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Aneurin Bevan University Health Board – Housing and Mental Health Support Analysis Final Report April 2019 Housing and Mental Health Mapping Analysis Contents 1. Introduction 3 2. Context 3 3. Executive summary 5 4. Methodology 7 5. Current services, good practice and innovation in Gwent – the base line 8 6. Findings – key issues for stakeholders 29 7. Examples of good practice and innovation in housing and mental health – national 58 8. Recommendations for a strategic programme 65 Appendix 1 – Project Steering Group membership 69 Appendix 2 – Stakeholders and contributors to the research 70 Appendix 3 – Documents reviewed 73 Appendix 4 – Service mapping 75 Appendix 5: Horizon Scan of innovative and good practice services 88 Aneurin Bevan University Health Board April 2019 2 of 111 Housing and Mental Health Mapping Analysis 1. INTRODUCTION 1.1 This housing and mental health support analysis was commissioned by the Aneurin Bevan University Health Board (ABUHB) in January 2019. The Board and its partners in Housing, Public Health, Supporting People formed a steering group (membership listed as Appendix 1) to oversee the project, meeting fortnightly with Campbell Tickell throughout the project’s duration. 1.2 The analysis has set out to provide a baseline assessment of Housing and Housing Related Support Services for adults with mental health issues, aged 18+ across the Gwent area (Blaenau Gwent, Caerphilly, Monmouthshire, Newport and Torfaen). The key objectives of this study are: 1) To identify the key issues for all stakeholders and describe possible solutions; 2) To map all current housing related mental health support available within health, social care, housing (statutory, registered social landlords and Supporting People) and the third sector; 3) To identify examples of good practice and innovation locally and across the UK that could inform possible solutions; 4) To organise and facilitate an event with key stakeholders to develop a strategic programme of work to take forward the findings of this study. 1.3 We have received support and co-operation from a range of individuals and organisations across Gwent throughout the project and we would like to thank all the contributors and participants in consultation events and meetings for their time and their contributions to this report. 2. CONTEXT 2.1 The operating environment for housing and mental health provision is challenging, with increasing homelessness, insecure housing, financial pressures, and the impact of welfare reform on people leading to increased demands on mental health services. Homelessness and poor housing multiply the impact of underlying inequalities and have a long-term impact on peoples physical and mental health. 2.2 The long-term economic squeeze and its impact on public services has also resulted in a dearth of resources for preventative services, the lack of which further increases demand on the mental health system. Aneurin Bevan University Health Board April 2019 3 of 111 Housing and Mental Health Mapping Analysis 2.3 A recent report from NHS providers1 in England highlighted the fact that socio- economic pressures on people are creating additional demands on and pressures for mental health service providers, with many now increasingly involved in supporting patients to address these issues in addition to their mental health needs. The issues referred to in that report will also be familiar to providers in Gwent and are illustrated below: 2.4 ABUHB has made significant steps in looking to address these pressures and demands on the mental health system in Gwent. Partnerships have been established with housing and Supporting People and Public Health colleagues and joint working is increasing at the strategic level, with regional Boards and at a practical level where housing and support providers and statutory partners are keen to do more. 1 https://nhsproviders.org/mental-health-services-addressing-the-care-deficit Aneurin Bevan University Health Board April 2019 4 of 111 Housing and Mental Health Mapping Analysis 3. EXECUTIVE SUMMARY Lived experience quotes: “I don’t feel like I can sort anything out until I have somewhere to live” “Hardest part is the nights and early mornings, especially when I can’t sleep and I’m having terrible dreams”. 3.1 The current system is failing some of the most vulnerable homeless people, who often struggle with the rules and conditions, stress, and lack of security in hostels, and who need higher levels of support as a result of poor mental health, substance misuse, physical or learning disabilities or a history of offending. 3.2 At the same time, the lack of appropriate, affordable housing with the right support across Gwent is a major barrier to recovery for many people who are ready to move forward on their recovery journey, whether that be by leaving acute hospital care, specialist services, residential care, or supported accommodation. 3.3 In addition, while the stresses associated with the social determinants of health increase amongst service users, preventative services that could alleviate some of these negative impacts on people’s mental wellbeing have been reduced through cuts to public spending arising from the economic squeeze since 2009. Front line services find themselves frequently working with a level of people’s mental distress that they know is preventable. 3.4 Our recommendations bring together the information gathered through service mapping, stakeholder interviews and two workshops conducted with stakeholders in summary these are: 1) Establish a mental health and housing pathway (or pathways) across Gwent based on mapping the journey’s into and out services for: a) Homeless/rough sleepers and those with complex needs related to homelessness b) People requiring ‘step-down’ services from high to low care and support and through to independent living c) People who are housed and in crisis or at risk of losing their housing as a result of mental health issues d) Young people in transition from children’s to adult services Aneurin Bevan University Health Board April 2019 5 of 111 Housing and Mental Health Mapping Analysis e) Offenders with forensic history or with mental health issues – in particular consider prison in-reach housing and mental health advice and support to access services 2) Identify the mental health offer to Housing First services for people with complex needs who are not able to benefit from a housing pathway approach and look to develop a Housing First Model across Gwent. 3) Consider how NHS Estates planning can be influenced to address some of the housing needs of people with mental health issues. 4) Work with private sector landlords to improve access to good quality secure private rented sector housing for people with mental health issues – building on existing initiatives. 5) Work with partners to address the impact of welfare reform e.g. through financial inclusion services, advice and assistance. 6) Agree information sharing protocols with partners across the pathway/pathways. 7) Commission a Gwent wide hospital discharge service that includes Housing Advice Workers, by bringing together and expanding existing provision. 8) Commission crisis support services based on a ‘recovery café’ model. 9) Build on dual diagnosis services. 10) Identify a mental health and housing pathway champion within ABUHB who can take oversight responsibility for: • maintenance and continuous development of the service mapping carried out as part of this project • building pathway access and exit routes, • joint working arrangements with partners across social care and housing 11) Work with social care colleagues to pool budgets for S117 service users and ensure that social care colleagues and mental health care managers are incorporated into the mental health and housing pathway(s). Aneurin Bevan University Health Board April 2019 6 of 111 Housing and Mental Health Mapping Analysis 4. METHODOLOGY 4.1 Our methodology has consisted of: a) A review of key strategic documents (listed in Appendix 3); b) Document and web-based research and collation of existing lists of provision to map current housing and housing related support services for people with mental health. This has resulted in a spread-sheet based database of provision. A word version is attached as Appendix 4); c) Face to face and telephone interviews with 30 stakeholders (see Appendix 2 for those interviewed); d) Face to face interviews with 30 people with lived experience of mental health and housing issues. Meetings were held with people who use Torfaen and Blaenau Gwent Mind services, Gofal supported housing, Monmouthshire Housing Options, the Olive Branch (a drop-in day service in Newport) and people who are currently in St Cadoc’s hospital in Pillmawr Ward (re-hab, low secure ward for men). These meetings resulted in creation of 30 case studies – six of which have been included in this report. The full set of 30 case studies are provided as a separate digest. e) A Horizon Scan of new models, examples of innovation and good practice, based on desk top research, consultants’ own knowledge and information gathered via stakeholder interviews; f) Workshop meetings with key stakeholders: • A half-day ‘reality check’ event with 32 stakeholders conducted in February 2019; • A second Programme event with 36 stakeholders to agree a strategic programme of work based on the findings of this study, conducted in March 2019; g) A report setting out our findings (this study). Aneurin Bevan University Health Board April 2019 7 of 111 Housing and Mental Health Mapping Analysis 5. CURRENT SERVICES, GOOD PRACTICE AND INNOVATION IN GWENT – THE BASE LINE 5.1 This section of the report sets out a description of the range of mental health and housing services mapped and identifies local examples of good practice. We have defined services for inclusion based on either having specialist mental health workers or being a designated mental health service. 5.2 To ensure that the mapping focusses appropriately and does not become too generic we have excluded services that support people with a mental health issues alongside other issues e.g.

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