Although a formal committee of Brighton & Hove City Council, the Health & Wellbeing Board has a remit which includes matters relating to the Clinical Commissioning Group (CCG), the Local Safeguarding Board for Children and Adults and Healthwatch.
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Title:
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Date of Meeting:
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8th November 2022 |
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Report of:
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Executive Director – Health & Adult Social Care |
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Contact:
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Jenny Knight, Commissioning Manager |
Tel: 01273 293081 |
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Email:
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jenny.knight@brighton-hove.gov.uk |
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Wards Affected:
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All |
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FOR GENERAL RELEASE
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Executive Summary
The links between mental health and housing are well established with good quality housing being a key component in enabling positive mental health and wellbeing. In Brighton & Hove there are high levels of mental health need coupled with pressures on housing with a high-cost competitive housing market and significant issues with rough sleeping and homelessness. In July 2020 the Sussex Health & Care Partnership (SHCP) published a Strategic Plan for Integrating the Housing and Mental Health systems across Sussex[1]. This plan included the requirement to create mental health and housing plans in each place i.e Brighton & Hove, East & West Sussex. In this context the Brighton & Hove Mental Health and Housing Plan brings together the whole system – Brighton and Hove City Council (Adult Social Care & Housing Department), NHS Sussex and Mental Health Services (both statutory and voluntary) around a shared set of priorities which aim to increase access to support and accommodation provision for those with mental health needs within the city and support better integration of services to improve outcomes for service users.
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Glossary of Terms
Delayed transfer of care – when a patient is ready to leave hospital but unable to do so.
Discharge to Assess – short term accommodation or community based support service for individuals being discharged from hospital to support transition and develop an onward accommodation and support plan.
Out of Area Placement – where an individual is placed in accommodation outside of the city
Supported Accommodation – Accommodation with support which can range from high support offering 24 hour staffing to low support offering 1-3 hours floating support per week.
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1. Decisions, recommendations and any options
1.1 That the Board notes the content of the report
2. Relevant information
2.1 The Strategic Plan for Integrating the Housing and Mental Health systems across Sussex published in July 2020 laid out 5 strategic objectives:
· Objective 1: Create Mental Health and Housing Plans for each place in East Sussex, West Sussex and Brighton & Hove.
• Objective 2: Ensure housing expertise is embedded within the new model for community mental health services being developed across the SHCP.
• Objective 3: Pilot, evaluate and extend the Discharge to Assess models, building on shared learning across each pilot to optimise outcomes and improve flow and transitions from inpatient provision.
• Objective 4: Deliver the ambition to create new integrated models of supported housing for people with multiple and complex needs thereby reducing the need for inappropriate out of area hospital placements and residential care.
• Objective 5: Drive forward the integration of housing, social care and mental health clinical services, by supporting Sussex Partnerships NHS FT to establish strategic and operational partnerships with providers of housing and housing services, that improves individual outcomes, service quality and reduces unnecessary variation.
2.2 The Brighton & Hove Mental Health & Housing Plan has been developed with a view to better integrating the work of Adult Social Care, Health and Housing within the city. The plan seeks to develop better links with East and West Sussex while ensuring that it meets the needs of our local population in Brighton & Hove. The development of the Mental Health and Housing Plan has been overseen by the Mental Health Accommodation Group which has representatives from Adult Social Care, NHS Sussex, Housing and Sussex Partnership Foundation Trust and with the support of a Sussex wide place based plan development group.
2.3 The plan and the priorities within it have been developed following
• A review of previous engagement exercises, reports and needs assessments.
• A review of local mental health and housing data.
• Engagement with stakeholders via survey and meetings.
• Engagement with people with mental health needs, their families and carers undertaken by Healthwatch
Findings of the Review and Engagement:
2.4 The information gathered as part of the review and engagement detailed above has been used to develop the priorities for the plan and the actions arising from those priorities. The main findings in the report are:
Waiting Lists & Delayed Transfers of Care
A lack of appropriate accommodation is leading to waiting lists and delayed transfers of care, this includes;
· Lack of High & Medium self-contained supported accommodation leading to increased waiting times and lack of appropriate placements for those with more complex needs.
· High numbers of placements out of area for residential care and supported living.
· Lack of local supported living for those with mental health needs leading to placements in higher cost residential care.
· Lack of accommodation for those with complex support needs.
· Lack of accommodation and support for young people with mental health needs.
Housing and Homelessness
· High numbers of people in the city with multiple and compound needs including mental health with homelessness and substance misuse.
· High numbers of young people (16-25) in young peoples supported accommodation with mental health needs. 60% reporting a mental health need or with a mental health diagnosis but only 12% engaged with mental health services.
· High volume of referrals to the mental health homeless team with 30% of those supported residing in council emergency accommodation and 23% rough sleeping, in short term placements or supported accommodation for homeless people
A number of gaps in provision were identified
· Support is needed from mental health professionals to non-mental health professionals working in supported & emergency accommodation.
· Support needs to be flexible, assertive and personalised.
· There needs to be greater integration of Mental Health & Substance Misuse services especially when working with homeless individuals with complex needs.
· There is a lack of services for young people with Mental Health & Autistic Spectrum Conditions
· It is difficult to access affordable & secure social or private rented accommodation.
Feedback from professionals, users of services, families and carers
2.5 A survey was undertaken asking for the views of mental health professionals,
and individuals working with people with mental illness including workers from supported accommodation, housing and charities operating in the city. This consultation found:
- 77% of professionals who responded said it was difficult for their clients to access mental health services, this included people with substance misuse and those whose needs were not deemed high enough.
- 70% of professionals felt their clients would not be able to access appropriate accommodation for their needs, some of the reasons given for this were a lack of affordable accommodation and long waiting lists for self-contained supported accommodation.
- 92% of respondents said they would know where to refer their clients to in a mental health crisis but 52% of those were not confident that their client would receive the help they needed.
- Feedback showed a lack of information and understanding between Housing, Adult Social Care and Mental Health Services of each others remits, services and pathways available.
- Housing workers and those working in supported accommodation feel they are holding high levels of need & risk with little support.
Healthwatch carried out a survey and one to one interviews with people who have mental health needs, their families and carers. They found:
• 58% of respondents found it difficult to access mental health services with reasons including waiting list times & being offered services which had previously not worked.
• Lack of specialist services specifically for Autistic Spectrum Condition.
• 70% of respondents felt listened to and treated with care and concern however 41% of people felt that the support they received did not address their needs or help them make plans to do so.
Feedback regarding supported accommodation for those with mental health needs conducted by Mind found:
• a lack of mobility accessible accommodation
• a lack of self-contained accommodation
• a lack of services which support those with complex needs
• a need for tailored support & training for staff specially those working with individuals with complex needs
• a need for therapeutic support for residents
Priorities
2.6 Five priorities have been identified as part of the Mental Health and Housing Plan. A two year action plan has been developed which has been approved by the Mental Health Oversight Board.
Priority 1: Improve Support to Young People & Transitions
Develop dedicated provision for 18–25-year-olds and improve transition from children’s to adult services to support at this vulnerable life stage.
Priority 2: Reduce barriers to hospital discharge
· Improve referral pathways and communication and increase use of out of hospital provision including Discharge to Assess and step-down provision to minimise delayed transfers of care.
· Increase capacity & “appropriateness” of onward accommodation and support offers to people leaving hospital.
· Improve confidence of hospital-based clinicians to discharge into services and remove barriers to earlier, safe discharge.
Priority 3: Improve Connection Between Mental Health, Adult Social Care and Housing to Prevent Homelessness and Improve Mental Wellbeing.
· Improve knowledge and understanding of respective roles and remits.
· Trial collaborative ways of working between clinicians and providers of supported & emergency accommodation to enable mental health to be managed effectively and ensure housing expertise is embedded in mental health services.
· Develop and improve housing pathways & improve access to independent accommodation and support in the community.
Priority 4: Increase the provision of supported accommodation and support for people with mental health and co-existing conditions within Brighton and Hove.
Reduce waiting lists; out of area placements; delayed transfers of care and the risk of acute admissions and homelessness due to inappropriate accommodation placements.
Priority 5: Develop accommodation and support services to meet the needs of people with co-existing conditions & multiple and compound needs.
Particular focus on complexity including people with mental health need who also have Autistic Spectrum Condition and/or Substance Misuse needs.
Next Steps
2.7 The actions within the plan are being taken forward in a number of working groups with monthly oversight of the plan taking place at the Mental Health Accommodation Group. Regular progress reports are also going to the ICB Mental Health & Housing Working Group and the Mental Health Oversight Board.
3. Important considerations and implications
Legal:
3.1 The Council has general duties under the Care Act 2014 to promote individual wellbeing, prevent needs for care and support and promote integration of care and support with health services. The duty applies equally to specific decisions about a person and to policy and strategy. Wellbeing includes mental health and the protection from neglect. Independent living is core to the well-being principle.
s2 Care Act 2014 places a duty on the Council to reduce, prevent or delay the development of needs. With the cooperation of health services, this plan identifies the pathways for suitable accommodation for those with mental health needs, and allows the Council through consultation to develop clear local plans to deliver the required services to this vulnerable group now and in the future.
Lawyer consulted: Farida Amin Date: 10.10.22
Finance:
3.2 The Mental Health & Housing Place Based Plan has a number of priorities which may impact on budget and resources going forward. Any changes in service delivery for the council will be subject to recommissioning processes and will need to be delivered within the available budget.
Finance Officer consulted: Sophie Warburton Date: 07/10/2022
Equalities:
3.3 An EHIA has been completed. The EHIA along with the consultation and data review has led to specific actions in the plan including the need to develop services for people with mental health needs and co-existing conditions.
Sustainability:
3.4 There are no sustainability implications arising from this report, individual actions within the plan may have implications however these will be dealt with as separate pieces of work and any implications in regard to commissioning or re-procurement will be brought to committee separately.
Supporting documents and information
Appendix1: Brighton & Hove Mental Health & Housing Plan
Appendix 2: EHIA
Appendix 3: Healthwatch Consultation Report
Appendix 4: Mind Supported Accommodation Consultation