Why an integrated approach to social housing is key

This blog will look at why supported housing is so important for people with mental health issues, learning disabilities, or autism and why an integrated approach that combines the NHS, housing, and local authorities to plan, commission and deliver supported housing is essential.

Homes are a critical foundation in people’s lives and a primary location of care and support. Safe, secure, and affordable housing is crucial in supporting people to live well, work and take part in community life, and it is considered a key determinant of positive physical and mental wellbeing.

It is sometimes necessary for people with serious mental health problems or people with learning disabilities, or autistic people to be admitted to hospital. It is accepted that for most people, this should be a short admission, and they should be discharged to an intensive community provision based on their clinical needs as soon as possible. A suitable place to live is essential for moving people out of hospitals.

Overall mental health bed occupancy has remained above the recommended safe levels since spring 2021. Delayed discharge from mental health units is not helping. Getting people out of hospital is important for them personally, so they can have a life, but improving patient flow in and out of hospital is also important. As a fifth of delayed discharges is linked to people waiting for supported housing, it is essential that housing is part of the mental health pathway.

It is well established that social determinants of health such as housing and financial security must be addressed if we are to improve people’s mental health and wellbeing.

Ill mental health is frequently cited as a reason for tenancy breakdown, with housing problems frequently referenced as a reason for someone being admitted or re-admitted to inpatient care. For people with serious mental illness, the right housing can be a critical factor in supporting them to live as independently as possible whilst also accessing the support they need to live and thrive in local communities.

It is estimated that healthcare is only responsible for about 20% of health outcomes, and the rest is linked to the social determinants of health, including housing.

Therefore, responsibility for addressing the social determinants of health largely sits outside of the NHS. The only way to truly address these issues is through the NHS working in partnership with the housing sector and local authorities and taking an integrated approach.

Now that integrated care boards (ICBs) and integrated care partnerships (ICPs) are statutory bodies, this should help make this a reality, but housing needs to be seen as a priority, and they need to understand why supported housing is so important.

The Mental Health Network’s Housing Forum, in association with HACT, recently held a housing summit and produced the Healthy foundations: integrating housing as part of the mental health pathway report, which looked at the steps needed to achieve a more integrated and strategic approach between health, housing and social care.

The report sets out several recommendations around the need for:

• A national strategy for supported housing
• A clear vision and national strategy for mental health and housing
• Long-term investment
• The development of expertise and the workforce to work in multidisciplinary teams across health, housing, and social care settings
• The development of consistent and explicit model of supported housing services, which are built on good practice, quality and co-produced
• Developing a comprehensive evidence base that addresses the quality and financial cases for investment, clinical integration, and excellence
• An enhanced appreciation of mental health and the impact current policy and practice by mainstream housing and homelessness services has on people experiencing poor mental health
• And finally, a commitment to doing ‘no harm’ in mainstream housing management by landlord

Sussex Health and Care Partnership is a multi-agency partnership that commissioned HACT to support the development of its first mental health and housing strategy. Partners across the NHS, social care, housing, and community sectors are committed to working together to take a more strategic and integrated approach to housing and mental health. They recognise that addressing housing issues for specialist mental health service users can be a key enabler in their recovery.

Home Group have developed discharge models. Offering housing support for patients in a ward-based setting and, following discharge, in the community. Based on the ward and working alongside the existing multidisciplinary team, the team support those identified as presenting with a housing-related need. Partnership working is critical to the success of the model. They work with the customer and the other agencies already working with that individual to improve their outcomes. As the service helps reduce delays on discharge to supported housing, it can save money by reducing inpatient stays.

The policy drive is to reduce the length of stay in mental health inpatient units, but people with serious mental illness or learning disabilities and autism need appropriate housing to enable them to live as independently as possible within their communities. This is possible, but it needs a national vision, investment, and the workforce to make this possible. The only way it will work is by working in partnership.