Friday, 28 April 2017

A step towards society

Is a new project in London’s King’s Cross that halves hospital costs the future of mental health supported housing? Jess McCabe investigates

Mary* is slouched on a sofa in a fresh white communal living room and kitchen, with white Apple earbuds stuffed in her ears, moving with the tinny music. She pops them out just long enough to introduce herself.

Sitting next to her on the sofa is Peter, a middle-aged man in a t-shirt, who stares a bit and answers most questions with another question. ‘Did you know we’re doing an outing?’ he asks. The residents are planning a trip to the seaside at Southend, he informs me, where Mary wants to swim.

These are two of the first 15 tenants to live in Tile House, a project specially designed so that people with mental health problems aren’t stuck in a hospital ward or a care home. Around the corner from King’s Cross station in London - on the edge of a massive construction site that is one of Europe’s biggest redevelopments - it houses people who no longer need to be an inpatient, but require a little more support than is available in traditional supported housing.

The £4 million project is also the result of a unique collaboration between One Housing Group - which paid for the development - and the Camden and Islington NHS Foundation Trust, which provides the four part-time clinical staff.

‘We call this product care and support plus,’ explains Kevin Beirne, director of housing, care and support at the 15,000-home landlord.

David Plummer, associate director of business development at Camden and Islington NHS Foundation Trust, says there is ‘a step between an inpatient environment and a supported living environment’.

‘Sometimes that step’s just been a little bit too large, and people end up in a rehabilitation environment for a lot longer than they need to be,’ he states.

Mr Plummer explains that Camden, where mental health services are in high demand, has found it difficult to find affordable accommodation in the borough. With Tile House open, ‘we can move them locally, and that means they can be near family and carers. It helps them to get better quicker,’ he adds.

As the government begins to mash together the separate bureaucratic universes of the health service and the care sector, Tile House could be the start of things to come. But does it genuinely offer something better than what went before, a hospital or a care home?

The residents I meet have mixed feelings about living here. Peter misses the friends he made where he used to live, but Richard, a middle-aged man, is more positive. ‘This place has more facilities. It’s nice. Freedom.

‘Privacy,’ he adds. ‘There’s a lot of privacy. You can be in your flat listening to music for hours and hours, which I do.’

Supported privacy

Staffed 24 hours a day, the residents are referred by the NHS trust and live in self-contained, one-bedroom flats, each with their own kitchen and doorbell. Although the project only accepts single adults, residents are able to have children to visit and partners can stay overnight. It has a communal room where residents can socialise. The only outward sign of extra security is that the entrance hall is an ‘air-lock’, with a glass window that looks directly into the staff office. Should staff want to stop someone entering or leaving, they are able to do so easily, Mr Beirne points out. One of the staff members working in the room ‘mm-hmms’ in appreciation of this option.


Residents of Tile House live in self-contained, one-bedroom flats, but there are communal areas where they can socialise

With a clinical psychiatrist, a consultant psychologist and an occupational therapist on staff, Tile House is able to accept higher-risk residents, who would likely be turned down by other supported housing projects.

At the moment three residents are classed as having a ‘forensic background’, in other words they are ex-offenders, subject to court-issued restriction orders imposed to protect the public from harm. Because of the clinical supervision of the project, it is possible to take on people who, as Mr Beirne puts it, ‘may commit significant offences’ if they are not on medication.

‘What’s critical about being in hospital? Well, if it’s medication we can do that in a community setting. It doesn’t mean you have to sit in an institution year on year,’ he says. So far, the project has had no negative reactions from the local community in King’s Cross. ‘It’s barely noticeable to the community it is in.’

Supporting a resident at Tile House costs £710.86 a week, generally paid by the local authority, plus £255.60 in rent, which is generally covered by housing benefit. Thirteen of the service users were previously living in residential care homes where the cost of care per week was up to £2,000.

Residents are expected to stay in Tile House for about two years - before moving on to a set-up with less intensive support. Because the first tenants only moved in last August, it is too early for anyone to have left. But Marta Banet, a clinical practitioner at Tile House, explains that living in the project is much better for residents than being patients in a hospital or living in a care home - there is already evidence of it speeding up recovery.

Monitoring medication

‘They are in the community. That’s what helps in their recovery,’ she explains. ‘There are people who came here who have been on the same, highly sedative, medication for 20 years. It stops their recovery. In approximately eight months they have reduced their medication.

‘Why? There is someone here who can monitor their medication, make sure it’s not dangerous. It’s great to get them out of hospital and into a community that’s alive. They’re connected to the world. And we can support them in a way so that they can do that without relapsing or it being too much for them.’

Another benefit is that dealing with problems and security incidents has been much easier for staff. Rather than trying to contact an NHS psychiatrist if there is an ‘incident’, people with the right expertise are onsite, explains Stephen Smith, manager of Tile House.

‘For nearly all of them, if they didn’t come here, they’d still be in hospital, because nowhere else would be able to take them,’ he adds.

‘We’ve had incidents, as all supported housing schemes do. But we’ve been able to manage them much more effectively here than we would have in other schemes, in my experience.’

For example, he says: ‘A customer at the weekend wasn’t feeling very well and they were impacting on other customers. So yesterday morning there was a clinical meeting held of the psychologist, care co-ordinator and support staff. A plan was developed to manage that behaviour and provide a better level of support. You’re not having to email everyone and say, are you available? Then have a meeting in maybe two weeks’ time.’

‘Thanks to that, most of the behavioural problems we are able to stop,’ adds Ms Banet.

Financial benefits

It is Camden Council that is benefitting from the project’s savings - an estimated £300,000 in the first year - as it is cheaper to place someone in Tile House compared with a hospital or care home. But this type of scheme is a business opportunity too. One Housing’s Mr Beirne believes that housing associations are a natural partner for the NHS. A shared belief in the betterment of society unites social landlords and the health service. Perhaps such a ‘synergy’, as One Housing describes it, will make projects such as Tile House successful.

But social landlords will need to get a move on. Mr Beirne predicts private house builders will be looking to set up similar services with NHS trusts before long. ‘We’ve got no doubt our competitors in the private sector are actively looking at this sort of proposition as well. What we have, and they don’t, is a shared ethos and a value set as a not-for-profit in the NHS,’ he says.

‘When you have a look around here, you’ll see that a lot of it is designed to say, you are a person, you can be a customer, you can have aspirations,’ Mr Beirne concludes. ‘That’s why you start to see people come out of their shell in terms of their recovery. And say, I want a piece of life.’

*Service users’ names have been changed

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