Housing seen as key determinant in new approach to mental health

Report says social determinants such as housing underline the importance of parity between prevention, treatment, and recovery of mental illness.

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Housing is seen as a key determinant in a new approach to mental health strategy recommended by a Parliamentary report.

MPs and social workers are jointly calling on the government and NHS Trusts to recognise the social factors of mental health distress and promote the social model of health within new mental health legislation.

The All-Party Parliamentary Group (APPG) on Social Work and the British Association of Social Workers (BASW) co-developed a new inquiry – Social Workers and a New Mental Health Act – in response to the Independent Review of the Mental health Act 1983.

A resulting report says that, on its own, the medical model too often seeks to identify a diagnosis and corresponding treatment plan, with little regard to social circumstances.

Greater attention to social determinants such as housing would underline the importance of parity for prevention and recovery alongside treatment, the report says.

The social model compels professionals to think about the determinants of ill-health – factors such as housing and socio-economics – alongside traditional medical explanations.

Greater attention to social determinants would underline the importance of parity for prevention and recovery alongside treatment, the report says.

Also recommended are recovery-focussed reviews that also consider housing among the “practical issues” toward long-term treatment.

The inquiry looks at the integration of health and social care, and how social workers’ role can be enhanced in new legislation to uphold the human rights of children and adults suffering ill mental health.

“The recommendations in the report affect people across the country – and could have a positive impact on their lives and those of their families. Simple things like funding to visit relatives placed away from home could make a tremendous difference,” said APPG chair Alex Cunningham MP.

BASW CEO Dr Ruth Allen said that, with social workers key to integrated mental health service, legislators “should take this opportunity” to emphasise social workers’ roles and potential in new legislation and guidance.

The report also highlights the decline in the number of multi-disciplinary teams across the country, with fewer local authorities and health providers working together.

This, the report says, is an issue the government needs to investigate to promote best practice and encourage greater cooperative working.

The inquiry was established in response to the Independent Review of the Mental Health Act 1983, published in December 2018.

Set out in the final report are four principles that should underpin new legislation:

  • Choice and autonomy – ensuring service users’ views and choices are respected
  • Least restriction – ensuring the Act’s powers are used in the least restrictive way
  • Therapeutic benefit – ensuring patients are supported to get better, so they can be discharged from the Act
  • People as individuals – ensuring patients are viewed and treated as rounded individuals

The inquiry was presented to the Department for Health and Social Care, which will prepare the government’s response to the Independent Review and subsequent legislation.

Overall, the report’s findings hinge on trusts and councils being held more accountable for the lack of progress – or even reversal – of integration at the level of service provision and treatment, with integration needing to be planned properly with “clear leadership and vision” from policymakers and commissioners who understand the value it brings.

The NHS Long Term Plan and developments through regional and sub-regional planning are acknowledged as “pointing in this direction” at structural and strategic levels, but the intention of more and better integration is identified as needing to translate into “real, sustainable” integrated delivery at the frontline.

Evidence to the inquiry showed that properly delivered integration and integrated or multi-disciplinary teams can provide the best possible outcomes, with services providing “coherence and joined up pathways” preventing patients from having to tell their story multiple times.

According to that evidence, many areas have fragmented and inaccessible systems that are very difficult to navigate, especially for those in crisis and their families.

In an increasing number of places, the inquiry heard, integrated health and social care teams have become “divorced” as partnership agreements have broken down.

Social workers in successfully integrated teams who gave evidence to the APPG inquiry said, in their experience, no “divorced” team could match the work they do.

For those with complex mental health and social needs, the ability of social workers to coordinate their care with psychiatrists, nurses, occupational therapists, peer support workers, and others is crucial.

Integration also provides the space to have frank discussions with other professionals, to collaborate over decision making, and to learn from each other, the inquiry heard. 

Three evidence hearings were held, overseen by Alex Cunningham MP, chair of the APPG for Social Work, who was joined by a cross-party team of Parliamentarians.

Written evidence was also received from social workers, universities, and local authorities.

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