No place like HOME: specialist housing services for people with mental health problems, outcomes, movements and experiences

Background: No exact and reliable data exists on the characteristics and needs of people with mental health problems in England living in specialist housing services (SHSs). Aims: To describe the cohort of service users’ with mental illness aged 18 to 65 living in various types of SHSs (care homes, supported housing, and Shared Lives schemes) as well as their housing satisfaction, taking into account their social inclusion, and social networks. Pathways into SHSs were accounted for: delayed discharge, referrals and move-on accommodation where applicable. Method: Semi-structured interviews were conducted - using interview schedules designed for the purpose of this study - with 86 service users and 40 managers of SHSs within 7 areas of England. Analysis: Based on a mixed-methods approach: each interview was coded and string variables were turned into quantifiable ones; anonymised quotes from service users and managers were included in the body of the text. Main analysis is quantitative, with a secondary qualitative study, using framework analysis. Results: Differing support levels influenced service users’ experiences and pathways into SHSs, as well as the outlooks of managers. Analyses revealed several aspects mediating housing satisfaction. Many service users were not very well integrated in the community although managers held different views. Some service users were very much reliant on staff and had small social networks. Discrimination was still persistent and recent policy initiatives, in terms of funding, housing, benefits and employment held a negative impact. Preferences of service users were for the most part not taken into account. Conclusions: Further research is needed with regard to BME groups as well as other SHSs settings like Shared Lives schemes. Data should be more systematically collected and in more detail and barriers to employment should be tackled. Better advocacy and information for service users should be established

How to select representative geographical areas in mental health service research

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Housing services for people with mental disorders in England: patient characteristics, care provision and costs

Background and aims: Since de-institutionalisation, housing services have taken a central role in the care of patients with severe mental illness. Yet, little is known about the characteristics of patients in different housing services, what care they receive, and what costs are generated. This study aimed to assess patient characteristics, care provision and costs in different types of housing services in England. Methods: In 12 representative local areas in England, 250 housing services were randomly selected. Information on services, characteristics of randomly selected patients and care received were obtained from managers. Results: Data from 153 services (61% response rate) and 414 patients were analysed. Most patients receive support with activities of daily living and are involved in some sort of occupational activities. 52% have a care co-ordinator in a community mental health team. Care provision and costs differed significantly between care homes, supported housing services and floating support services. Conclusions: Quality standards may have to be defined and applied to ensure that all patients in housing services receive appropriate care. More input of mental health services may be required for the rehabilitation and recovery of patients