tenuous, and sometimes fractious.
Poor and insecure housing and homelessness are both significant causes of mental ill health and triggers for a crisis. People living with a mental illness face higher risks of housing insecurity, with poverty (and now increasingly destitution) putting people’s health and housing at risk. Homeless people have very high rates of mental ill health. And for people with poor mental health who have been in both prisons and hospitals, homelessness is often a consequence of being institutionalised.
Some NHS mental health trusts are taking steps to address these interconnections between housing, homelessness and mental health. Sheffield’s mental health trust has, since the 1970s, worked alongside the city’s Citizens Advice Bureau to provide ready access to welfare advice for people using its inpatient and community services.
More recently, two mental health trusts in the south of England have employed housing directors: Jon Pritchard at Southern Health in Hampshire, and Chris Harris at Sussex Partnership. Both have begun work that could herald a sea change in the way mental health support works.
In Sussex, housing officers are embedded within community and inpatient clinical teams – similarly in some ways to how employment specialists work in Individual Placement and Support. They work closely with the relevant housing authorities across the two counties, and have already noticed a marked drop in delays discharging people from hospital, and the potential in future to prevent some admissions from happening at all. This is part of a five-year housing strategy that also includes a supported tenancies scheme for people in the trust’s rehabilitation pathway, an area characterised in some parts of the country by long hospital stays, often far from home. Learn more about Sussex’s work on housing.
At Southern Health, mental health nurses are embedded in housing offices in some of Hampshire’s district and borough councils. The mental health workers use their clinical knowledge and expertise to inform people’s housing needs assessments and support plans: a ‘liaison’ approach where mental health professionals bring their expertise into other places. They too have a ‘step out’ service for people leaving inpatient rehabilitation wards, drawing on the principles of Housing First so that people get tenancies with intensive support in locations they prefer. And like Sheffield, they have located a Citizens Advice service in their four acute inpatient units, with a case worker who helps people to deal with money, housing and family issues, both in the run-up to being discharged and afterwards.
These trusts are still, sadly, the exception. But they are demonstrating what can be achieved by prioritising people’s housing rights within mental health services. By taking different routes to achieve similar ends, they also tell us that there may not be a ‘one-size-fits-all’ solution here. It will also take time for these innovations to become established and provide learning for mental health services elsewhere to draw upon. That should not, however, stop other areas finding their own ways to do this. The NHS Confederation’s mental health and housing forum is enabling its members to share their knowledge and ideas in order to prompt further action and improvement.
In our report with the NHS Confederation’s Mental Health Network on what mental health services could be like in ten years’ time, a key element was to take a whole person approach, understanding individuals in their economic and social circumstances, and addressing the structural inequities too many people with a mental illness have to face. Nothing could better exemplify this approach than protecting people’s housing rights. Acting now, in mental health trusts, local councils, and integrated care systems, means we won’t have to wait another ten years for that to be a reality across the country.
