1. Community Links Personality Disorder Services. The role of Housing and Resettlement within local and regional personality disorder services.

2. Community Links 3 rd sector provision working across Leeds, York, Kirklees, Humberside & Yorkshire. Services include: Hostels Community resettlement and sustainment EIP and IAPT Drug and Alcohol Women specific Offender mental health Training and development. Self directed support. Personality Disorder within the Leeds PDCN – providing accommodation support for clients under Care Coordination. Regional PDS – Yorkshire and Humber - for those leaving secure and acute hospital environments

3. Why a Housing Team? – Highlighting the Need People with a personality disorder diagnosis are much more likely to experience homelessness, live in deprived areas and be placed in inappropriate accommodation. (DOH 2009) It has been recognised that without a stable base, further treatment options are likely to fail. A lack of appropriate move on accommodation is a major contributor to a blocked pathway. Whether coming from secure hospital or prison, housing is often overlooked as part of care/sentence planning. Appropriate accommodation can greatly improve an individuals life and help to manage their risk.

4. What we do. Offer a three step model of Assessment, Broker and Consultation. Holistic assessment highlights level of need, risk and recurrent themes in a person’s housing history. Also highlights additional resettlement needs – e.g. out of hours support, respite The findings from the assessment informs the brokering process – create individual recommendations based on availability within local service provision. (Ideals vs realities) This is facilitated via the CPA/MAPPA process. Work alongside the current Care Coordinator as part of wider MDT. The Consultation process aims to support the accommodation provider to understand personality disorder with a view to maintaining the tenancy and providing containment for the organisation. – e.g client hard to engage On-going tenancy support for PDCN – skills for independent living, issues with ASB, property adaptations for physical needs.

5. How do we do this? We don’t hold any of our own housing stock. Source resettlement pathways via existing provision. Seek out and maintain good links with a variety of local providers. Attend local and regional provider & homeless forums. We aim to promote consistency throughout an individual’s resettlement journey, as we understand this is not linear. Aim to offer something different that would enable housing providers to take a chance with our clients and feel supported to manage the risk. Consultation process with a personality disorder knowledge base – supporting services to understand the function of behaviour.

6. The Challenges Lack of Local Authority housing stock - reliance on private rented market Wider changes to benefits and increased rents – Bedroom Tax Cuts to SP funded services – more emphasis on independent living when people don’t have the experience or relevant skills. Time limited approach to service provision does not match with the complex nature of personality disorder. Similarly, with targets for move on set by commissioners. Access to appropriate funding for more intensive/specialist placements can be a postcode lottery. Supported accommodation is oversubscribed – long waiting lists. Lack of training and wider agency support can lead to housing providers feeling unable to manage the risk, so will turn down referrals for more complex cases. Lack of ongoing communication/involvement between services. Work with clients with no experience of stable accommodation.

7. Good Practice Regular, open communication with the provider and client is encouraged. Client and referrer are engaged in the assessment process. All parties need to “buy in” to the process in order to support a successful transition. Having a shared vision. That we are clear about our role and remit and how this compliments the wider MDT approach. Having a good working knowledge of local provision and commissioning enables us to identify the most appropriate/realistic pathway. Regular mapping of local and regional provision. Awareness of other agencies to signpost/refer on to. Regular professionals meetings and CPA to drive the resettlement process – Co ordinated approach not working in silos.

8. Positive Outcomes Clients find suitable accommodation in a timely manner Housing services feel supported. Increased confidence for staff and client that safety and risk can be maintained within a community setting. Will maintain stable accommodation and reduce risk of eviction/tenancy breakdown. Reduce hospital admission/return to custody as clients feel contained within community. Where possible, attempt to keep clients out of the NFA population. If clients return to hospital or custody, that work is done to maintain their tenancy and support package, (where possible) to offer consistency.

9. References. Department of Health, Recognising Complexity. Commissioning guidance for personality disorder services (2009).