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1 2nd Australasian Housing Researchers' Conference Housing & Mental health - Best Practice in Australia? Helen Cameron & Penny Worland University of South.

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Presentation on theme: "1 2nd Australasian Housing Researchers' Conference Housing & Mental health - Best Practice in Australia? Helen Cameron & Penny Worland University of South."— Presentation transcript:

1 1 2nd Australasian Housing Researchers' Conference Housing & Mental health - Best Practice in Australia? Helen Cameron & Penny Worland University of South Australia Hawke Research Institute for Sustainable Societies

2 2 Introduction The paper examines some key issues surrounding debates about approaches to housing for consumers with psychiatric illness. The primary question for this paper is whether or not identified best practice approaches can be identified with application for Australian conditions. An outline of this presentation is as follows – Deinstitutionalisation Housing approaches and mental health from international and national perspectives Impacts of housing options on mental health patients Existing gaps in current research into best practices

3 3 Deinstitutionalisation Deinstitutionalisation of mental health patients is one of the most important social health policy reforms in Australia in the last few decades. Most psychiatric hospitals across Australia have now been closed, although there are significant differences between states in the nature and pace of reform. Financially, care in a hospital setting has been calculated at almost twice the cost of care in a community setting (Lapsley, Tribe, Tennant, Rosen, Hobbs, & Newton, 2000). However, there are concerns that the policy has not met its original promise.

4 4 Deinstitutionalisation In South Australia for example, lack of community- based accommodation with appropriate support means that people are still being admitted to institutional facilities or placed in below standard facilities with deleterious impacts on mental health outcomes. Poorly conceived or implemented alternative housing options pose risks to mental health patients, creating unhappy clients, and placing the community at risk, both in social and economic terms Knowing how to establish stable, effective and flexible housing options for those with mental health issues remains elusive

5 5 Housing Needs & Mental Health Major issues under debate in the literature are not only whether or not identified best practice approaches can be conceptualized, but whether these approaches make a long term difference to mental health outcomes for residents. The reasons for the success or failure of models internationally and nationally does seem linked to how much and in what forms support is provided as part of the housing arrangements The task remains one of identifying accommodation approaches that are appropriate, humane, flexible, cost effective and enduring - requiring longitudinal evaluation of different approaches

6 6 Health Housing from International and National Perspectives Substantial analytical and critical European and North American literature documents the successes and failures of housing initiatives. Because usage differs across jurisdictions, it is essential to define key terms. Some authors consider supported housing to be different from independent housing (e.g. Fakhoury, Murray, Shepherd & Priebe 2002: 308), whereas for others supported housing includes it. In Australia, ‘congregate housing’ is often used to describe Supported Residential Facilities (SRF), boarding houses and sometimes group homes. Canadians Parkinson, Nelson & Horgan, 1999) have established definitions of three main approaches to mental health housing: custodial, supportive and supported.

7 7 Housing Approaches – Custodial Housing (Parkinson et al 1999) Custodial housing is described as ‘the medical model in the community, characterised by board and care homes, single room occupancy, foster homes and nursing homes. Characteristics of custodial housing include restrictive rules, staff control, high dependency of residents, little choice for consumers (over housing, living companions or daily activity), long term residency and large numbers of residents, many with long histories of mental health problems. The consumer’s role is that of patient. Parkinson et al claim there is no evidence that the custodial approach has benefits for consumers Clark’s South Australian research (2006) suggests clients can get stuck in SRF’s

8 8 Housing Approaches – Supportive Housing Supportive housing is described as the ‘residential continuum approach’ (Parkinson et al 1999) This approach is part of community treatment and rehabilitation models. Within such arrangements, the number of ‘housemates’ reduces as functioning increases and the norm is a group home with a relatively low level of support and/or treatment for residents. Support decreases as consumers stabilise - with eventual independence as the aim. Peer support and community participation is encouraged.

9 9 Housing Approaches – Supported Housing Supported housing is described as the new paradigm emerging in the 1990s as a “person- centred focus of support, emphasizing self- help and natural supports and de-emphasising professional services” (Parkinson et al 1999 p149). Consumers live on their own or in pairs. Wong, Filoromo & Tennille (2006) define it as characterised by consumer choice, normalised housing with resource accessibility, consumer control and individualised and flexible support.

10 10 Housing Needs & Mental Health Remaining central in this discussion is understanding about the nature of accommodation and its related support for people with psychiatric disability, with particular attention to the provision of stable, & flexible housing. For example, O’Brien, Inglis, Herbert & Reynolds(2002) found that there were four key elements that combine to provide acceptable and stable housing. These are: the housing situation does not aggravate the individual’s illness; reliable support for medication is available and trusted (including informal support); the person is willing and able to manage daily challenges of independent living; any issues that put housing at risk have been identified and proactively addressed

11 11 Inadequate Housing & Impacts on Mental Health ‘ Stable, secure and safe housing is the most important component of rehabilitation for people with a mental illness’ according to findings reported through the NSW Framework for Housing and Accommodation for People with a Mental Health Problems and Disorders in Other existing studies also show that it is vital for people leaving psychiatric care to have living arrangements that offer a balance of independence and assistance or support (O’Brien et al 2002). An inability to deal with life stressors, leading to risk of stopping medication with danger to oneself and others, is often cited as a reason for re-hospitalisation (Langdon, Yágüez, Brown & Hope, 2001). Self-harm, violent behavior and re-hospitalisation all have a high social, psychological and economic costs for the individual, the community and local neighbourhoods.

12 12 Inadequate Housing & Impacts on Mental Health White and Whiteford (2006) suggest that those with mental health problems travel the broad and circular path between mental institution, inadequate housing and support at the community level and prison. They see that access to stable housing impacts on a person’s mental recovery and in turn on staying out of prison. Zapf, Roesch & Hart (1996, p. 439) also note the research of Leukfeld indicating that prisons are often warehouses for offenders with mental illness; they link inadequate housing to homelessness - with its accompanying risk of heightened police notice and arrest.

13 13 Can we define best practices then? Generally, flexible, independent and stable living arrangements with integrated support have been linked positively by many to levels of recovery for mental health patients - increasing quality of life and steady reintegration into the community Appropriate and stable housing with key support and risk management strategies are vital rehabilitative and preventative measures Key variables in effective housing include the balance between support and independence, flexibility in terms of resident’s needs over time, the importance of consumer control and choice in housing, and the crucial aspect of affordability Long term studies internationally consistently suggest some form of support - integrated with the accommodation - is the most effective option (Forrester-Jones, Carpenter, Cambridge et al., 2002, Hobbs Newton, Tenant, Rosen & Tribe, 2002) One longitudinal study provides useful Australian data (Hobbs et al., (2002) but there is a need for wider understanding of Australian mental health clients’ experiences of supported housing.

14 14 Existing Gaps in Current Australian Research into Best Practices The following appear to be some gaps in assessing the effectiveness of Australian mental health housing in terms of definable outcomes in Australian research A better evidence base to understand the experiences and outcomes for a broad range of consumers A more complete assessment of the cost effectiveness of different approaches and models Approaches that best facilitate community integration Australian research conducted longitudinally into the application of approaches, again using a broad sample of consumers. Assessment of housing approaches most able to meet the needs of all those involved - including consumers, family and care workers.

15 15 Conclusions Deinstitutionalisation of those with mental health problems is well established in Australia as is the provision of alternative and more economic accommodation However, there remains limited agreement on best practice in housing for those with a background of mental illness Evidence about the most viable, economic & effective housing approaches for enhancing quality of life & community integration needs to be gathered for Australian settings Further research must interrogate policy directions, best practice housing options both nationally and internationally, consumer satisfaction and the impact of state and national policy on available options.


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