Circles of support: A floating support service for moving people with mental health problems to independent living Richard Wynne, Work Research Centre Paula McNulty, HAIL Housing Aoife Farrelly, HSE NDA conference 2017
A floating support service • 2 Genio funded projects – Doras and Slan Abhaile • Collaboration: HAIL Housing and HSE Mental Health Rehab team – Housing – Tenancy and personal support – Clinical support • 56 clients over 4 years
Homeless Inappropriate Private Rental Living Situation Tenants Psychiatric Floating Support Hospital (mental health oriented) Transition/ Preparatory Settling in Maintenance & Phase Phase Recovery Enhancement Hostels / Community Residential ‘Recovery’ dimension Tenancy-related support Other Hospital HAIl Tenants Prison LA Tenants Other Social Housing Tenants 3
Dublin North City Mental Health Services | CHO 9 CURRENT SERVICES • DNC provides community and local and regional in- patient services to 337,000 people in north inner city Dublin. • 13 CMHT’s • Programme for the Homeless team • 3 Community Rehabilitation Teams
Dublin North City Mental Health Services | CHO 9 REHABILITATION AND RECOVERY MENTAL HEALTH SERVICES • A Specialised Tertiary Service for people with complex needs that can’t be met by general adult MH services • Individuals with severe and enduring mental health issues and complex needs aged 18-65. • People with prominent symptoms and partial response to medication. • Difficulties with communication and engagement and repeated hospitalisations / involuntary detentions. Some with difficult to manage behaviours and forensic issues. • Some loss of self confidence, life purpose, institutionalisation, unemployment, social isolation and housing difficulties.
HSE VISION FOR THE PROJECT • Collaboration between HSE, Rehabilitation CMHT and HAIL i.e. Mental health professionals working with housing specialists. • Implement Vision For Change - social housing responsibility of local authority. • Provide secure independent housing in safe environments . • Promote active community participation and meaningful social roles. • A model of CMH rehabilitation based on community outreach and homecare. • Reconfigure services - reduce places in hostels, close high support hostels and reassign staff to community teams.
Process • Develop personalised support plan and set goals (ICP) • Housing Support Worker essential member of team, attends team meetings and ICP meetings. • Meaningful engagement with families and service users. • When client is housed – plan for reduced support, follow up by team, in some cases referral back to local CMHT. • Joint training HSE and HAIL in SSDL (SRV)
About HAIL • Founded in 1985 – St Brendan’s, Grangegorman following the publication of the report “ Let’s Look at Housing • Approved Voluntary Housing Association • HAIL provides exceptional quality social and affordable rented accommodation for people from local authority housing waiting lists, primarily those with mental health difficulties. • Currently 340+ tenancies • Individually tailored services ( floating support ) to support people with mental health difficulties to integrate and live independent lives in the community.
Our Support Services PICCLS Cloverhill Remand Prison Referred by NFMHS Homeless Complex Needs VISITING SUPPORT SERVICE HAIL SUPPORT TENANT SUPPORT SERVICE Tenancies at risk ( MH Individual's needs related) Permanent home with Partnership working HAIL Range of tenancies Community Integration Holistic Crisis Intervention Phased but open-ended Time limited Non- clinical Towards Independence PEER SUPPORT SLAN ABHAILE One to one Peer Support From hostels to Social, Emotional, Independence Practical Low/med /high support Recovery focused Working with Rehab teams
Move On • Meet with MHRT, Client & Families to discuss move on, and area of choice. • Begin the “discovery process” to explore interests, dreams, previous experiences of clients in order to enhance or develop new positive roles. • Advocate with Local Authorities and Housing Bodies in order to source suitable housing.
Moving In • Familiar with locality of choice. • Support them with interview & signing a tenancy. • Social Welfare and Benefits. • Shopping • Assist with setting up utilities (Electric, Gas, & Water) in clients names. • Encourage clients to pay utility bills and rent through direct debit. • Rent payment system (An Post).
Did the project work and the value case for continuing? • Stakeholders perspectives • Resources used on the project • Value for money 15
Doras and Slan Abhaile projects Marker Doras Slan Abhaile Number of clients 18 51 69 people supported by the project; 56 had moved in; Client status only one failed tenancy Nature of MH issue 39 Schizophrenia, remainder mostly bipolar disorder Length of time in previous 10.2 years (< 1 year to c. 40 years) accommodation Hostel – 53; hospital ward – 6; Previous accommodation Family friends – 6; others – 4. 16
The sample • 16 individual interviews • 10 clients in focus groups • 28 Hail key workers assessments • 14 HSE key workers assessments Data from 37 clients in all 17
87% say it is better than previous accommodation Having my own place, feeling Quiet, good for secure, being in studying, good control of my life accommodation, Invaluable for subsidy is good recovery enough 18
HSE KW: 86% ‘OK’ or ‘very well’ My accommodation and living conditions are better now I can manage better because my new home Because I am living allows me time and space on my own now to deal with issues 19
HAIL KW: 95% managing ‘OK’ or ‘Very well’ I am saving now and I have no problems in paying my bills managing daily activities 20
The other patients I want to be annoyed me better in my studies I am trying to get Not having my a job now and I own personal am doing other space things 21
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Value case • Delivery on policy – the projects help realise policy on: • Health • Housing • Employment 24
Value case • Value for clients with enduring mental health needs Mental health & Wellbeing gains Housing-related gains Recovery-related gains Social inclusion gains 25
Value Case • Enabling/enhancing service provision HSE service provision – Better throughput of clients, potentially lower service usage Housing sector – enabling clients to reside in housing, reduced problems associated with client group 26
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