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Durham E-Theses Durham E-Theses The role of housing in community care for mentally disabled people Scott, Heather J. How to cite: Scott, Heather J. (1992) The role of housing in community care for mentally disabled people, Durham theses, Durham University. Available at Durham E-Theses Online: http://etheses.dur.ac.uk/5732/ Use policy The full-text may be used and/or reproduced, and given to third parties in any format or medium, without prior permission or charge, for personal research or study, educational, or not-for-prot purposes provided that: • a full bibliographic reference is made to the original source • a link is made to the metadata record in Durham E-Theses • the full-text is not changed in any way The full-text must not be sold in any format or medium without the formal permission of the copyright holders. Please consult the full Durham E-Theses policy for further details. Academic Support Oce, Durham University, University Oce, Old Elvet, Durham DH1 3HP e-mail: [email protected] Tel: +44 0191 334 6107 http://etheses.dur.ac.uk ABSTRACT THE ROLE OF HOUSING IN COMMUNITY CARE FOR MENTALLY DISABLED PEOPLE HEATHER J. SCOTT It is argued that housing is a fundamental element in successful community care programmes for people who have a long-term mental illness, but that the significance of the immediate living environment on the individual's psych- social well-being has been underestimated in the formulation and implementation of policy. Using a grounded theory approach, Part One reports an exploratory study of the catchment area of one psychiatric hospital, which included parts of three health districts and three local authority areas. The study examined in detail, with a focus on housing, the operation of services for mentally disabled people , the plans for creating locally-based facilities, and the implementation of those plans in the mid-1980's, by means of a combination of documentary evidence and key informant interviews. All three parts of the study area were found to have encountered major but differing problems. Wide variations between and within local areas in policy and resources were found, but most stiking was the emergence of two distinct key informant perspectives: those of policy makers/managers, and workers in face-to-face contact with mentally disabled people, indicative of separate discourses of rights and needs. Part Two sets up a model of three functions of housing based on psychological needs, and argues for a compensatory role for housing in community care, which is contrasted with the reality of increasing difficulty in meeting even basic survival needs. It is suggested that the emphasis on negative rights of much mental health reform was inadeguate to ensure that needs were met when the welfare net began to contract, and renewed emphasis on citizenship and social rights is proposed as a means to represent more adequately the housing needs of mentally disabled people at the levels of policy and service planning. THE BOLE OF UQUmMQ M ©DMAflUNDTY CARE FOR MENTALLY OiSABLED PEOPU HEATHER J. SCOTT The copyright of this thesis rests with the author. No quotation from it should be published without his prior written consent and information derived from it should be acknowledged. SUBMITTED TO THE UNIVERSITY OF DURHAM FOR THE DEGREE OF DOCTOR OF PHILOSOPHY YEAR OF SUBMISSION: 1992 DEPARTMENT OF SOCIOLOGY AND SOCIAL POLICY TABLE OF CONTENTS Page Introduction 1 Part One = Rationale, Research Study and Findings Chapter One: Overview 13 Chapter Two: Research Study: Aims, Design 32 and Method Chapters Three - Seven: The Study Findings Chapter Three: Derwentside 60 Chapter Four: Gateshead 96 Chapter Five: Newcastle: Health Services 135 Chapter Six: Newcastle: Local Authority 162 and Voluntary Services Chapter Seven: Front-Line Views 223 Chapter Eight: Conclusion to Part One 240 Part Two: Towards an Explanation Chapter Nine: Mentally Disabled People: 260 Shelter, Home and Residence Chapter Ten: The Reality Of Community Care 289 Chapter Eleven: Conclusion 312 Appendices 330 Bibliography 382 LIST OF TABLES MD FIGURES Page Tables: 2.1 Initial Informants 40 2.2 Key Informants 45 3.1 Numbers deemed intentionally homeless 84 4.1 Gateshead: Deprivation rankings of 99 selected wards 6.1 Homelessness in the study area 186 6.2 Voluntary agencies' housing provision, 204 Newcastle Figures s 9.1 Maslow's hierarchy of needs 264 9.2 Cognitive-phenomenological 271 theory of stress DECLARATION No part of the material contained in this thesis has previously been submitted for a degree in this or any other university. All the material is the sole work of the author. COPYRIGHT The copyright of this thesis rests with the author. No quotation from it should be published without her prior written consent and information derived from it should be acknowledged. I am extremely grateful to numerous colleagues and friends who have supported me by their interest and encouragement over the last seven years. Thanks are due to Peter Farrell, George Hepburn, Jan Hepburn, David Stephenson and Lynn Stephenson, who all at different times provided oases of guiet and calm in their homes to enable me to write. Esther Moffitt undertook the daunting task of typing and coped cheerfully with delays, deadlines and changes of mind. Jan Hepburn kindly took on the substantial and tedious task of printing and putting together the initial version. I am deeply grateful to three friends whose help on the final lap was invaluable: Barbara Hudson, for intellectual stimulus at a critical point, and friendship throughout; Jean Gough, who created the 'space' for me to do the writing; and Cheryl Rivers, whose computing skills rescued me at the eleventh hour. My thanks go above all to David Byrne, without whose judicious combination of carrot and stick the work would not have reached this point. Responsibility for the text which follows of course remains mine. DMTIRODUCTDOINI 2 "All of us want to live somewhere nice in a reasonable house or flat with privacy and our own things around us, yet...the very aspects of life we all hold so dear are denied to people at their most vulnerable" (Bayliss, 1987, p.5). My interest in the housing of people with a long-term mental illness developed over the course of a number of years spent working with them as a social worker in psychiatric hospitals and area teams. It was impossible to remain unaware of the difficulties which many people faced in relation to their accommodation. Some lived in appalling conditions; many lost their homes before or during their admissions to hospital; some had had no kind of stable home for many years, and many had remained in hospital for years because they had nowhere else to go. In those cases where the social worker's role involved helping the person to find or establish him/herself in new accommodation after a stay - sometimes prolonged - in hospital, three aspects stood out: the enormous amount of time and patient attention to detail which most often appeared to be essential if the person was to be helped to make a successful transition from the role of patient to becoming an 'ordinary person' once more (Ramon, 1989); the difficulty of achieving even a minimal degree of material comfort for people with very limited income and resources; and the consequent bleak precariousness of their lives. Work as a practitioner centred on two main areas: detailed negotiation and liaison with a wide range of agencies and professionals, which was essential to ensure that their different policies and practices were co-ordinated in the best interests of the individual; and work with the person to accommodate a plethora of individual wishes, anxieties and difficulties. 3 The majority of people who experience mental illness, whether acute or chronic, have a home to which they are able to return and where they have the support of family and friends. However, my experiences led me to a conviction that, for the significant minority unable to do this, where and how they found themselves living played a key role in their ability to survive outside institutional care. They led equally to a conviction that this role and the reasons for it were barely recognised or understood by those involved in developing and implementing community care policies: Wansborough and Cooper's comment about employment rehabilitation appeared equally applicable to housing: "Mentally disabled people were not deliberately excluded . they were simply not thought of" (Wansborough and Cooper, 1980, p.23). My original intention had been to explore some of the implications of Bayliss's assertion (p.l) by documenting the 'housing careers' of people with a long-term mental illness in the community. Except for those long-stay patients discharged through a hospital rehabilitation process, evidence about where and how they lived was haphazard: where were those people who previously found themselves in mental hospitals now living?; what happened to them over time?; what quality of life did they have? and in what ways might this be related to their housing circumstances? However, the subject emerged as an increasingly complex one, involving a number of different disciplines and bodies of knowledge, levels and structures. It became clear that issues which appeared to me more fundamental had yet to be addressed, so that the idea of a prospective study was premature. I therefore decided that a different approach was preferable at this stage. 4 Although it could be argued that recent thinking about community care began with the mentally ill (Busfield, 1986), its implementation in relation to this group had encountered particularly difficult problems (and continues to do so). Indeed, in many aspects of community care, the situation of mentally ill people appeared to be the limiting or paradoxical case: a recurrent impression was that where a particular part of the welfare system found that mentally ill people presented difficulties or challenges, the system tended to respond by ignoring or excluding them.
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