Far Away Voices Report March 2013
Introduction The Far Away Voices project was funded by a grant from the Whitefriars Housing ‘Pride in Our Streets’ fund. The project team, with the exception of the Project Manager, were made up of Whitefriars tenants who have severe and enduring mental ill health and are engaged with Coventry City Council‘s service at the Pod. The project's aim was to explore the relationship between home, neighbourhood and community for people experiencing severe and enduring mental ill health. The principal deliverables were a report exploring the resources available in Coventry’s Hillfields and Tile Hill areas to support social inclusion and a film illustrating the essence of the report in a visual way. The decision was taken not to look city wide due to resource limitations and these areas were selected since they represented regions of dense social housing both near and far from the city centre. It soon became apparent however that community resource was not the key to social inclusion for this vulnerable group. Through interviews and conversations with the target group the realisation was reached that in fact the home lay at the centre of the matter. A safe and secure home was found to be essential to any engagement with any form of community.
The percentage of people that I see who have housing issues ranges between 25 and 40% depending on the nature of the area of the city they live in. Dr Zaghloul, Consultant Psychiatrist
In addition, it became plain to see that a person’s ‘community’ was seldom defined by geography and much more likely was a community of interest and relationships which both spanned and exceeded the boundaries of the city. Often these relationships are sustained by the use of social networking websites such as Facebook. As a consequence this report was refocused to explore the relationship between housing, mental ill health and social inclusion.
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When does a house become a home? ‘A safe and secure place to live is essential to everybody’s health and well being. For many people however, poor mental health is linked to insecure, poor quality and overcrowded housing and homelessness.’ (No Health Without Mental Health: A Cross Governmental Mental Health Strategy for All Ages).
Research suggests that housing has a relationship with everybody’s mental well being and that this can be compromised by a number of mitigating factors which may ‘contribute to the development of mental health problems or make health problems more difficult to manage’ (Mind) When people first come in contact with Mental Health services their housing status is explored illustrating how important a factor it is to a person's mental well being. In the CANSAS assessment tool which considers the needs of people with severe mental health problems, accommodation is given consideration first.
A house is a collection of bricks and mortar whereas a home is a place in which a person invests their identity and sense of self. In Mazlow’s Hierarchy of Needs, the security of housing is classified as a second order need only surpassed by the basic physiological needs. The concept of ‘home’ appears somewhere in the levels of belonging and self-esteem both of which are considered to be essential for a person’s well being. The sense of safety associated with a home reflects a person's feeling that their tenancy is secure and that their neighbourhood is safe. This is true for all people not just those with an inherent mental disorder.
(Diagram Mind publication)
If a person is not feeling safe and secure in their own home it will have a detrimental impact on their mental health. Peb Johal, Mental Health Social Worker
From the above diagram it can be seen that there is a reciprocal relationship between mental ill health and matters affecting a person’s housing status. A period of severe mental ill health is likely to cause a problem in one or more of the above areas and a significant problem in any of the above areas is likely to have a negative impact on a person’s mental wellbeing. It is often the case that these relationships can lead to a devastating downward spiral resulting in eventual homelessness.
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Statistics Nationally approximately 2.87% of the population has a severe and enduring mental illness, this represents some 1.82 million people. Of these 1.3 million use secondary mental health services and 520,000 primary services only. If these figures are used as a representation for Coventry’s 316,960 citizens then some 9,096 people could be assumed to have a severe and enduring mental illness across the city. Seventeen percent of Coventry’s citizens live in social housing which represents 53,883 people. It is likely that the prevalence of mental ill health in people living in social housing is greater than the national average due to social deprivation but no statistics could be found to substantiate this. Based on the national average it can be assumed in excess of 1,546 people in Coventry’s social housing have a severe and enduring mental illness.
There are 152 homeless and in priority need people in Coventry. (The Guardian 2012)
Severe and enduring mental ill health is four times more prevalent in the homeless compared to the general population. (Gill et al 1996) Eighty four percent of people living with severe and enduring mental ill health report that they feel lonely and isolated compared to twenty nine percent in the general population.
One in four people will experience mental ill health at some point in their lives.
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Key factors affecting housing When things go wrong When a person's mental health falters and things go badly wrong, their ability to look after their affairs usually suffers too. People are less likely to be able to take care of themselves and their homes. Not paying attention to the payment of bills is a common problem when a person experiences a severe episode of mental ill health. Behaviour changes can lead to difficulties with neighbours and problems dealing with matters around and about the home.
Going to hospital A real concern for people who are admitted to a mental hospital is what will happen to their home. If someone is sectioned under the Mental Health Act or have to go into hospital suddenly there may be insufficient time to make arrangements for the home to be secured and looked after. In addition after a period of four weeks in hospital benefits may be cut or lost entirely which can result in an inability to continue to pay rent or fees for temporary accommodation.
Money worries Someone with a severe and enduring mental illness is much more likely to be unemployed and living on benefit. This lack of financial resource gives less choice about where a person can afford to live and the chances are they will have to live in less favourable areas. In addition financial constraints affect a person’s ability to pay their mortgage, rent, household bills etc. For people experiencing an episode of mental ill health there is the likelihood that they will be less able to manage their financial affairs and in some cases may spend excessive amounts of money, both of these can result in financial default resulting in a loss of tenure. Both the Citizen's Advice Bureau and the Coventry Law Centre were contacted to establish how many people requested their support in such circumstances but they were unable to provide any figures.
I had nobody who made sure the bills had been paid so when I was discharged from hospital I received post almost every day telling me I was in arrears, this added greatly to my distress. Amy, a Coventry citizen with severe and enduring mental ill health
People that matter Relationships with other people are very important for the well being of all and can often become damaged when people have a severe and enduring mental illness. Breakdowns in relationships can often result in a person becoming isolated or acting irrationally. This can lead to problems with landlords and neighbours which if not understood and resolved can lead to eviction.
It is important for the person who is unwell to feel comfortable and also for the family members who are supporting them because they need peace of mind too. June Cooley, Coventry Carers
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Mental ill health and Social Inclusion Social relationships and support is important for everybody’s well being. Research strongly supports the proposition that for those recovering from mental illness, reconnection with society promotes recovery and decreases the chance of relapse.
Most of the time I am quite isolated, I'm insecure to get involved out there, unless there is a specific programme to get involved with. Namirah, a Coventry citizen with severe and enduring mental ill health
‘Social connections include engaging with friends and peers, maintaining employment and economic wellbeing, undertaking education, art, hobbies, and other activities, physical exercise, leisure and recreation and social relationships. Engagement in society encapsulates the principles of having a sense of purpose and agency, feeling safe and secure, being free from violence or threat of violence, and having hope for the future.’ (View from the Peak, 2007)
I don't take part in my local community, this is probably my fault, because of my mental health issues I'm wary of people. Susan, a Coventry citizen with severe and enduring mental ill health 06
Far Away Voices Report | March 2013
Understandably it has been found that people with unstable housing have limited prospects of accessing work or community activities. During the course of this project it has become very apparent that a number of people with severe and enduring mental ill health experience the threat of violence and stigma associated with the neighbourhood. This can cause extreme anxiety and often deterioration in mental health. Furthermore some people approached for interview were unwilling to comment or sought anonymity for fear of reprisal either from their community or housing provider.
I have endured many sleepless nights due to anti social behaviour from my neighbours but have not reported it for fear of reprisal and harassment. Amy, a Coventry citizen with severe and enduring mental ill health As stated earlier a person’s community connectivity is more often based around relationships rather than geography. Research has shown that people with a serious mental illness are more likely to have smaller social networks spanning 5 to 13 relationships compared to the general public’s average of 25 (View from the Peak, 2007). An impoverished social network web is the fundamental reason for social exclusion and health practitioners often work with people to help them grow these networks. In Coventry, Mental Health professionals use a self-evaluation tool, the 'Recovery Star' which specifically focuses on Social Network development as one of the principal recovery factors. It is essential therefore that those relationships are maintained and where possible expanded if social inclusion is to be achieved. A key to forming a good relationship with others is a sense of worthiness which in turn can, as previously discussed, be influenced by the nature of a person’s home.
Hopes and Fears Recognising the shortage of social housing and the negative impacts of homelessness or poor transient accommodation on those living with severe and enduring mental ill health it is strongly recommended that such people be given a priority status in the allocation of social housing.
There is a real concern that the current changes in benefits will lead to increased financial difficulties surrounding tenancy resulting in an increase in evictions. In addition, the reduction in health and social care support resulting from current and future public spending cuts may result in an increased frequency and intensity of periods of mental ill health which again may cause a rise in the number of evictions and hospital admissions.
From a housing provider perspective the aspiration is that more social support would be made available to people with mental ill health when housing issues arise. This would provide the opportunity for pragmatic dialogue to resolve issues therefore reducing evictions and their associated costs which are estimated to be between £3,500 and £4,000 on average. There is a problem however that if a person does not disclose that they have a mental health problem the housing provider will not know and cannot act accordingly.
Summary Housing and social inclusion are essential to a person’s ability to ‘recover’ their lives after the devastation of the onset of a severe and enduring mental illness. In this context ‘Recovery emphasises that, while people may not have full control over their symptoms, they can have full control over their lives. Recovery is not about 'getting rid' of problems. It is about seeing beyond a person’s mental health problems, recognising and fostering their abilities, interests and dreams’ (Mental Health Foundation). Improvements in these will not only improve the lived experience of these people but is likely to reduce the cost associated with their support including, hospital admissions, social care, benefit claims and evictions.
The National Institute for Health and Clinical Excellence guidelines emphasise the importance of social inclusion, access to work and the stability and quality of accommodation. Dr Zaghloul, Consultant Psychiatrist
STABILITY CONTROL
RECOVERY IMPROVE QUALITY
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