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We need better communication between supported housing providers and the NHS
Jonathan Moore calls for supported housing providers, councils and the NHS to share information and work better together to improve mental health
That safe and secure housing is crucial to promoting and maintaining good mental health is unlikely to be news to anyone reading this article.
Importantly, NHS England’s five-year forward view for mental health concluded that “housing is critical to the prevention of mental health problems and the promotion of recovery”.
While the value of housing to mental health is increasingly being recognised, changes in practice still lag far behind.
Nearly three years on from its publication and ahead of the next NHS strategy, we’ve become very good at acknowledging the connection between the two. This is an important first step.
“While the value of housing to mental health is increasingly being recognised, changes in practice still lag far behind.”
Pockets of innovative practice between housing associations and NHS trusts, where supported living projects are part of mental health services, have also emerged. Evidence of their success is emerging and this points an important way forward.
Yet on a much more fundamental level, the way supported housing providers and the NHS talk to each other needs to change.
Rethink Mental Illness is both a provider and a campaigning organisation, and our services give us a conduit to the ‘real world’. One the most frequent issues raised by our service managers are the difficulties they and the people they support have in engaging with the NHS.
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A visit to one of our mental health supported housing services in Folkestone gave a very real illustration of what these problems mean in practice. We heard of a tenant who had repeatedly attempted to take their own life but, despite the best efforts of staff, were unable to get treatment in the community after they left hospital.
In the absence of treatment, they tried again a few months later, resulting in another spell in hospital. This needless cycle repeats itself far too frequently. This isn’t right for the NHS. Treating patients in hospital is the most expensive setting of all.
It isn’t right for supporting housing services, whose attempts to support tenants through recovery are undermined by these periods of crisis. Most importantly, it isn’t right for patients, who lurch from episode to another without getting the treatment or care they need.
“Treating patients in hospital is the most expensive setting of all.”
We learned that the service turns down 50% of the referrals it receives because the needs of the people in questions are too high for it to be able to properly support them.
Despite the service refusing these referrals on the same grounds each time, they continue to be made over and over again from the same organisations. This demonstrates a sustained pattern of unmet need, but a shared understanding of that need is lost each time the phone is put down.
Similarly, we were told of one former tenant with addiction issues who was discharged from hospital without the service being notified, despite them knowing he lived at the service. Thankfully, he went to see his mum after leaving hospital but on another day the repercussions could have been very different and far, far worse.
On a far more basic level, tenants at the service often struggle to get the medicines they need. Antipsychotics can only be prescribed by psychiatrists.
This makes sense given the severity of the drugs involved but the system only works when psychiatrists are available as part of community mental health team. This wasn’t the case in Folkestone.
As a result, tenants frequently have to take other less effective medicines that can be prescribed by a GP. Such suboptimal treatment would not be accepted in physical health and shouldn’t be in mental health either.
This is not an attempt to place at the blame for all these problems at the door of the NHS.
Mental health services are under enormous pressure and despite recent funding commitments have suffered from decades of under investment. These come on top of staff shortages and enormous demands on their time that existing staff face.
People do not fall through the gaps because of a lack of care on behalf of those who could give it if the circumstances were different.
The staff we met in Folkestone acknowledged that in different circumstances providers could do more to work more effectively with the NHS, but spend the bulk of their time helping tenants who reach crisis point in the best way they can when other services aren’t available.
“If the NHS, local authorities and supported housing providers shared information… then some of these problems could be averted.”
Many people working in the NHS would doubtless say the same thing.
The point is that if the NHS, local authorities and supported housing providers shared the kind of information we heard on our visit, then some of these problems could be averted.
This needs to take place at a systemic planning level, so that the conversations can inform the design and commissioning of services and how they subsequently communicate with one another.
Talking can’t replace additional investment but if local leaders of supported housing providers, the NHS and councils make a collective effort to come together, it would help ensure that the resources that are available are used in the most effective way possible.
Jonathan Moore, social policy manager, Rethink Mental Illness
