Joint Commissioning Team Mental Health Accommodation Strategy 2008 - 2011
Draft 2
Adult Mental Health
Hertfordshire Accommodation
Strategy
2008 - 2012
Contents
Section / Title / PageDefinitions / 3
1. / Vision / 5
2. / Introduction / 5
3. / Key Aims and Objectives of the Strategy / 7
4. / A Total Systems Approach / 6
5. / The National and Local Context / 9
6. / Recent Trends in Mental Health / 10
7. / Housing Related Support in Hertfordshire / 11
8. / Historical Perspective to Specialist Mental Health Accommodation / 13
9. / Supply and Demand / 15
10. / Eligibility for Specialist Mental Health Accommodation / 17
11. / Matching Supply and Demand for Specialist Accommodation / 19
12. / Finance and Unit Costs of Specialist Mental Health Accommodation / 20
13. / Communication Strategy / 23
14 / Strategic Objectives and Action Plan / 25
15 / Review / 25
Appendices
Title / PageA / Data on Supply and Demand / 26
B / Action Plan / 27
C / Mapping of Services / 30
D / Hospital Beds in the Community / 38
Definitions
1. Specialist Adult Mental Health Accommodation
Eligibility for specialist mental health accommodation is dealt with in section 10
1a. Supported Accommodation. Supported accommodation is defined as accommodation at a specific address, where support and care are offered to meet the day to day needs of the resident. The period of residence is variable and can be long-term.
The property at which the care and support is offered is available only to a person that is eligible for care and support. The property will be managed by a housing association and care support provided by Hertfordshire Partnership NHS Trust (HPFT) or the housing association.
The average level of support will vary according to the setting:
· Group Homes – 2 or 3 people share a house and receive up to 5 hours support per week from visiting care workers.
· Independent low support flats - up to 5 hours support per week from visiting care workers.
· Independent high support flats – staff on site, available as required and offering high levels of daily support
1b. Rehabilitation is defined as a hostel with a specific number of beds and 24/7 staffing on site and delivering a structured rehabilitation programme for a period of up to 2 years. Property will be managed by a housing association and care provided by rehabilitation workers from HPFT or the housing association.
1c. Long stay/residential is defined as accommodation in a specific home with 24/7 staff on site and offering full daily care including the provision of some, or all, meals. The period of residence is usually long-term. Many of the homes are registered care homes however some have been de-registered and within these homes residents will have greater responsibilities to do their own catering.
2. General Needs Accommodation.
2a. General Needs Housing is defined as rented accommodation that is of a suitable size for the number of people who will be resident in the house, flat or maisonette. Residents apply for general needs housing to the local housing provider and are prioritised for nomination for a dwelling according to local authority eligibility criteria
2b. Homeless accommodation is defined as temporary accommodation that is made available in a local area. Homeless accommodation can be in bed and breakfast or in homeless hostels or in any other dwelling defined as available for homeless people by the local authority.
2c. Privately owned accommodation is defined as owner occupied or shared ownership
Adult Mental Health
Hertfordshire Accommodation Strategy
1. Vision
1.1. To recognise residents of Hertfordshire with mental ill-health are first and foremost ordinary citizens who do not wish to be marginalised or excluded in any aspect of everyday life
1.2. To recognise the provision of affordable, decent quality, adequately supported accommodation is a key factor in helping people with mental ill health achieve the highest degree of independence and social inclusion.
2. Introduction
2.1. The objective of this strategy is to ensure people with mental ill-health are able to appropriately access general needs housing but also have access to a range of specialist mental health accommodation when this is required.
2.2. The strategy concentrates on accommodation that required for people with mental ill-health in permanent or medium to short-term accommodation. The strategy does not encompass mental health acute or crisis care.
2.3. For any strategy to be successful there must be agreement and commitment by all stakeholders. The strategy should be based on evidence which should identify the major changes required
2.4. The Adult Mental Health Accommodation Strategy is based on evidence gathered and is written following discussions with representatives of:
· Viewpoint
· Carers in Hertfordshire
· 10 District/Borough Councils
· Registered Social Landlords (RSL) Sub Regional Group
· Other local RSLs
· Hertfordshire Partnership NHS Foundation Trust
· Supporting People
· Adult Offenders Project Group
2.5. Evidence presented in a 1999 Sainsbury report identifies that the largest percentage of people with mental ill-health prefer to live independently within the community. There are, however, many who live on their own, or are homeless, that are vulnerable and, due to mental ill-health, require a period of time in a supported or rehabilitation environment.
2.6. Living in a supported environment at a time of vulnerability due to mental ill-health enables most people to achieve levels of confidence and independence and as a result be able to make the transition to independent living.
2.7. For a minority of people with serious mental illness the transition to independent living may not be possible due to the nature of the illness. In such situations access to specialised accommodation in a long stay/residential setting is essential
2.8. This strategy identifies how access to a range of accommodation can be achieved by 2012 to ensure residents of Hertfordshire with mental ill-health can access appropriate accommodation to meet their needs.
2.9. The strategy is agreed following the consultation and agreement of:
· Strategic Commissioning Group (SCG)
· Joint Commissioning Partnership Board (JCPB)
· Supporting People Commissioning Group
· Stakeholders as identified in S2.4 above
3. Key Aims and Objectives of the Strategy
3.1. To work closely with all stakeholders, including service users, local councils, Supporting People, Hertfordshire Partnership NHS Trust, Adult Offenders Accommodation Project and Registered Social Landlords (RSLs) ensuring they are adequately represented on the Joint Commissioning Team Mental Health Accommodation Steering Group. The Steering Group will agree and deliver on an Action Plan arising out of this strategy. Section 16
3.2. To ensure the Mental Health Accommodation Strategy dovetails with national priorities and other relevant local strategies such as Supporting People and Adult Offenders Strategies Section 5 and 7
3.3. To set priorities for action to ensure that by 2012 people with mental ill health will have as greater a choice as possible over where and how they live. Section 16
3.4. To plan for the future in partnership with housing providers ensuring the range of accommodation provision is based on what people need now and will also cater for future needs. Sections 5, 6 and 8
3.5. To ensure that the supply and demand for all types of specialist accommodation and rehabilitation is monitored and that the data is analysed, at regular intervals of no less than bi-annually. Sections 9 and 11
3.6. To re-configure existing specialist accommodation according to demand and taking into account current trends in demand. Sections 8 and 12
3.7. To ensure that the accommodation needs of Mentally Disordered Offenders and those leaving prison with mental ill-health are taken into account within this strategy. Section 6
3.8. To ensure a comprehensive communication strategy is in place and that this strategy dovetails, and does not overlap, with other similar working groups within Adult Care Services or housing providers. Section 13
3.9. To ensure the Action Plan agreed to deliver the strategy is reviewed at bi-annual intervals taking into account data collected in regard of supply and demand. Section 16
4. A Total System Approach
4.1. Planning for any change requires a whole system approach and this is essential when considering accommodation issues. All stakeholders should have an interest in ensuring the strategy will be able to deliver on set targets.
4.2. Stakeholders however will also wish to ensure the strategy complements their own organisations targets. Service users and carers will have personal targets they wish to see delivered.
4.3. This strategy therefore represents a model that is agreed by stakeholders and is focussed upon social inclusion, the appropriate evidenced based re-configuration of existing resources and the development of new resources in order to achieve the vision identified in section 1.
4.4. Below is a model for a social inclusion approach. The key goal for stakeholders is to enable service users to move to the greatest independence provided by level 1 and 2.
Level 1
Level 2
Level 3
Level 4
Level 5
4.5. Essential partners in the delivery of the social inclusion model are:
· Service users and carers
· District and Borough Councils
· Hertfordshire County Council
· Registered Social Landlords
· Supporting People
· HPFT
Recommendation.
A Total System Approach model is formally accepted by stakeholders
5. The National and Local Context
5.1. The Adult Mental Health Accommodation Strategy dovetails with national and local policies some of which are detailed below.
5.2. National Policies, including the Promoting Mental Health Strategy and the National Social Exclusion Programme, clearly identify the importance of housing and appropriate support for people with mental ill health.
5.3. The Hertfordshire Supporting People Strategy recognises the central role Supporting People plays in addressing homelessness and enabling people to live as independently as possible. Thus contributing to improving the health and well-being of local people, reducing social exclusion and enabling people to contribute and participate fully in their local communities.
5.4. The Hertfordshire Adult Offenders Accommodation Project in partnership with the Supporting People Programme have been charged with leading the development of a detailed strategy for meeting the housing related needs of adult offenders in Hertfordshire.
5.5. District and Borough Councils within Hertfordshire recognise the needs of vulnerable and/or homeless people including those with mental ill health. The councils are currently working together to inform and shape the London Commuter Belt Sub-Region (LCBSR) Housing Strategy which will be delivered in the autumn of 2008. The LCBSR housing strategy will establish the key areas where joint working across administrative boundaries can deliver economic, effective solutions to commonly identified issues. A sub-regional approach has been adopted in tackling homelessness, bringing empty homes back into use, developing more affordable homes, identifying and promoting good practice and achieving savings, by way of joint procurement, where the opportunities arise.
5.6. Recommendation
Ensure the needs of people with mental ill-health are adequately identified within the Sub-Regional Housing Strategy
Ensure that within each District a specific allocation of a number of units for people with mental ill-health are identified when new developments of affordable housing occur
6. Recent Trends in Mental Health
6.1. Over a 15 year period improvements in the medical treatment for mental ill-health have taken place. New anti-psychotic medication has assisted stabilise many people with the most serious mental illness.
6.2. The importance of social care has been recognised and within Hertfordshire the recovery approach of working adopted.
6.3. The development of Assertive Outreach Teams and Crisis, Assessment and Treatment Teams throughout county has led to intensive home support and treatment. This development has reduced the demand for in-patient beds and numbers of beds have been reduced accordingly.
6.4. There has been a shift away from institutional and paternalistic care to a model encouraging recovery, social inclusion and independence. The expectations of people with mental ill-health, in relation to all aspects of their life including housing, is to be able to have similar opportunities and choice as other members of the community.
6.5. Despite improved treatment some people with mental ill-health continue to require intensive support or rehabilitation for times varying from 12 months to long-term. This group will include those with the most serious illness and some mentally disordered offenders and ex-offenders.
6.6. The trend, in relation to specialist accommodation, is for high need intensive supported resources. This is evidenced in data collected. See Appendix A. Within Hertfordshire a number of sites, currently owned by the County Council, will be re-developed over the next few years offering opportunities for specialist new mental health development.
6.7. Recommendation
Liaise with HCC Property Unit in order to prepare a business case for the development of high needs and risk accommodation. This development should specifically consider the needs of mentally ill offenders. Consider the Core and Cluster model which will allow for move-on from the core high dependence unit into the cluster low support flats.
7. Housing Related Support in Hertfordshire
7.1. Specialist single person accommodation. There is a pool of accommodation specifically identified as available to people with mental ill-health who are single, not living within a supportive family setting and who therefore require a longer and more intense level of support within specialised accommodation.
7.2. The specialist accommodation pool has been developed over the years by Hertfordshire County Council. Local District and Borough Councils, Voluntary Agencies and Housing Associations.
7.3. In general the properties are managed by a local Housing Association who hold responsibility for ensuring they are allocated in accordance with agreed eligibility and nomination procedures. See Section 10.
7.4. Over the last 2 years all specialist accommodation in Hertfordshire to which the provider trust, Hertfordshire Partnership NHS Foundation Trust (HPFT) has nomination rights has been mapped and information has also been identified regarding placements in the private sector. Information is as follows and Appendix C identifies the areas in which the accommodation is situated.