CEO on the frontline

Taking long-term mental health patients out of locked wards and into independent supported housing requires partnership and risk management. One Housing CEO Richard Hill shows Mark Lawrence how it can be done.

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Supported housing is not a new concept to many in the housing association sector, but there are few supported housing schemes that are dedicated to supporting those with mental health issues.

One Housing has built a small portfolio of the schemes, with more planned for the future.

The scheme works in close partnership with local NHS trusts and has been pivotal in moving people from long-term hospital care into independence.

Most of the patients come from locked wards, where they are served a meal every four hours and everything is done for them.

But if they are transferred to One Housing’s Thrale Road scheme, they are given their own budget, cook their own food and can be more independent.

One Housing CEO Richard Hill explains why that was initially a hard conversation between the housing provider and the NHS Trust.

“They were initially concerned about the transition,” he says. “They are now owning their own money, cooking their own meals, and it has taken the Trust some time to get beyond that.”

But staff are on hand to help people to cook, shop and gain further independence.

And while the Trust “now sees the benefits of the way we are operating”, there are still some myths to bust.

Partly, this has come from the families of those who are being placed in the scheme, with horror stories from programmes such as Panorama highlighting the bad practice of some care providers.

The approach Hill and One Housing took was to meet the parents early on and talk through the scheme and what it wanted to achieve.

“From a parent perspective it is about the change,” says Hill. “Before, the hospital would be a set three meals a day in a controlled environment and here it is independent.

“Even if you know it is the right thing to do to create more independence for people, it is quite a leap for them. It is a really good thing we are trying to do.

“The NHS for some people is a reassuring thing in itself.”

The scheme also allows parents to ring and speak to their child directly – rather than going through an intermediary.

“When people are on the ward, they could ring there and ask if they are okay,” says Hill.

“The people staying here are adults. They may not want to tell their parents everything in their lives, but it does shift the conversation from mediating relationships through a nurse.”

Another myth to bust was from the health side of things, some thinking that as soon as it was incorporated within the scheme it would be ignored.

However, Hill explains this isn’t the case. “We have support officers who work here, and the scheme manager has a clinical background and qualification.

“I think for people who have only been looked after by nurses for so long, there is an anxiety about how that is going to work.”

He adds: “Having health professionals on site throughout the month that often helps with the health side of the relationship – it helps with the confidence that they are not out of sight, out of mind.

“They are still able to see people and the progress they are making. The first two schemes we had in Camden allowed the Trust to be convinced this model worked. The NHS is brilliant but sometimes a bit slow to see if a new model works.”

The scheme also has clinicians who can make quick decisions about a patient, so they are not waiting around, and if there is a concern they can quickly be taken back to hospital.

“There are people who previously were just stuck in the system and no one could work with them,” says Hill. “Now we have this offer.

“You have to demonstrate that value to local authorities and housing with money, looking at hospital referrals and other costs. But it is also about communities and allowing people to contribute back.”

It is clear from walking around the scheme that those living here are happy, with an outside area being particularly popular. According to Hill, it’s all part of the culture.

“It is about teaching life skills not in a patronising way, supporting people to do the things they want to do anyway,” he says.

“Everything we do is not with a focus on their diagnosis and medication, but we focus on the person they are, the experiences they have had and what they want to achieve.

“You can’t do that when you are in hospital as it is about, ‘Have you had your meds? Have you eaten?’”

Despite the positive outcomes for both the health service and the local authority, it doesn’t come without its challenges.

The scheme has higher staff-to-tenant ratios than in most supported housing schemes, due to the challenging nature of the support provided. But, as Hill explains, this is something that the association has been able to take on that maybe others wouldn’t.

“We always had a good care and support offer, probably the biggest of all the London housing associations.

“We have always had a good relationship with Camden and Islington, and the initial conversations with the Trust was about if we could do something that would help them and be good for us to do.

Hill adds: “For us, it sits really well within the care and support offer that we have – it isn’t outside of it on its own. We did lots of what looks a bit like this in other places.

“This isn’t something that is of interest to many of the bigger associations in London. That is not a criticism – they do many other things.

Although there may not be as many supporting the scheme as Hill would like, does he think more associations need to provide similar services? Moreover, are they able to?

“We feel there is a huge potential for schemes like this. It is not a competition between associations, it is about how we can together work to grow the market.

“My guess is that because it is a lot of work to set up, people wouldn’t want to enter this market unless they have experience.

“Given the level of risk, it is quite a hard thing to do, but we have people across the business who have experience in this area who can grow that. If you are starting from scratch, you probably wouldn’t.”

With the association planning to do more and incorporate more trusts into its plans, it seems the model is proving popular on both sides of the fence.

But ultimately, it’s all about the end user, and despite only being open six months Thrale Road has already transformed lives.

If that isn’t the type of work housing associations should be doing to ease the crisis in mental health, building stronger communities by improving the lives of those who have slipped through the cracks, then what is?

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