circles of support: a floating support service for moving...

Circles of support:A floating support service for moving people with

mental health problems to independent living

Richard Wynne, Work Research CentrePaula McNulty, HAIL Housing

Aoife Farrelly, HSE

NDA conference 2017

A floating support service

• 2 Genio funded projects – Doras and Slan Abhaile

• Collaboration: HAIL Housing and HSE Mental Health Rehab team

– Housing

– Tenancy and personal support

– Clinical support

• 56 clients over 4 years

Hostels /CommunityResidential

Floating Support(mental health oriented)

‘Recovery’ dimension

Tenancy-related support

PreparatoryPhase

Transition/Settling in

PhaseMaintenance &

Recovery Enhancement

Homeless InappropriateLiving Situation

LA Tenants

Other SocialHousing Tenants

HAIl Tenants

PsychiatricHospital

OtherHospital

Private RentalTenants

Prison

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Dublin North City Mental Health Services | CHO 9

CURRENT SERVICES

• DNC provides community and local and regional in-patient services to 337,000 people in north inner city Dublin.

• 13 CMHT’s

• Programme for the Homeless team

• 3 Community Rehabilitation Teams

Dublin North City Mental Health Services | CHO 9

REHABILITATION AND RECOVERY MENTAL HEALTH SERVICES

• A Specialised Tertiary Service for people with complex needs that can’t be met by general adult MH services

• Individuals with severe and enduring mental health issues and complex needs aged 18-65.

• People with prominent symptoms and partial response to medication.

• Difficulties with communication and engagement and repeated hospitalisations / involuntary detentions. Some with difficult to manage behaviours and forensic issues.

• Some loss of self confidence, life purpose, institutionalisation, unemployment, social isolation and housing difficulties.

HSE VISION FOR THE PROJECT

• Collaboration between HSE, Rehabilitation CMHT and HAIL i.e. Mental health professionals working with housing specialists.

• Implement Vision For Change - social housing responsibility of local authority.

• Provide secure independent housing in safe environments .

• Promote active community participation and meaningful social roles.

• A model of CMH rehabilitation based on community outreach and homecare.

• Reconfigure services - reduce places in hostels, close high support hostels and reassign staff to community teams.

Process

• Develop personalised support plan and set goals (ICP)

• Housing Support Worker essential member of team, attends team meetings and ICP meetings.

• Meaningful engagement with families and service users.

• When client is housed – plan for reduced support, follow up by team, in some cases referral back to local CMHT.

• Joint training HSE and HAIL in SSDL (SRV)

About HAIL

• Founded in 1985 – St Brendan’s, Grangegorman following the publication of the report “Let’s Look at Housing

• Approved Voluntary Housing Association

• HAIL provides exceptional quality social and affordable rented accommodation for people from local authority housing waiting lists, primarily those with mental health difficulties.

• Currently 340+ tenancies

• Individually tailored services (floating support) to support people with mental health difficulties to integrate and live independent lives in the community.

Our Support Services

HAIL SUPPORT

Individual's needs

Partnership working

Holistic

Non- clinical

Towards Independence

PICCLS

Cloverhill Remand Prison

Referred by NFMHS

Homeless

Complex Needs

TENANT SUPPORT SERVICE

Permanent home with HAIL

Community Integration

Phased but open-ended

SLAN ABHAILE

From hostels to Independence

Low/med /high support

Working with Rehab teams

VISITING SUPPORT SERVICE

Tenancies at risk ( MH related)

Range of tenancies

Crisis Intervention

Time limited

PEER SUPPORT

One to one Peer Support

Social, Emotional, Practical

Recovery focused

Move On

• Meet with MHRT, Client & Families to

discuss move on, and area of choice.

• Begin the “discovery process” to explore

interests, dreams, previous experiences of

clients in order to enhance or develop

new positive roles.

• Advocate with Local Authorities and

Housing Bodies in order to source suitable

housing.

Moving In

• Familiar with locality of choice.

• Support them with interview & signing a tenancy.

• Social Welfare and Benefits.

• Shopping

• Assist with setting up utilities (Electric, Gas, & Water) in clients names.

• Encourage clients to pay utility bills and rent through direct debit.

• Rent payment system (An Post).

Did the project work and the value case for continuing?

• Stakeholders perspectives

• Resources used on the project

• Value for money

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Doras and Slan Abhaile projects

Marker Doras Slan Abhaile

Number of clients 18 51

Client status69 people supported by the project; 56 had moved in; only one failed tenancy

Nature of MH issue 39 Schizophrenia, remainder mostly bipolar disorder

Length of time in previous accommodation

10.2 years (< 1 year to c. 40 years)

Previous accommodationHostel – 53; hospital ward – 6;Family friends – 6; others – 4.

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The sample

• 16 individual interviews

• 10 clients in focus groups

• 28 Hail key workers assessments

• 14 HSE key workers assessments

Data from 37 clients in all

17

18

Quiet, good for studying, good

accommodation, subsidy is good

enough

Invaluable for recovery

Having my own place, feeling

secure, being in control of my life

87% say it is better than

previous accommodation

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I can manage better because my new home

allows me time and space to deal with issues

Because I am living on my own now

My accommodation and living conditions

are better now

HSE KW: 86% ‘OK’ or ‘very well’

20

I have no problems in managing daily

activities

I am saving now and paying my bills

HAIL KW: 95% managing ‘OK’ or ‘Very well’

21

I want to be better in my

studies

I am trying to get a job now and I am doing other

things

The other patients

annoyed me

Not having my own personal

space

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Value case

• Delivery on policy – the projects help realise policy on:

• Health

• Housing

• Employment

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Value case

• Value for clients with enduring mental health needs

Mental health & Wellbeing gains

Housing-related gains

Recovery-related gains

Social inclusion gains

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Value Case

• Enabling/enhancing service provision HSE service provision – Better throughput of clients,

potentially lower service usage

Housing sector – enabling clients to reside in housing, reduced problems associated with client group