Blurring boundaries between ‘Health’ and ‘Housing’,
Jon Pritchard, Southern Health's first Associate Director of Housing (and first in an NHS organisation), describes the relationship between health and housing and what impact it can have our mental health and recovery.
“Before I joined Southern Health, I worked for a national charity that provides housing and care & support to people living with mental ill health and learning disabilities. It was clear from that work that the worlds of ‘health’ and ‘housing’ often had many similarities, but the language used to describe them was different. There was also a real challenge around the funding or commissioning of housing solutions for patients who might need them.
I realised that bringing these traditionally separate areas together and working smarter, produces better outcomes for patients and is a more efficient use of collective resources. I truly feel that being able to drive that change through the lens of the NHS is both humbling and rewarding.
But what impact does housing have on mental health? Well, research shows that the one in five of us have experienced mental health problems because of housing (Shelter). For example, an overcrowded home can cause sleep problems or strain on relationships which in turn causes stress, anxiety and even depression. Likewise, with soaring rental prices, housing can be the cause of money worries which again can be linked to stress and anxiety.
My role at Southern Health means the Trust are tackling the social and housing needs of patients head on. For a long time, patients could be delayed in being discharged from mental health inpatient units because they didn’t have suitable housing. Sometimes, they will have been discharged, but to inappropriate or unsustainable accommodation that ultimately added to their mental health challenges, often resulting in a further admission. This pattern then becomes a vicious cycle, which can only be broken by changing the way we work to meet the needs of our population.
As part of the Government’s COVID response, anybody sleeping rough was accommodated under the call to get ‘Everyone In’. This placed people who were homeless into temporary accommodation that enabled them to remain safe and isolate against COVID. Once accommodated the individuals were supported to resolve their longer-term housing challenges. What the Government response didn’t necessarily cater for was the increase in mental healthcare needs for this population. According to the Mental Health Foundation 80% of homeless people in England reported that they had mental health issues, with only 45% having been formally diagnosed with a mental health condition.
How are we addressing these problems? Well, as one example, we recently started working with New Forest District Council (NFDC), one of our Local Authority partners. NFDC’s successful housing support team experienced first-hand the increasing mental healthcare needs of the people they had accommodated and knew that they needed expert help. They applied for additional ‘Rough Sleeper Initiative’ grant funding from the (former) Ministry of Housing, Communities and Local Government to arm their team with mental health expertise.
From the outset, Southern Health agreed to a new partnership model, whereby a mental health nurse is seconded into the Local Authority’s housing team. The aim is to provide direct mental health care to people in temporary accommodation, insecure housing, or those who are homeless or at risk of homelessness, and support the individual to carry on with their tenancy and ultimately move on to longer term accommodation. Our nurse has already spent time with our NFDC colleagues and together they immediately recognised where improvements can be made, along with the impact the joint working will have.
Why wasn’t this happening before? You’d be right to ask! There are some significant things that prevent this proactive work taking place. Firstly, not all the individuals will be known to mental health or support services, nor might they have a formal diagnosis initially. Secondly, increasing acuity or frequency of symptoms means we need to be able to respond in a timelier way than current practices allow. To address this, we must be more creative with the resource we have.
This is such an exciting and important step forward. Together, we are deliberately blurring the traditional boundaries between ‘Health’ and ‘Housing’, meaning the people we care for can access the right support, at the right time, in the right place, regardless of who they contact.
In the absence of this new collaboration, those people who may not have been in contact with mental health services previously are likely to have continued to struggle until their challenges escalated, potentially to a point of crisis. This holistic approach will allow us to engage with people much earlier in their illness, resulting in any treatment or support being much more effective. If, through this initiative, we enable people to stay at home well, prevent (re)admission, engaged in and with their communities then, in my eyes, it will have been a huge success. I’ve every confidence that that will be the case.
Thanks to our wonderful colleagues at New Forest District Council for hosting our mental health nurse and enabling such an innovative collaboration to get off the ground. Likewise, without the grant funding from the (former) Ministry for Housing, Communities and Local Government we wouldn’t have had the opportunity to progress this quite so quickly.”
If you’d like to find out more about the Trust’s Housing projects, please contact Jon.Pritchard@southernhealth.nhs.uk.