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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
3
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
15
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.
16
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
19
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
22
23
24
Value case
• Delivery on policy – the projects help realise policy on:
• Health
• Housing
• Employment
25
Value case
• Value for clients with enduring mental health needs
Mental health & Wellbeing gains
Housing-related gains
Recovery-related gains
Social inclusion gains
26
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