Durham County Council, in partnership with the local the primary care trust (PCT) and others, has provided independent but supported housing for people with chronic mental health conditions. St Stephen's Close is seen as an intermediate step to fully independent living and residents are actively encouraged to participate in local community life.
Key learnings for other councils
Staff at St Stephen's Close felt initially that the support needs of clients had been underestimated. They found that preparing clients adequately for independence takes longer than estimated. They emphasise the importance of having suitable accommodation for clients to move on to for independent living. Floating support is vital to ensure that people who have moved on do not relapse and return to hospital.
Throughout the UK, the closure of large psychiatric hospitals in the 1980s resulted in an increased demand for mental health-related residential accommodation. County Durham was no exception.
Many chronically mentally ill patients are released after a short stay in hospital, only to be rapidly readmitted. This is due to a number of complex factors and has become known as the ‘revolving door' syndrome.
One of its effects is that people with long-term mental health problems have found it difficult to feel part of or see any community as ‘home'. This in itself can contribute to the sense of isolation and exclusion that exacerbates mental ill-health (Quilgars, 1998).
Who was involved?
Durham County Council, Wear Valley District Council, Three Rivers Housing Association (a registered social landlord (RSL) and The Richmond Fellowship (a mental health charity).
Commissioning The Richmond Fellowship was an important strategic decision for the council and the PCT. The Richmond Fellowship is both a local housing provider and a floating support provider for people with mental health problems.
This is very helpful for people moving on from St Stephen's. For example, Richmond Fellowship staff are involved in the council-run homelessness action group and is helping develop its choice-based lettings strategy.
This kind of networking enables The Richmond Fellowship staff to maximise the support they can give St Stephen's residents. This includes finding council housing for people moving on from St Stephen's or working with private landlords through the Accredited Landlord schemes.
The problem and how it was tackled
The partnership has made a concerted attempt to break the ‘revolving door' cycle. The aim is to provide better outcomes for people with mental illness and improve efficiency.
The project is jointly funded by NHS County Durham, the primary care trust (PCT) and Durham County Council social care. The properties are owned by Three Rivers and The Richmond Fellowship acts as managing agent.
They take people either from in-patient care or on referral from social services. Project staff usually work with someone for about 18 months, on the understanding that they will move on to independent living when they are ready.
The service has eight self-contained flats built around a communal space. Entry to the premises is controlled 24 hours a day so that new clients feel safe and each client has a key to their own flat and is responsible for their own bills.
The council provides monitoring through a contract under the national Supporting People housing programme for vulnerable people. Adult mental health services also commission ‘beds' (that is places in flats) through spot purchasing. This is based on assessment of an individual at the time of their being referred to adult mental health services.
Clients are usually in their early 20s with few informal support mechanisms. Self-harming behaviour increasingly features in referrals as well as other complex issues, including offending or substance abuse. While residents live at St Stephen's Close, support staff are available 24 hours a day.
Staff aim to help clients develop the skills to manage their own tenancies and live independently. There is also floating support to help clients make a successful transition to mainstream accommodation. This operates for the first four weeks after they leave St Stephen's Close while they settle into their new home.
The project is innovative in seeking to ‘re-enable' people to live independently in linked self-contained flats, rather than the more commonly adopted shared accommodation.
Project staff help people develop their ‘social housing skills' to enable them to live in more conventional social or other housing. For this reason St Stephen's community-based setting is very useful.
The underlying understanding is that mental and physical health go hand in hand. There is a strong link between housing, support, social care and health needs. The service is commissioned to deliver outcomes in all of these areas, which it does successfully.
Project staff try to get people actively involved in their community and using mainstream services, such as GPs and dentists. The overall objective is to try to ensure that people settle into and don't have to leave their community, for example, to become a hospital in-patient.
Outcomes and impact
In all cases, the current cost at St Stephen's is less than the alternative. This level of saving equates to at least £22,000 per client a year across the wider health and social care system. Savings may in fact be higher if account is taken of better outcomes for clients with concomitant reductions in support costs.
Most clients who have left St Stephen's have moved on to independent accommodation. Of the five most recent moves, three have moved on to a private landlord and two to housing association accommodation, all with floating support.
Service commissioners at the county council note that the service:
- is well managed
- has well trained and supported staff
- delivers high quality services
- is innovative
- achieves positive outcomes for people with enduring mental health needs.
Future plans include developing closer links with clinical rehabilitation services and forensic units to build on successes in moving people on from intensive health services.
There are also plans to assist clients to move on from current placements in residential care services. The floating support service will become more outcome-focused to provide a clearer stage of support in a service user's recovery.
References and further information
Quilgars, Deborah (1998), ‘A life in the community: supporting people with mental health problems in ordinary housing', Policy Press.
Alan Curry, Policy and Planning Officer, Durham County Council
Andy Rowe, Service Manager, The Richmond Fellowship