Housing and Support Program (HASP): Final Evaluation Report

Department of Psychiatry (UQ) and 

Service Evaluation and Research Unit 

The Park, Centre for Mental Health 

Final Evaluation 

Report 

of the Queensland Government’s 

Housing and Support Program 

November 2010

Evaluation team 

Dr Tom Meehan 

Dept of Psychiatry (University of Queensland) 

and Director, Service Evaluation & Research 


Wacol Qld 4076 

Dr Dan Siskind 

Consultant Psychiatrist 

Queensland Centre for Mental Health Research 

and Metro South Health Service District 

Ms Kathy Madson 

Project Offi cer 

Service Evaluation & Research Unit 



Ms Nicole Shepherd 

Project Offi cer 

Service Evaluation & Research Unit 



Acknowledgments 

We are indebted to a number of organisations and individuals for their support and 

assistance during the conduct of this study. We would like to thank the consumers 

and staff of the various non-government organisations and government departments 

who so generously gave of their time to participate in this evaluation. 

This evaluation was funded by the Queensland Department of Communities 

and Queensland Health.

Final Evaluation 

Report 

of the Queensland Government’s 

Housing and Support Program 

Dr Tom Meehan 

Ms Kathy Madson 

Ms Nicole Shepherd 

Dr Dan Siskind 

Department of Psychiatry (UQ) 

and Service Evaluation and Research Unit 


November 2010

II 

Executive summary 

Since the 1990s, a range of housing models has 

emerged as an alternative to institutional care for those 

with high levels of psychiatric disability. ‘Supported 

housing’ is one of the service options being promoted 

across Australia for those with more severe problems. 

A key factor in the success of supported housing 

has been the provision of ‘non-clinical’ support by 

visiting workers, typically employed through the nongovernment 

sector. This non-clinical support is aimed 

at assisting individuals to access services in their local 

community, manage day-to-day living activities and 

sustain their tenancies. In Queensland, supported 

housing has been made possible through a number 

of initiatives. One of these, the Housing and Support 

Program (HASP), was established in 2006 to support 

individuals with psychiatric disability leaving acute 

and extended treatment mental health facilities. 

HASP is a cross-departmental initiative involving 

the collaboration of two government departments 

— Queensland Health and the Department of 

Communities (Housing and Homelessness Services 

and Disability and Community Care Services). 

Each individual accessing HASP is provided with 

a ‘package’ of services consisting of mental health 

services, disability support services and normal 

community housing. HASP was designed to provide 

a stable home environment in the community for those 

with severe disability and increase the potential for 

individuals to maximise their inclusion in their 

chosen community. 

During 2010, a research team comprising of staff 

from the Park, Centre for Mental Health and the 

University of Queensland was engaged to evaluate 

HASP. Qualitative and quantitative data were collected 

from a broad range of staff and clients to enable an 

assessment of the Program to be carried out. 

Final Evaluation Report 

Key fi ndings 

• Clients supported 

Since HASP commenced in 2006, some 204 clients 

have been offered a HASP package. Of these, 

153 were living in the community at the time of 

data collection (March–July 2010) and 80 of these 

consented to participate in the evaluation. 

• Overwhelming support for HASP 

During our interviews with staff and clients we 

heard several accounts of the way in which HASP 

had helped clients to move from a life fi lled with 

despair to one of hope and promise for the future. 

Indeed, 82.2% of clients indicated that involvement 

in HASP had helped them (or was currently helping 

them) to achieve their goals. Both clients and staff 

appreciated the holistic approach of HASP and noted 

that collaboration between the agencies involved 

was integral to the success of the Program. 

• Accommodation 

More than half of the HASP clients followed up 

(56%) were living in apartments and unit blocks, 

while the remainder were living in townhouses 

or detached houses. Satisfaction with housing 

was high, with almost 90% of clients claiming to 

be very satisfi ed/most satisfi ed with their housing. 

The majority of HASP tenancies have remained 

stable with 82.5% of individuals living in the original 

accommodation provided through HASP. Only 14 of 

the 80 clients interviewed (17.5%) had moved house 

since joining HASP. Eleven of these had moved once, 

one had moved twice and two had moved thrice. 

The reasons cited for moving included discord with 

neighbours and to be closer to family members. 

• Non-clinical support 

Non-clinical support is provided through a range 

of non-government agencies. These agencies 

were able to demonstrate success in reducing the 

amount of support provided to clients. The number 

of support hours provided each week decreased 

signifi cantly (p=.002) by 7.2 hours from an average 

of 27.6 hours on entry into HASP, to an average of 

20.4 hours at the follow-up time point.

• Community integration 

While eight of the 80 HASP clients followed up were 

in paid employment, clients worked an average 

of 18.06 hours per week. In addition to paid 

employment, 13 clients (16.2%) indicated that they 

participated in volunteer work. The mean number 

of hours spent on volunteer work was 8.15 hours per 

week (range = two to 24 hours per week). Finally, 

eight clients (10%) indicated that they attended 

TAFE or other training programs. Over 40% of clients 

indicated that they would like paid employment as 

their main activity in the future. This suggests that 

there is some scope for clients and service providers 

to focus on employment as a long-term goal for 

those with a desire to work. 

• Changes in the need for inpatient care 

The average time in inpatient care decreased 

signifi cantly (p=0.001) from an average of 

227 days/per client in the 12 months prior to 

HASP, to an average of 18.9 days/per client in the 

12 months post-HASP. Moreover, the number of 

admissions also decreased signifi cantly (p=0.002) 

from an average of 1.22 admissions/per client in 

the 12 months prior to HASP, to an average of 0.66 

admissions/per client in the 12 months post-HASP. 

• Changes in functioning 

While improvements in functioning were not 

statistically signifi cant, the clients, as a group, 

did not deteriorate following entry into HASP. 

Indeed, the fi ndings indicate that over half of 

the clients (51%) demonstrated improvement 

in general functioning, while 40% produced 

improvement in clinical functioning in the 

12 months since joining HASP. 

• Changes in Mental Health Act status 

Restrictions placed on clients through the Mental 

Health Act had been signifi cantly relaxed since 

entering HASP. The proportion of clients on 

Involuntary Treatment Orders (ITOs) decreased 

from 46% to 22%, while the proportion of clients 

with voluntary status increased from 43% to 70%. 

This relaxation of the legal restrictions placed 

on clients suggests that client functioning and 

compliance with treatment improved following 

access to HASP. It also demonstrates that efforts 

are being made by clinical services to reduce 

restrictions on clients where possible. 

• Cost – HASP versus alternative options 

Overall, the recurrent cost of keeping the ‘average’ 

client in HASP for 12 months is approximately 

$74,000 less expensive than keeping the same 

client in a Community Care Unit (CCU) and $178,000 

less expensive than keeping the same client in an 

acute inpatient unit. The fi ndings suggest that one 

could maintain two clients in HASP for the cost of 

keeping one client in a CCU and almost four clients 

in HASP for the cost of keeping one client in an acute 

inpatient unit. However, programs such as HASP 

should not be promoted as a substitute for the 

services of a CCU or acute inpatient unit. All of these 

treatment and housing options should be included 

in a comprehensive mental health program. Finally, 

it should be noted that the costs provided here are 

based on recurrent costs only. Initial costs involved 

in selecting clients for the program, securing housing 

options and establishing infrastructure in the 

community to support each individual have not 

been considered in our estimates. 

• Overall quality of life 

An overall rating of quality of life was obtained 

by asking clients to rate their quality of life 

on a 10-point scale where ‘1’ was the worst quality 

of life possible and ‘10’ was the best quality of life 

possible. HASP clients provided a mean rating of 

almost ‘7’ out of a possible total score of 10. This 

high quality-of-life rating is in keeping with previous 

evaluations of clients living in supported housing 

in Queensland (Project 300) and New South Wales 

(The Housing and Support Initiative). 

Over 85% of clients were pleased about having 

accomplished something in the past month. 

These accomplishments included staying well, 

being able to stay out of hospital, making a new 

friend or getting a job or volunteer work. A further 

80% were happy that ‘things had gone their way’ 

and were proud that someone had complimented 

them on something they had done (77%). 

Housing and Support Program (HASP) 

III

IV 

Executive summary 

Conclusion 

Given the focus on community care in national 

policy, the fi ndings have a number of implications 

for service provision. HASP is an excellent example 

of how government agencies can work together to 

improve the wellbeing of people with psychiatric 

disability. The program demonstrates that given 

adequate support, stable housing and good case 

management, the accommodation needs of people 

with severe psychiatric disability can be met through 

ordinary/normal housing in the community. Indeed, 

those involved in the planning of future resettlement 

programs are encouraged to consider the HASP 

model. However, supported housing models such as 

HASP should not be promoted as a substitute for care 

settings such as Community Care Units (CCUs). A range 

of treatment and housing options should be included 

in a comprehensive service delivery system. 

Assessed on any measure, the fi ndings indicate that 

HASP has been as successful, if not more successful, 

than the majority of the resettlement programs 

reviewed. Community care within HASP appears to 

have an overall economic advantage over hospital 

care and no disadvantage for clients. Those who 

participated in the interviews expressed high levels 

of satisfaction and felt that HASP was instrumental 

in promoting their recovery. 


All of the clients in the evaluation demonstrated 

a strong preference for community living. The freedom 

and choice that community living offers appears to 

compensate for the increased responsibility associated 

with such living. Nonetheless, it is clear that while 

some clients made considerable advances in securing 

a future in the community, others had been less 

successful in taking advantage of the opportunities 

available to them. While service models continue to 

provide support, they must also allow for what Deegan 

(1992) calls the ‘dignity of risk and the right of failure’. 

Thus, the challenge for service providers is to fi nd 

the right balance between the provision of planned 

interventions for clients and ensuring that clients have 

the freedom to be self-determining individuals. Too 

much support may encourage dependency on support 

systems, while too little support may contribute to 

relapse and even homelessness (Cameron, Athurson 

& Worland, 2008).

List of contents 

Executive summary __________________________ II 

Key fi ndings ..........................................................................................II 

Conclusion ........................................................................................... IV 

1 Introduction ____________________________ 1 

1.1 The Housing and Support Program 

(HASP) .........................................................................................2 

1.2 Housing and supports – 

previous research ..............................................................5 

1.3 Current evaluation .........................................................11 

2 Method _______________________________ 13 

2.1 Design ......................................................................................13 

2.2 Participants .........................................................................14 

2.3 Data collection ..................................................................18 

2.4 Procedure ..............................................................................21 

2.5 Data analysis ......................................................................22 

3 The effectiveness of the collaborative 

process established across agencies ______ 24 

3.1 Collaboration between government 

agencies .................................................................................24 

3.2 Governance arrangements established 

to support ongoing development and 

delivery of HASP ..............................................................26 

3.3 Perceptions of agency collaboration — 

Case Manager, support workers and 

Supports Facilitators ...................................................30 

3.4 Section summary ............................................................31 

4 The process of providing clinical, 

non-clinical and housing services 

to clients ______________________________ 32 

4.1 Process of providing clinical services............32 

4.2 Process of providing non-clinical 

support services ..............................................................36 

4.3 Process of providing accommodation ...........42 


5 The opportunities available through 

the program for clients to maximise 

their recovery and participate in 

community life _________________________ 48 

5.1 Client perceptions of HASP and 

how it supports their recovery .............................48 

5.2 Satisfaction with key life domains ...................49 

5.3 Involvement in vocational activities ...............49 

5.4 Involvement in activities...........................................50 

5.5 Number of friends ..........................................................50 

5.6 Satisfaction with the number 

of friends they have ......................................................50 

5.7 Depth of friendships ....................................................51 

5.8 Satisfaction with family 

relationships .......................................................................52 

5.9 Satisfaction with money ...........................................52 

5.10 Lack of money ....................................................................52 

5.11 Community involvement ...........................................53 

5.12 Client goals ..........................................................................54 



V

VI 

List of contents 

6 The ability of the program to maintain 

clinical functioning and provide an 

acceptable quality of life for those 

supported by the program _______________ 56 

6.1 Readmissions to acute inpatient care ...........56 

6.2 Changes in functioning ..............................................56 

6.3 Clients who improved, 

stayed the same, or deteriorated ......................57 

6.4 Perceptions of change in client 

functioning – Case Managers versus 

support workers ...............................................................57 

6.5 Perceptions of future improvement 

in clients – Case Managers versus 

support workers ...............................................................58 

6.6 Changes in Mental Health Act (MHA) 

status ........................................................................................58 

6.7 Physical and mental health ....................................59 

6.8 Overall quality of life ....................................................59 

6.9 Emotional responses experienced...................60 


7 How do costs of providing care under HASP 

compare with alternative care options? ____ 62 

7.1 Costs associated with 

Community Care ...................................... 62 

7.2 Comparing HASP with 

inpatient/residential alternatives ............ 63 

7.3 Cost of care pre and post-HASP ............... 63 

7.4 Section summary ..................................... 63 


8 Discussion ____________________________ 64 

8.1 The effectiveness of the collaborative 

process established across agencies ............64 

8.2 The process of providing clinical, 


to clients .................................................................................65 

8.3 The opportunities available through 

the program for clients to maximise 

their recovery and participate 

in community life.............................................................68 

8.4 The ability of the program to maintain 

clinical functioning and provide 

an acceptable quality of life for those 

supported by the program ......................................69 

8.5 Program costs ....................................................................70 

8.6 Conclusions .........................................................................70 

9 Recommendations ______________________ 71 

10 Reference list __________________________ 73 

Appendix 1 

HASP 2009–2010 Process fl owchart 

with timelines...................................................................................76

Section 1 

Introduction 

Since the 1970s, mental health policy in Australia has promoted the downsizing of 

‘stand-alone’ psychiatric hospitals and the decentralisation of mental health services 

into the broader community. The rationale for these reforms was based on the belief that 

community alternatives would provide a therapeutic and rehabilitation function such 

that individuals would move from higher to lower levels of dependence and eventually, 

to independence (Bachrach, 1989). Underpinning the process was the desire to provide 

a range of community supports that best suited the needs of people leaving hospital 

and also, new consumers with serious mental illness. 

There was an underlying belief that many of the 

services provided in the institution could be better 

provided in the community or in the individual’s own 

home (Bachrach, 1989). The movement towards the 

closure of psychiatric hospitals was driven in part by 

the philosophy of freedom, independence and the 

hope of providing a better quality of life for individuals 

with mental illness in the community (Meehan, 2007). 

Mental health policy in Queensland has also been 

infl uenced by these broader trends in service reform. 

Over the past 20 years, a signifi cant number of 

individuals have been relocated to the community 

under hospital downsizing programs such as 

‘Project 300’ (Meehan et al, 2011). While many of these 

former long-stay clients are now elderly or deceased, 

a new group of individuals with severe disability has 

emerged. This group is made up of young, mostly male 

clients with a diagnosis of schizophrenia, frequently 

complicated by substance misuse (Meehan, 2007; 

Reuland, Schwarzfeld, & Draper, 2009). Many of these 

clients are too disabled or fearful to make and keep 

appointments at mental health centres and are at high 

risk of homelessness and frequent contact with police 

and other community agencies (Fry, O’Riordan, & 

Geanellos, 2002; Commonwealth of Australia, 2006). 

In Queensland, a continuum of housing options has 

emerged to cater for the needs of those with more 

severe problems. These services range from 24-hour 

residential care (in the form of Community Care Units) 

through to independent living options. One of the 

initiatives in this continuum includes ‘supported’ 

housing. Individuals are provided with public housing 

and are supported by visiting workers, typically 

employed through the non-government sector. This 

non-clinical support is aimed at assisting the individual 

to access required services in their local community, 

manage day-to-day living activities and sustain their 

tenancies (O’Malley & Croucher, 2005). 

One of the earliest supported housing models to be 

introduced in Queensland was known as ‘Project 300’. 

The program was established in 1995 with the aim 

of relocating 300 individuals with severe psychiatric 

disability from the three existing psychiatric hospitals. 

In 2006, a similar supported housing initiative, known 

as the Housing and Support Program (HASP), was 

established to support individuals who were unable 

to leave acute and extended treatment mental health 

facilities due to lack of housing and appropriate 

supports. This report focuses on the evaluation of the 

Housing and Support Program. 


1

2 

Section 1 Introduction 

1.1 The Housing and Support Program (HASP) 

The Housing and Support Program (HASP) is an initiative under the Council of Australian Governments’ (COAG) 

National Action Plan on Mental Health 2006–2011. HASP is a cross-departmental initiative involving Queensland 

Health and the Department of Communities which includes both Housing and Homelessness Services and 

Disability and Community Care Services (see Fig. 1.1). 

Fig. 1.1 HASP Service Provision Framework 

Housing and 

Homelessness Services 

(HHS) 

Housing Services 

Stable accommodation 

The Queensland Government Department of 

Communities is responsible for a wide range of human 

services that support people with a disability. The 

services provided include disability and community 

care services, housing and homelessness services, 

translating and interpreting services, sport and 

recreation services, and community and individual 

support services. The overall aim of providing 

a number of services through one department is to 

enable easier access to government services and 

information. Two key services within the Department 

of Communities are involved in supporting HASP clients. 

These are briefl y described below. 

i) Department of Communities — 

Housing and Homelessness Services (HHS) 

The services provided through the former Queensland 

Department of Housing are now provided under the 

Department of Communities through the division of 

Housing and Homelessness Services. Housing and 

Homelessness Services provides accommodation 

for those clients accepted into HASP. Clients referred 

to HASP must be eligible for social housing. HASP 

clients comprise an Interagency Priority Group, 

meaning they are the subject of inter-departmental 

or inter-governmental agreements, or are designated 

by the Queensland Government for priority housing 

assistance. 


HASP Clients 

Queensland 

Health 

(QH) 

Mental Health 

Services 

Clinical Support 

Disability and Community 

Care Services 

(DCCS) 

Program funding and 

support services 

Non-clinical support 

Like other Queensland Government-funded housing 

and support programs, capital funding for social 

housing under HASP enabled HASP clients to be 

designated for priority housing assistance. Once 

allocated to Government or community-managed 

long-term social housing, HASP clients become 

social housing tenants with the same rights and 

responsibilities as other social housing tenants, 

for example by paying 25% of the household’s 

assessable income in rent. 

ii) The Department of Communities — 

Disability and Community Care Services (DCCS) 

DCCS has responsibility for funding, developing and 

implementing, and monitoring all existing and new 

mental health programs delivered through nongovernment 

service providers. 

In addition to the service providers described, 

Queensland Health provides a range of clinical support 

services to HASP clients. The primary role of Case 

Managers within HASP is to provide clinical support 

to the clients enrolled in HASP. Case Managers are 

also responsible for providing support and education 

to families, carers and disability support workers. 

In addition, they are responsible for consultation 

and liaison with primary health care providers with 

a focus on assessment and a collaborative approach 

to individual management.

1.1.1 HASP — Management Structure 

The overall management of HASP is carried out through 

the HASP Management Group which has senior 

representation from HHS, DCCS and QH. The group 

provides strategic leadership and operational direction 

for the program. Below the HASP Management Group 

is the HASP Operational Partnership (HOP) which also 

has representation from all key agencies. The HASP 

Operational Partnership monitors implementation of 

the program and ongoing service provision. Members 

of HOP work collaboratively at a central offi ce level 

to facilitate the delivery of social housing assistance, 

clinical support and non-clinical support to individuals 

accepted into HASP. The HOP Group also actively 

promotes stakeholder collaboration and informationsharing 

at a local level to achieve positive outcomes for 

people who access HASP. Finally, an interdepartmental 

group called the ‘HASP Interagency Panel’ examines 

applications for the program and endorses individuals 

to progress to the assessment and verifi cation phase 

of HASP. This panel has representatives from each of 

the government agencies involved. 

1.1.2 The aim of HASP 

HASP is designed to provide a stable home 

environment in the community and increase the 

potential for individuals with psychiatric disability 

to maximise their inclusion in their chosen community. 

This is achieved through the provision of a coordinated 

framework of social housing and support, tailored to 

each individual’s needs. The suite of services offered 

through HASP refl ects the involvement of the three 

government agencies. Each individual accessing 

HASP is provided with a support ‘package’ of services 

consisting of mental health services, disability support 

services and community housing in keeping with their 

needs. Clinical services are provided by local mental 

health services, while non-clinical support is provided 

by a range of non-government agencies. 

1.1.3 Target Group for HASP 

The target group for HASP includes individuals with 

a psychiatric disability who are current inpatients 

of acute/extended treatment mental health facilities 

and unable to be discharged due to homelessness 

or risk of homelessness. Those living in the community 

and who are homeless or at risk of homelessness 

and frequently require admission to an acute inpatient 

facility can also access HASP. The specifi c eligibility 

criteria established for HASP specify that individuals 

must be: 

over the age of 18 years 

an Australian citizen, or permanent resident 

of Australia 

living in Queensland 

diagnosed with a psychiatric illness 

(resulting in disability) 

currently or repeatedly housed 

in an inpatient care facility 

unable to be discharged due to homelessness 

or risk of homelessness 

does not own a home, rent privately or have a current 

Housing and Homelessness Services home 

has ongoing clinical needs that can be met by 

community mental health services 

requires non-clinical support to live successfully 

in the community 

willing and ready to transition to the community 

with the appropriate level of support 

committed to maintaining stable housing 

able to meet Housing and Homelessness Services 

eligibility criteria 

agreeable to participate in the program 

willing and able to provide informed consent. 


3

4 


1.1.4 Securing HASP Support — The process 

The reader is referred to Appendix I for a schematic 

representation of the process. In brief, Queensland 

Health staff identify and nominate, for the program, 

individuals meeting the selection criteria described 

above. Applications are examined by the ‘HASP 

Interagency Panel’ which endorses applications to 

progress to the assessment and verifi cation phase. 

Disability and Community Care Services (DCCS) then 

verifi es the person’s eligibility for DCCS services and 

their non-clinical support requirements to live in the 

community. DCCS and housing coordinators engage 

with the person to: 

identify where they would like to live (location, 

type of housing, lifestyle needs, hobbies, etc) 

determine the level of ongoing support required 

select a funded non-government service provider 

engage with selected support provider (identify 

support needs, personal goals, develop support 

plans and select support workers) 

determine how they could best participate in the 

review of supports, goals and future plans. 


Housing and Homelessness Services (HHS) assesses 

the person’s housing and tenancy management needs 

and identifi es a suitable property to meet identifi ed 

needs. DCCS allocates funding to the person’s selected 

support agency which engages in the provision of 

support services to the person. All stakeholders work 

together to collaboratively develop and implement 

a plan to transition the individual to the community. 

Throughout the process, the individual is encouraged 

to make informed choices about: 

their preferred location and type of housing 

the NGO providing their support 

their household possessions 

personal goals and lifestyle 

the involvement of informal supporters. 

The actual move from hospital to the community 

is directed by each consumer. Some consumers 

transition slowly and gradually increase the amount 

of time they spend in the community until they are 

living there permanently. Others depart on the agreed 

date and do not return to the hospital again. While 

consumers are encouraged to commence living in 

their new homes as soon as possible, some took up to 

12 months to make the transition. It should be noted 

that in some of the more protracted transitions, issues 

outside the control of the consumer (e.g. Mental Health 

Act status), rather than the inability of the consumer to 

transition, were responsible for the delays.

1.2 Housing and supports – 

previous research 

In Australia, the inclusion of psychiatric disability 

in the Commonwealth Disability Services Act 1986 

brought into focus the distinction between illness 

and disability. It was noted that illness should be 

the domain of clinical interventions, while the 

disability component should become the concern 

of those skilled in the management of disability. 

Whiteford (1994, p.343) argues that no single agency 

should take complete responsibility for the lives 

of people with mental illness (as mental health has 

historically done). Whiteford outlined several reasons 

for this: 

access to social and disability programs available 

to people with other disabilities should be available 

to people with a mental disability. This is in keeping 

with equitable access and non-discrimination in 

service provision; 

mental health professionals can specialise in the 

provision of treatment and rehabilitation rather than 

the provision of services that can be provided more 

effectively or effi ciently by other agencies; 

mainstreaming people with mental illness into 

current social and disability services is likely 

to decrease marginalisation and stigmatisation; 

no single agency (including mental health) would 

have suffi cient resources to meet the broad range of 

services required by people with a mental disability. 

Thus disability support is provided on some 

assumptions about the desirability of moving care 

and treatment away from a focus on clinical concerns 

towards a broader community approach. The 

research evidence supporting greater involvement 

of the disability sector is increasing. Indeed, in 

Australia, funding provided to the non-government 

sector to support people with psychiatric disability 

has increased by 294% or $75 million since 1993 

(Commonwealth Department of Health and Ageing, 

2004). 

1.2.1 Services provided by disability support workers 

Support agencies work in collaboration with mainstream 

mental health services and tend to target people at 

the more severe end of the spectrum. They assist 

people to connect to mainstream social and disability 

services by linking them to community-based recreation 

and vocational services (Walter & Petr, 2006). While 

different models of disability support have developed, 

the interventions provided seem to be common across 

models. Warner and colleagues (1998) collected 

information on the services provided by support staff 

in a number of different support programs in the UK 

and Northern Ireland and found that service provision 

could be categorised into three domains — assisting 

clients ‘within the home’, ‘outside the home’, and 

‘liaising’ on behalf of clients (Warner et al., 1998). 

Services offered within the home were classifi ed 

as being emotional or practical in nature, while those 

provided outside the home were classifi ed as social, 

practical and leisure based (Table 1.2.1). 


5

6 


Table 1.2.1 Summary of the services provided by disability support workers (Warner et al. 1998) 


Support type Content 

Within the home (i) Emotional support Companionship, someone to talk to, watch TV with, 

planning and goal-setting 

(ii) Practical support Household tasks – cooking, cleaning, writing letters, 

claiming benefi ts, paying bills 

Outside the home (i) Social support Having a meal in a cafe or drink in a pub, going for walk 

in a garden or park, going to bingo, going to church, 

assessing local social networks 

(ii) Practical support Using public transport, shopping, visiting GP, 

mental health appointments, etc 

(iii) Leisure activities Taking part in sports – swimming, aerobics, bowling, 

fi shing, going to football games, etc 

Liaison (i) Liaison with agencies Working with statutory agencies, such as housing, 

mental health, disability services, support agency, 

employment 

(ii) Liaison with family Building relationships with family, friends and 

other natural supports 

Other studies (Harrington-Godley et al., 1988; 

Mak & Gow, 1996; Clarkson et al., 1999; Lord & 

Hutchison, 2003) report a similar range of support 

interventions, including assistance with budgeting, 

personal hygiene, building social networks, promoting 

links to family/friends, providing psychological 

support, advocacy and advice. It is also clear that 

support workers provide a sense of psychological 

assurance for people with severe disability – 

they tend to be available at weekends and out of hours 

when health professionals cannot be contacted (Oliver 

et al., 1996). In effect, support services compensate 

for the lack of family networks and other natural 

support systems for those with psychiatric disability 

living in the community (Oliver et al., 1996). Support 

workers are frequently expected to serve as ‘bridges’ 

between the world of professional service providers 

and the world of clients (Wadsworth & Knight, 1996). 

It does appear that the services provided by disability 

staff and clinical staff are on a continuum of service 

provision, rather than being separate or parallel 

services. While there are some activities that are 

clearly the domain of clinical staff and some the 

domain of support staff, there is likely to be some 

overlap in service provision. For example, Case 

Managers and support workers are likely to engage 

in providing emotional support to clients, albeit 

at different levels. 

1.2.2 Outcomes for clients living in independent 

housing with support services 

While governments in Australia and overseas 

are promoting involvement of the non-government 

sector in the provision of support services to people 

with psychiatric disability, there has been limited 

evaluation of the services provided by the NGO sector. 

Notwithstanding this, a small amount of literature 

has emerged from work carried out in North America, 

England and Australia. The table below provides a 

summary of the key fi ndings from these evaluations.

Table 1.2.2 Outcomes for clients moving to supported accommodation — summary of research 

Author 

(Year) Country 

Mak & Gow 

(1996) 

Hong Kong 

Clarkson et al. 

(1999) 

England 

Anthony et al. 

(1999) 

USA 

Prince 

(2006) 

USA 

Morris et al. 

(2005) 

NSW, Aust. 

Deslandes 

& Kilner 

(1997) 

SA, Australia 

Carter 

(2008) 

VIC, Australia 

Meehan et al. 

(2011) 

QLD, Australia 

Sample 

(Follow-up 

period) 

N=64 

32 treatment 

& 32 controls 

(18 months) 

N=37 

(6 months) 

N=21 

(20 months) 

N=315 

(3 months) 

(HASI) 

N=100 

(12 months) 

(Individual 

Tenant Support 

Program) 

N=32 

(24 months) 

(NEAMI) 

N=28 

(12 years) 

(Project 300) 

N=181 

6, 36 & 84 

months 

Details of support 

provided 

One ‘after-care’ 

worker for the 

32 clients in 

treatment group 

35 hours of support 

per client per month 

(only 8 hours in 

direct contact) 

26 hours 

per month 

provided by 

a mixture of 

professional and 

non-professional 

staff 

A range 

of programs – 

hours of contact 

not recorded 

Not stated – 

‘based on client 

needs’ 


‘provided support 

to tenants on 

a fl exible basis’ 

(Up to 21 hours 

per week) 


Support 

‘client-directed’ 

Each client 

received 20 hours 

per week 

(range = 0-86 

hours) 

Findings 

12.5% of treatment vs. 46.1% of control clients 

rehospitalised 

Control clients spent 1640 days longer 

in hospital than clients in treatment group 

No difference in symptoms 

No difference in overall functioning (GAF scores) 

Signifi cant decrease in depression and anxiety 

No changes in client satisfaction with services 

Social contacts decreased over study period 

10 of the 21 clients engaged in communitybased 

employment 

37% reduction in costs in follow-up year 

96.4% of time spent in community versus 

hospital 

Support hours decreased from an average 

of 33.9 to 26.2 per month by year 2 

Support services provided by Case Managers 

Services that enhanced daily structure 

decreased readmission 

Interventions more effective in individuals 

with 4 or more prior hospitalisations 

Support provided by NGOs 

Reduction in the need for inpatient care 

90% decrease in hospital days 

Support provided by NGOs, including service 

users, service providers and community-based 

organisations 

Project used a model of support based 

on Direct Care Workers 

Limited options for community integration 


Program offered shared living arrangement 

where up to three clients shared 

The need for hospitalisation reduced 


Reduction in hospital admissions 

Cheaper than other alternatives 

No change in symptoms and functioning 

Reduction in need for support over time 


7

8 


While there appears to be some consensus on the 

interventions to be provided by the non-government 

support sector, there are clear differences in the way 

in which these components are delivered. This makes 

it diffi cult to compare the outcomes of the different 

approaches described. As outlined, the intensity 

of support provided (i.e. hours of support) and the 

professional backgrounds of those providing the 

support vary among the studies. For example, 

clients in the study by Clarkson et al. (1999) received 

an average of 35 hours per month, while those in the 

study by Mak & Gow (1996) had only one worker for 

32 clients. It is also clear that the clients in the various 

studies differed in important ways. While some of the 

studies involved ‘new’ long-stay clients, others involved 

clients leaving psychiatric hospitals after many years of 

hospitalisation (e.g. Project 300). 

In many of the studies reviewed, support staff were 

employed directly by mental health services rather than 

separate support agencies. For example, in three of 

the studies (Oliver et al., 1996; Clarkson et al., 1999; 

Anthony et al., 1999), support services were provided 

via specially designated rehabilitation teams, led by 

professionally trained rehabilitation workers. This 

raises questions about the independence of the 

support agencies involved and their ability to provide 

a range of ‘alternate’ services based on their 

assessment of client needs. While it is acknowledged 

that all the agencies involved in the treatment of 

the client must cooperate, there needs to be some 

independence in decision-making around the services 

that agencies provide. 

Most of the studies relied on a single outcome measure 

– most employed the number of rehospitalisations over 

the study period. Those studies that did evaluate other 

domains, such as symptoms and clinical functioning, 

found that these components were unlikely to change 

despite an increase in service intensity. While there 

was a trend for general functioning (ADLs, self-care, 

work) to improve (Warner et al., 1998), the extent 

of this improvement in most of the studies reviewed 

did not reach signifi cance. Indeed, social networks 

tended to decline following the introduction of support 

workers; in that support staff replaced the role of family 

and friends. 


Overall, there appears to be general agreement that 

the provision of disability support can be a useful 

adjunct to current treatment options, such as case 

management (Mak & Gow, 1996; Clarkson et al., 1999; 

Lord & Hutchison, 2003). However, a major limitation 

of the literature has been the lack of clarity regarding 

the active ingredients of disability support that lead 

to a reduction in admissions and improvements in 

general functioning and the quantity of support 

to be provided to maximise outcomes. For example, 

Prince (2006) demonstrated that support services 

that enhanced daily structure, service continuity, 

and provided symptom education, reduced the 

chances of readmission by 50%. However, most of 

these support services were provided by professionally 

trained workers who held tertiary qualifi cations in 

mental health (e.g. mental health nurses). 

1.2.3 Australian Studies — Overview 

The number of supported housing models in Australia 

has steadily increased over the past 10 years. While 

many of these have not been subjected to evaluation, 

a small number have and the main fi ndings from these 

are described below. 

The Housing and Support Initiative — (NSW) 

The Housing and Support Initiative (HASI) 

(Morris et al., 2005) is a jointly funded program 

provided by the Department of Health and Department 

of Housing in New South Wales. The program was 

designed to assist people with mental illness acquire 

accommodation, to maintain the tenancy of that 

accommodation, and to improve their quality of life. 

A primary objective of the program was to reduce the 

need for hospital admission. The program provides 

support in three areas — housing, disability support 

and clinical stability. 

Housing was provided by a combination of community 

housing agencies and the Department of Housing. 

A range of housing options were available, including 

units, townhouses and detached houses in the 

community. Properties were either leased or owned 

by the housing providers through a landlord system. 

Disability support was provided by a range of NGOs, 

and focused on domestic, emotional, vocational, 

advocacy and living skills. Community integration 

was a major focus of the support provided. Some 

of the agencies linked clients into community-based

activities, while others tried to connect clients to 

existing disability support groups in their communities. 

The intensity of support provided to each client 

remains unclear as it was based on client needs and 

the willingness of the individual to accept support. 

Stage one provided support to 100 people with 

complex mental health problems and high levels 

of disability. The majority had schizophrenia (71.9%) 

and almost all (86.4%) had been hospitalised prior 

to entering the program. One in 10 had been living 

in unsatisfactory accommodation, including boarding 

houses, crisis accommodation, tents, or squatting. 

The most signifi cant outcome was the reduction in the 

need for acute inpatient care. Prior to joining the HASI 

program, clients had a total of 12,486 days in hospital. 

This is compared with 1,461 days (or a 90% decrease) 

in the 12 months following the program (Morris et 

al., 2005). Cost-effectiveness analysis indicates that 

the cost per person was estimated for start-up at 

$110,337.88 and a recurrent annual cost of $57,530. 

This does not include a number of cost factors, such 

as the recurrent program management costs by the 

NSW Health Department, the cost to HASI participant, 

family and other services providers (such as GPs), 

or foregone costs because resources (such as 

management and housing stock) were spent on 

HASI rather than elsewhere. 

‘Project 300’ – (Queensland) 

‘Project 300’ was established in Queensland in 1995 

with the aim of relocating 300 long-stay clients who 

were resident in the three psychiatric hospitals in that 

state back to their community of origin or choice. 

An independent evaluation of the initiative found 

that the Project 300 ‘model’ was able to maintain 

a group of formerly institutionalised people in their 

chosen community. Days spent in the community 

remained high and most people were engaged in 

some form of structured activity outside the home. 

The cost of keeping individuals in the community 

was about one-third that of keeping the same 

individual in hospital (Meehan et al., 2011). 

Follow-up at seven years post-discharge to the 

community found that while the majority of people in 

the study remained unemployed, many were involved 

in community activities. While some individuals had 

made signifi cant progress, there was no evidence of 

systematic gains in general functioning for the group 

as a whole. The evidence of successful community 

tenure, notwithstanding in many cases, a history of 

unsuccessful discharge prior to the introduction of 

Project 300, suggests that the support worker role 

actively contributed to successful community tenure. 

Indeed, follow-up found that 40% of those discharged 

had not required admission to inpatient care in the 

seven years since entering the program. This is a 

remarkable fi nding given that almost all of the clients 

in the program had been in hospital for the two years 

prior to entering the program. 

Individual Tenant Support Program – 

(South Australia) 

The Individual Tenant Support Scheme in South 

Australia was established in the inner-south region 

of Adelaide and was designed for people with 

long-term mental illness at risk of relapse through 

an accommodation/support crisis. The scheme, which 

was in place from November 1994 to November 1996, 

was designed to provide support to tenants on a 

fl exible basis. This was achieved through a partnership 

arrangement between service users, service providers 

and community-based organisations (Deslandes & 

Kilner, 1997). The project had the unexpected diffi culty 

of being able to recruit the minimum target of 15 tenants 

at any one time. The reason for the low referral rate is 

unclear, but could have been a consequence of inbuilt 

prejudices, which made it very diffi cult to create good 

working relationships across the different sectors 

(Deslandes & Kilner, 1997). The project used a model 

of support based on Direct Care Workers (DCWs), with 

each individual receiving up to 21 hours of support per 

week. The fi nal report was critical of some DCWs being 

more enabling than others and this may have restricted 

the manner in which DCWs interacted with tenants and, 

therefore, limited options for community integration. 

The report was generally descriptive and very little 

information was available on the background of these 

workers, other than that they were non-professionally 

trained staff employed for a minimum of four hours per 

week and received training and orientation. 


9

10 


The NEAMI Community Housing Program 

— (Victoria) 

This program offered shared living arrangements 

where up to three clients shared accommodation. 

Because the number of potential tenants was more 

than expected, clients had little choice about the 

individuals with whom they would share. Many 

households experienced diffi culties with sharing. 

Support workers invested signifi cant time in mediating 

disputes between tenants, and a number of clients 

relocated to other properties managed by NEAMI. 

Over time, NEAMI moved towards a policy of having 

no more than two tenants per property, adopting 

this position formally in 2002. 

Clinical staff from the psychiatric hospitals from 

which clients were discharged were nominated to 

‘follow’ the 30 clients, forming a community-based 

Mobile Support and Treatment Service. Funding for 

psychiatric disability support through NEAMI came 

from the mental health budget for clinical services. 

The decision by mental health to use its clinical 

services budget in this way was criticised by clinical 

staff, and consequently, the NEAMI Community 

Housing Program was established in an environment 

of industrial unrest. 

An evaluation commissioned by NEAMI in 1996 found 

that, of the 28 clients (19 men and nine women) 

discharged from the mental health service in 1995, 

all but one remained with NEAMI. Several clients 

had had brief hospital admissions after joining the 

program. NEAMI staff attributed the low number of 

readmissions to the responsiveness of clinical support 

available to clients (Cox, 1996). 

The NEAMI Community Housing Program has been 

effective in enabling a cohort of people with ongoing 

disability associated with mental illness to sustain 

tenancies and live in the community over a period 

of 12 years (Carter, 2008). In a recent follow-up study, 

Carter (2008) found that the fl exibility and duration 

of support provided by NEAMI was critical to the 

program’s success. 


NEAMI provides support that changes in response to 

clients’ changing needs, and continues for as long as 

is needed. Support is directed by priorities identifi ed 

by the client, enabling them to create their own 

recovery in their own way (Carter, 2008). Clients have 

access to support from familiar and responsive clinical 

services when they need it. 

1.2.4 Consumer perceptions of the services 

provided by support workers 

All of the studies reviewed suggest that consumers see 

non-professionally trained support workers as being 

more attuned to their everyday needs (Shepherd et al., 

1994; Warner et al., 1998; Onyett & Smith, 2001) and 

to be credible helpers with whom they can develop 

easy rapport (Beeforth et al., 1994; Meek, 1998). Many 

consumers see support workers as paid friends that 

provide a degree of social support (Harrington-Godley, 

1988; Meek, 1998). This in itself is an important factor 

since lack of social support has been found to be 

associated with rehospitalisation (Mak & Gow, 1996; 

Clarkson et al., 1999) and increased contact with the 

criminal justice system (Caton et al., 1993). 

1.2.5 Mental health staff perceptions 

of support worker involvement 

There is a paucity of research in this area. Two early 

studies from the UK suggested that mental health 

professionals were unhappy with the introduction 

of support workers and felt that they could potentially 

devalue professional roles and status (George, 1997; 

Murray et al., 1997). Although support agencies 

may provide services which cost less (Mak & Gow, 

1996), there was a perception that this may deprive 

vulnerable individuals of skilled interventions 

previously delivered by a regulated and professional 

workforce (Murray et al, 1997; Meek, 1998). However, 

Murray and colleagues (1997) concluded from a review 

of support services in the UK that greater involvement 

of non-professionally trained staff in service delivery 

would not necessarily sacrifi ce the effectiveness 

of care and that there would be clear advantages 

in terms of cost.

1.2.6 Section summary 

It is clear from the literature reviewed above that 

people with psychiatric disability require intensive, 

fl exible support over long periods of time. As noted 

by Perkins and Repper (2001, p.103), this support 

frequently involves ‘complex packages of care 

that focus on minimising symptoms, preventing 

relapse, optimising functioning in normal social 

roles, preventing admission to hospital, increasing 

skills and access to activities and relationships in 

the community’. A number of commentators (Oliver 

et al., 1996; George, 1997; Clarkson et al., 1999) 

suggest that many of these support functions could 

be met by the non-government sector using nonprofessionally 

trained disability support workers. The 

role of support workers is continually developing and 

includes elements of supervision, skill development, 

and community integration, while encouraging hope 

and self-determination in the client. Support workers 

assist clients to live in the community and ensure that 

treatment outside hospital does not lead to increased 

risk for the client or the community. However, while 

clients value the services provided by support workers, 

mental health staff have mixed feelings about the 

introduction of a group than can provide services 

at a lower cost. 

Although disability support services are becoming 

an established part of mental health service provision 

in Australia and overseas, there is limited empirical 

evidence for the effectiveness of these services. 

An extensive review of the ‘support’ literature revealed 

a handful of studies that included some appraisal 

of disability support. The only consistent fi nding in all 

of the studies reviewed relates to rehospitalisation. 

Those clients in receipt of disability support services 

tend to have fewer readmissions to hospital and 

fewer days in inpatient care once admission becomes 

necessary. Australian research has produced similar 

fi ndings. Morris and colleagues (2005), in a NSW 

study, found there was a 90% reduction in hospital 

bed days following the introduction of the support 

program. Meehan and colleagues (2011) found that 

40% of clients who could not be discharged prior 

to the introduction of the Project 300 Program in 

Queensland had not required admission to hospital 

in the seven years since entering the program. 

1.3 Current evaluation 

In mid-2008, a submission from the Service Evaluation 

& Research Unit located at the Park, Centre for 

Mental Health, in collaboration with the University 

of Queensland, was successful in securing funding 

for the evaluation of HASP. The evaluation protocol 

was developed to include a comprehensive package 

of assessments to be undertaken with the clients and 

the agencies involved in the program. The protocol 

involved the collection of data from both clients and 

staff and included structured and semi-structured 

interviews, focus group interviews and self-completed 

questionnaires. While the Department of Communities 

— Housing and Homelessness Services (HHS) was 

the lead agency for the evaluation, all three agencies 

(Housing and Homelessness Services, Queensland 

Health, and Disability and Community Care Services) 

were represented through the Evaluation Steering 

Committee. 

While the evaluation team worked closely with the 

different government departments involved, 

it maintained its independent status and did not 

become unduly involved in the planning and decisionmaking 

processes. The focus of the evaluation team, 

therefore, remained the systematic evaluation of the 

resettlement process on the welfare of individual 

clients, rather than its impact on the service system 

as a whole. During the course of the evaluation, 

feedback was provided to the Evaluation Steering 

Committee, primarily through the dissemination 

of fi ndings in the form of progress reports, and 

presentations targeted for policy-makers, service 

providers and care staff. 

1.3.1 Scope of evaluation 

The purpose of the evaluation was outlined in the 

Invitation to Offer Document (HPS001/09) which 

stated that the contractor will: 

‘Undertake an evaluation of the Housing and 

Support Program to determine delivery and outcome 

effectiveness and effi ciencies, as well as to identify and 

recommend opportunities for the future management 

of the Program.’ 


11

12 


More specifi cally, the evaluation team was asked 

to focus on the following objectives: 

the effectiveness of the collaborative process 

established across agencies 

the process of providing clinical, non-clinical 

and housing services to clients 

the opportunities available through the program 

for clients to maximise their recovery and participate 

in community life — the focus here will be on social, 

recreational, educational, and vocational activities 


the ability of the program to maintain clinical 

functioning and provide an acceptable quality 

of life for those supported by the program. 

Key evaluation questions related to the above outcome 

objectives were also outlined in the Invitation to Offer 

Document. These included: 

1. Was an effective collaborative process established 

across agencies? 

2. Have effective governance arrangements been 

established to support ongoing development 

and delivery of HASP? 

3. To what extent has the program been effective 

in delivering timely and coordinated clinical, 

non-clinical and housing services to clients? 

4. Has HASP enhanced access to specialist and 

generalist support services, including housing, 

mental health, disability and other human services 

through processes of partnership and planning? 

5. What are the costs and benefi ts of providing 

coordinated clinical and non-clinical support 

and appropriate housing to clients through HASP, 

compared with traditional forms of assistance? 


6. What proportion of clients reported that 

participation in HASP has supported their recovery 

or that it will provide a basis for future recovery? 

7. Does HASP enhance the quality-of-life 

outcomes for clients? 

8. What proportion of HASP clients experienced 

improved functioning? 

9. Has there been a reduction in hospital admissions/ 

presentations/duration of stay for clients of HASP? 

10. What proportion of HASP clients had sustained 

tenancies? Over what period? 

11. Where tenancies have ended have these been 

planned exits? What arrangements have been 

made for clients exiting HASP? 

12. What proportion of HASP clients of working age 

had an increase in participation in employment? 

13. Was there an increase in participation rates 

by HASP clients aged 18–30 in education 

and employment? 

14. Has there been a positive impact in the 

client’s community — with friends, community 

acceptance,participation in meaningful activities 

and reduction in stigma? 

1.3.2 Ethical considerations 

Ethical clearance for this evaluation was obtained from 

the relevant Human Research Ethics Committee in each 

Queensland Health Service District. Every consumer 

participating in the evaluation was given a written 

explanation of the purpose of the evaluation and its 

focus on their experiences and views. All participants 

signed a form registering their consent to participate. 

In keeping with National Health & Medical Research 

Centre (NH&MRC) guidelines, no names or other 

identifying personal details of any participant will 

be reported in the presentation of fi ndings.

Section 2 

Method 

2.1 Design 

The study employed a multi-site, multi-method 

approach. Follow-up evaluation data were collected 

over a four-month period between March and June 

2010. The fi rst clients entered HASP in 2006 and as 

a consequence, some of the clients followed up had 

been in HASP for close to four years, while others 

(e.g. those who entered HASP in early-2010) had been 

in the program for only two to three months 

(see Table 2.1 below). 

Quantitative and qualitative data were collected from 

consumers and the staff of the government agencies 

involved (QH, HHS, and DCCS) and the NGO support 

agencies. The overall approach was designed to 

address the evaluation questions outlined previously. 

As such, data collection focused on perceptions 

of HASP, inter-agency communication and working 

relations, and the outcomes for consumers. 

Fig. 2.1 Overview of evaluation components 

Consumers 

Domains assessed: 

1. Perceptions of HASP 

2. Perceptions of 

Housing 

3. Perceptions 

of Supports 

4. Quality of Life 

5. Functioning and 

Symptom data 

derived from CIMHA 

Evaluation of the Housing and Support Program (HASP) 

Mental Health 



2. Interactions with 



Housing services 

While some data were collected as a ‘one-off’, data 

concerning consumer functioning were downloaded 

from the Consumer Integrated Mental Health 

Application (‘CIMHA’), a computerised information 

system maintained by Queensland Health. This 

application enabled the evaluation team to assess 

changes in consumer functioning pre and post-entry 

into HASP. 

By assessing measures on individuals at different 

stages of the program, the clients acted as their own 

controls. Finally, data concerning the number 

of support hours allocated to each individual on entry 

into HASP and at the follow-up assessment were 

also collected to provide an estimate of the cost of 

supporting individuals through HASP. This provided 

a means of comparing HASP with alternate inpatient 

and residential rehabilitation programs. An overview 

of the evaluation components is provided in Fig. 2.1. 

Disability Services 




Mental Health 

3. Provision of 






MH services 




13

14 

Section 2 Method 

2.2 Participants 

As noted, data were collected from a range of key 

individuals and groups associated with HASP. The 

clients involved in HASP formed the cohort of primary 

interest. Other key groups included clinical staff, 

support workers/staff, Supports Facilitators and 

housing providers. An overview of each sample is 

provided below. 

2.2.1 Client sample 

HASP commenced as a ‘pilot’ program in 2006 with 

80 places being made available over the 2006–2007 

fi nancial year. All individuals entering HASP in the 

2006–2007 year had existing recurrent funding 

arrangements in place either through Disability 

Services or Queensland Health. Their accommodation 

needs were met by the former Department of Housing 

(now known as Housing and Homelessness Services). 

Since HASP commenced in 2006, 194 places have 

been funded through the program (Table 2.1). 

However, since 10 new clients were selected to fi ll 

the vacancies created by those who left the program, 

a total of 204 clients have been offered HASP 

packages over the four years (2006–2010). 

Table 2.2 Clients enrolled in the study 

Total clients 

funded through 

HASP (n=204) 


Clients unavailable 

to the evaluation 

204 26 withdrawn from program 

14 in transition – not living in 

community 

6 deceased 

1 in High Secure Unit 

1 in Medium Secure Unit 

1 in CCU 

1 in nursing home 

1 in hospital (physical health) 

Clients available but unwilling/ 

unable to participate 

45 refused to participate 

19 too unwell to participate 

7 have intellectual/cognitive 

problems – unable to 

participate 

2 living in remote location 

51 Unavailable 73 Unable/unwilling 

to participate 

Of these, 153 were living in the community at the time 

of the evaluation (March–July 2010) and 80 of these 

were enrolled in the study (Table 2.1). 

Table 2.1 Funded places and clients living 


Year Number 

of HASP 

places 

HASP 

clients 

living in the 

community 

at time of 

evaluation 

Clients enrolled 

in the evaluation 

204 204 – 51 = 153 153 – 73 = 80 80 

Clients 

enrolled 

in the 

evaluation 

2006–2007 80 64 26 (40.6%) 

2007–2008 40 33 18 (54.5%) 

2008–2009 40 34 21 (61.8%) 

2009–2010 34 22 15 (68.2%) 

Total 194 153 80 (51.6%) 

Of the 153 clients available for inclusion in the 

evaluation, 73 of these were unable or unwilling 

to be involved in the evaluation. The reasons for this 

are summarised in the table below. 

80

2.2.1.2 Clients unavailable to participate 

As noted above, 51 of the 204 clients (25.0%) who 

entered HASP were unavailable to the evaluation. 

The reasons for this are discussed below. 

(i) Clients who have left HASP 

Twenty-six of the 204 clients allocated a HASP place 

were subsequently withdrawn from the program. Of 

these, 13 failed to transition/move to the community 

and three moved into private accommodation after 

joining the HASP. Two moved interstate and three 

others were unable to adapt to life in the community 

and returned to 24-hour care. Two breached their 

forensic orders and one was withdrawn due to 

poor physical health. Finally, two refused to accept 

support services despite having an obvious need 

for such services. 

(ii) Clients in transition 

Clients who were spending less than four nights per 

week in the community at the time of follow-up were 

considered to be ‘in transition’ and not included 

in the study (as they were spending more time in 

hospital than in the community). Using this criterion, 

14 clients (6.8%) were treated as being in transition 

to the community. There was wide variation in the 

duration of time spent in transition. One client has 

been in transition for over three years and two others 

have been in transition for over 12 months (due to 

complications with forensic orders). The remainder 

have been in transition for less than 12 months. The 

average time in transition was 163 days (i.e. the time 

between allocation of a house by HHS and the date 

of discharge to the community). 

(iii) Clients deceased 

Six of the 204 clients (2.9%) were deceased by 

the time of evaluation. Two died by suicide and two 

others died from cardiac-related conditions. One client 

died from a physical health problem and the cause 

of death for the remaining client is currently being 

investigated. 

(iv) Clients in other healthcare facilities 

Five of the clients had been admitted to a range 

of other facilities by the time the evaluation team 

conducted the follow-up assessment. While one 

had committed an offence requiring admission to 

a High Secure Unit, none were in prison (or had been 

in prison since discharge). One was in hospital for 

physical health problems and one had been admitted 

to a nursing home. 

2.2.1.3 Clients available to participate but unable/ 

unwilling to participate 

Of the 153 clients eligible to participate in the 

evaluation, 73 of these were unable or unwilling to 

participate. The reasons for this are discussed below. 

(i) Clients who refused to participate 

Of the 153 remaining clients, 45 (29.4%) refused 

to participate in the evaluation. This is a relatively 

large proportion of the cohort. The reasons for nonparticipation 

are speculative. The evaluation team 

gained access to clients through their support agency 

– in keeping with ethical considerations. While the 

majority of support agencies were willing to assist 

in recruiting clients, some were less motivated to 

promote the evaluation to their clients. 

(ii) Clients who were too unwell to participate 

Nineteen clients (n=19) were too unwell to participate. 

Seven of these were receiving care in acute inpatient 

units at the time of data collection. In addition, 12 

clients were considered by their support agency/Case 

Manager to be too unwell to complete the interview/ 

questionnaire and these were not approached to 

be involved. 

(iii) Clients unable to complete questionnaire 

The support agencies for seven of the clients felt 

that these clients would be unable to complete the 

questionnaire or participate in an interview. The 

evaluation team accepted this advice and these clients 

were not invited to participate. 

(iv) Clients in remote areas 

Two clients were living in remote locations in north 

Queensland and these proved too diffi cult to reach. 


15

16 


2.2.1.4 Demographic profi le of clients enrolled 

in the evaluation 

While 204 clients accessed HASP, data were available 

for 80 of these. The majority of the 80 clients enrolled 

in the evaluation were male (76%) and 72% (n=58) 

had completed year 10 or higher. While two clients 

(2.5%) had obtained a TAFE certifi cate, none of the 

80 clients had attended university. 

Table 2.3 Profi le of clients in study (n=80) 


The majority had a diagnosis of schizophrenia 

(89%) and 61 (78.2%) were single/never married. 

The majority were born in Australia (90%) and 

eight of the 80 clients (10%) were Indigenous 

(see Table 2.3 below). 

Characteristic Clients enrolled in evaluation (n=80) 

Gender Male 61 (76.2%) 

Female 19 (23.7%) 

Education Did not complete year 10 22 (27.5%) 

Year 10 and higher 58 (72.5%) 

Marital status Single/Never Married 63 (78.7%) 

In a committed relationship 9 (11.2%) 

Separated/Divorced 7 (8.7%) 

Spouse deceased 1 (1.2%) 

Country of birth Australia 70 (87.5%) 

Other 10 (12.5%) 

Background Aboriginal or Torres Strait Islander 8 (10.0%) 

Other 72 (90.0%) 

Diagnosis Schizophrenia 71 (88.7%) 

Other 9 (11.3%)

2.2.1.5 Clinical staff — sample 

Forty (n=40) of the Case Managers who provided 

services to HASP clients completed the Case Manager 

Questionnaire. Attempts were made to ensure that 

Case Managers were drawn from rural and remote 

locations and in proportion to the number of HASP 

clients in each location. It should be noted that while 

the fi nal sample represents approximately 50% of 

Case Managers providing services to HASP clients 

(some Case Managers provide services for up to 

three HASP clients), participants were not randomly 

selected. As such, generalisation of fi ndings to the 

broader Case Manager group requires a degree 

of caution. 

Approximately half of the respondents were from the 

greater Brisbane area, with signifi cant representation 

also from the Gold Coast, Townsville and Cairns. 

Approximately 61% were female and 23.7% were 

between 31–40 years. The average length of time that 

Case Managers had been working in mental health 

was 12 years and they had been involved with HASP 

clients for an average of 2.4 years. Approximately half 

(52.6%) were nurses and 21.1% were occupational 

therapists. Social workers and psychologists made up 

the remainder of the sample. 

2.2.2 Support services – sample 

Fifty-eight (n=58) support workers completed the 

support worker Questionnaire. It should be noted 

that while the fi nal sample represents approximately 

35% of the total number of support workers providing 

services to HASP clients (some support workers 

provide services for up to three HASP clients), 

the fi nal sample was not randomly selected. Again, 

generalisation of fi ndings to the broader support 

worker group should be carried out with a degree 

of caution. 

Approximately 60% of those who completed the 

questionnaire were female and approximately half 

(53.4%) were between 30 to 50 years (24% were below 

30 years and 22.6% were above 50 years). More than 

half (56.1%) had worked as a support worker for one 

to three years (26.3% worked less than a year and 

17.6% worked more than three years). Almost 63% had 

prior experience working with people who had mental 

illness prior to joining their present support agency. 

This experience was gained from previous employment 

in aged care, as youth workers, and in communitybased 

mental health support centres. Others had 

experienced mental illness themselves or had 

a sibling or family member with mental illness. 

Approximately 78% had some form of qualifi cation 

for their role as a support worker. The most common 

qualifi cation was Cert III or Cert IV in Mental Health 

(non-clinical) offered through TAFE or a similar training 

facility. Others had completed or were completing 

courses in social work, psychology, mental health 

nursing or training in mental health fi rst-aid. The modal 

number of clients supported by each support worker 

was two and the average hours spent with all their 

HASP clients was 11.9 hours. The average hours spent 

with all their mental health clients (including HASP 

clients) was 29.35 hours. 

2.2.3 Supports Facilitators 

Nineteen (n=19) Supports Facilitators participated 

in interviews and 10 of these completed the Supports 

Facilitator Questionnaire. Nine of the 10 were female 

and 60% were 31–50-years-old. Each facilitator 

supported an average of 8.5 clients and the average 

time spent with each HASP client per week was 

3.3 hours. 

2.2.4 Housing and Homelessness Services — sample 

Twenty-six (n=26) HHS staff from 14 Housing Service 

Centres across Queensland participated in either 

individual or group interviews. These interviews 

enabled staff to describe, in their own words, how they 

perceived their role in the program. The interviews 

enabled them to discuss their relationship with the 

other agencies, concerns with the process of providing 

housing under HASP, and suggestions for future 

initiatives such as HASP. 


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18 


2.3 Data collection 

As outlined, data were collected from a number of key 

agencies involved with the program. These included: 

(i) clients who entered the program since 2006, 

(ii) support staff who provide non-clinical support 

to these clients, 

(iii) clinical staff who provide case management 

services, and 

(iv) staff from Housing and Homelessness Services 

who provide accommodation. 

1) Data collected directly from consumers: 

a. Consumers completed a modifi ed version of 

the Wisconsin Quality of Life Index (Becker et al., 

1993). This measure was developed in the USA 

to assess quality of life in individuals with severe 

mental illness. A number of domains that contribute 

to quality of life are assessed. These include 

ratings of mental and physical functioning, work 

and vocational outcomes, contact with family and 

friends, community activities and overall quality of 

life. In addition to this information, the evaluation 

team added a number of domains concerning 

consumer perception of the interventions delivered 

by mental health and disability support services. 

The scale was completed by the consumer in the 

presence of the research assistant or through 

an interview with the research assistant for 

those participants who had diffi culty reading/ 

understanding the questionnaire. 

b. In addition to this scale data, in-depth interviews 

were conducted with 15 consumers. These 

interviews were designed to gain consumer insights 

into how they perceived their recovery and the 

components of HASP that helped in this recovery. 

These interviews enabled participants to describe, 

in their own words, the factors (housing, clinical 

support, non-clinical support, etc) that they believe 

were important in their recovery. 


2) Data collected from support services 

a. Data on the level of support provided (i.e. hours of 

support/week) was sought from support agencies 

for two time-points; at the time the consumer 

entered HASP and at the time the consumer was 

interviewed. Information concerning the ‘actual’ 

hours provided, rather than the hours funded, 

was collected and used in the evaluation. 

(There may be some variation between the 

hours provided and the hours funded as support 

agencies can increase or decrease levels of 

support to meet client needs). 

b. Support workers were asked to complete a scale 

designed by the evaluation team to assess the 

support worker role, support worker involvement 

in treatment decisions, and general comments 

on the program. Fifty-eight (n=58) support 

workers from across the state returned completed 

questionnaires. 

c. In addition to the above data, in-depth interviews 

were conducted with a sub-sample of 11 support 

workers to gain insights into the issues confronting 

support workers caring for people with psychiatric 

disability. These interviews explored how support 

workers perceived their role, their preparation and 

training for the role, their relationship with 

other service providers, such as Case Managers, 

the day-to-day challenges of providing care, how 

decisions are made concerning the activities 

carried out with/for clients, and what, if anything, 

is required to improve their contribution to the 

recovery of the clients in HASP. 

3) Data collected from Supports Facilitators 

a. In-depth interviews were conducted with 

19 Supports Facilitators to gain insights 

into the issues confronting this group. These 

interviews explored how Supports Facilitators 

perceive their role, how decisions are made about 

their work, their relationship with other players, 

such as support agencies and Queensland Health 

staff, the day-to-day challenges, and what, if 

anything, is required to improve their contribution 

to the Housing and Support Program. In addition, 

10 Supports Facilitators completed the Supports 

Facilitator Questionnaire.

4) Data collected from mental health services 

a. Case Managers involved with HASP were 

also identifi ed and asked to complete a brief 

questionnaire to assess their perceptions of the 

program, current concerns, and future concerns 

for the program. Forty (n=40) completed 

questionnaires were returned for inclusion 

in the evaluation. 

b. In-depth interviews were also conducted with 

31 clinical staff employed in community and 

inpatient services (such as Community Care Units). 

The interviews were designed to gain insights 

into the issues confronting clinical staff employed 

in these positions. The interviews explored how 

clinical staff perceived their role, how decisions 

were made about their work, their relationship 

with other players such as support agencies 

and housing staff, the day-to-day challenges, 

and what, if anything, was required to improve 

their contribution to HASP. 

c. In-depth interviews were also conducted with 

10 Service Integration Coordinators (SIC). 

The interviews were designed to gain insights 

into the issues confronting staff employed in 

these positions. The interviews explored how 

SICs perceived their role, how decisions were 

made about their work, their relationship with 

other players such as support agencies and 

housing staff, the day-to-day challenges, and 

what, if anything, was required to improve their 

contribution to HASP. 

5) Data relating to accommodation 

a. An assessment of the living environment for each 

participant was also carried out. An Environmental 

Assessment Scale used in the evaluation of 

Project 300 was employed to assess individual 

satisfaction with accommodation. The scale 

covers a number of domains, such as comfort, 

safety, proximity to transport and shops, building 

security, privacy, available space, etc. 

b. Feedback about access to and allocation 

of accommodation and living environments 

for HASP clients was also obtained through 

in-depth interviews and focus group discussions 

with Housing and Homelessness Services staff in 

Service Centres offi ces across Queensland. Twentysix 

(n=26) staff from 14 Housing Service Centres 

across the state participated in these interviews. 

6) Data relating to costs 

a. The total number of support hours provided on 

a weekly basis to each individual was collected 

to estimate the cost of maintaining clients in the 

community. In addition to support costs, the 

costs for case management/GP services and 

accommodation were estimated and included 

in the model to provide an estimated annual cost 

for maintaining individuals in the community 

under HASP. 

7) Data relating to consumer outcomes – CIMHA Data 

a. The collection of routine outcomes data is now 

mandated for all publicly funded mental health 

consumers in Queensland. Three measures — 

The Life Skills Profi le (LSP), the Health of the Nation 

Outcome Scales (HoNOS), and the Mental Health 

Index (MHI) — are collected by the consumer’s Case 

Manager at admission and discharge from mental 

health services and every 91 days for continuing 

care clients. This information is entered into the 

Consumer Integrated Mental Health Application 

(‘CIMHA’), a database maintained by Queensland 

Health. Of the 80 clients consenting to be involved 

in the evaluation, 77 provided consent for their 

CIMHA data to be used for the purpose of the 

evaluation. Clients were not asked a reason for 

refusing access to their CIMHA data, but two of the 

clients outlined that they would be embarrassed 

if people could see how unwell they had been 

in the past. 


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20 


To summarise, a large quantity of both qualitative and quantitative data was collected from consumers 

and the service providers that support these consumers. An overview of the data collected is provided 

in the table below. 

Table 2.4 Overview of data collected 


Target Group Data collected 

Consumers 80 Clients completed Wisconsin Quality-of-Life Scale in the presence 

of a Research Assistant (RA). 

Department of Communities – 

Funded NGOs 


Disability and Community 

Care Services 


Funded NGOs 

12 Clients participated in face-to-face interviews with RA 

Data relating to support hours collected from Support Agencies 

Data relating to client functioning (n=77) downloaded from CIMHA 

(3 clients refused access to their CIMHA data) 

58 Support workers completed support worker Questionnaire 

11 Support workers participated in face-to-face interviews 

19 Supports Facilitators in 12 DCCS Offi ces participated in interviews 

10 Supports Facilitators completed the Supports Facilitator Questionnaire 

19 Supports Facilitators in 12 DCCS Offi ces participated in interviews 

10 Supports Facilitators completed the Supports Facilitator Questionnaire 

Queensland Health 40 Case Managers completed Case Manager Questionnaire 

Department of Communities — 

Housing and Homelessness 

Services 

31 QH clinical staff participated in face-to-face interviews 

10 Service Integration Coordinators participated in interviews 

26 HHS staff in 14 Housing Service Centres across Queensland 

participated in interviews

2.4 Procedure 

2.4.1 Clients – procedure for data collection 

Initial contact with clients was through their support agency. All HASP clients were approached by support staff 

and invited to participate in the evaluation. Clients were informed about the evaluation and provided with details 

of what their involvement would entail. Those interested in being involved completed a ‘consent to be contacted’ 

form and this was then mailed to the evaluation team. The evaluation team then made contact with the client 

to arrange a time for interview. At this initial meeting the client was again provided with information about the 

project, and fully informed consent in writing was obtained. Having obtained consent, the client was invited to 

complete the Wisconsin Quality of Life Index. Eighty clients participated in this component of the evaluation. 

In addition to providing consent to be involved in the evaluation, each client was also asked to provide consent 

for the evaluation team to access his/her data in CIMHA and 77 of the 80 did so. Having identifi ed the date that 

each individual entered HASP, it was possible to obtain the outcomes data from CIMHA for clients at 12 months 

and three months prior to entering HASP and for three months and 12 months post-entry into HASP (Table 2.5). 

We also examined data at 24 months post-entry into HASP, but the number of clients with completed measures 

was too small to be useful in the study. 

Table 2.5 Overview of data collection time-points (CIMHA D=data) 

Time 1 Time 2 Time 3 Time 4 

Clients enter HASP 

12 months-pre 3 months-pre 3 months-post 12 months-post 

In addition to the above data, a sub-group of consumers was invited to participate in in-depth interviews with 

a member of the research team. These individuals were selected on their ability to contribute to an interview 

and their willingness to discuss their views of HASP. Both of these criteria were assessed through observations 

made by the research assistant during the completion of the Wisconsin Quality of Life Index and in subsequent 

discussions with support agency staff. 

2.4.2 Clinical staff – procedure for data collection 

The name of the Case Manager responsible for each consumer was obtained directly from consumers during 

their initial interview with the research assistant (described above). Case Managers were then contacted directly 

by a research assistant and invited to complete a brief questionnaire (i.e. Case Manager Questionnaire). 

This questionnaire invited Case Managers to comment on their perceptions of HASP and their interactions 

with support and housing staff. 

Case Managers were asked to provide general information about the program — no information concerning 

any individual client was collected from Case Managers. The questionnaire was sent to Case Managers via 

mail or email. 

In addition, a sub-group of 31 clinical staff participated in focus group discussions and individual interviews 

with a member of the research team. These individuals were selected on their willingness to contribute to 

an interview and their experience of working with HASP clients. A member of the research team also conducted 

individual interviews with 10 Service Integration Coordinators from across Queensland. These individuals were 

contacted via email and invited to be involved in the evaluation. None of the Service Integration Coordinators 

contacted refused to be involved. 


21

22 


2.4.3 Support Staff — procedure for data collection 

Information from support workers was collected 

through the HASP Coordinator at each Support Agency. 

The Coordinator distributed the support worker 

Questionnaire to relevant support workers (i.e. those 

working with HASP clients). Again, no information 

concerning any individual client was collected from 

support workers. The questionnaire was general in 

nature and invited support workers to rate perceptions 

of HASP and their role in the care process. 

In addition, a sub-group of support workers was 

invited to participate in in-depth interviews with 

a member of the research team. These support workers 

were selected on their experience as a support 

worker (i.e. more than 12 months’ experience) and 

their willingness to contribute to an interview. The 

names of support workers meeting the selection 

criteria were provided to the evaluation team by the 

agency manager. Individuals were then contacted by 

the evaluation team and invited to participate in an 

interview. Attempts were made to ensure that support 

workers from rural and urban areas were included 

in the sample. 

2.4.4 Supports Facilitators — 

procedure for data collection 

In-depth interviews were also conducted with 

19 Supports Facilitators to gain insights into the 

issues confronting this group. These Supports 

Facilitators were selected from across the state. 

In addition, 10 Supports Facilitators completed the 

Supports Facilitator Questionnaire. Questionnaires 

were left with every Supports Facilitator interviewed 

and they were asked to return the completed 

questionnaire to the evaluation team (anonymously) 

in the reply-paid enveloped provided. Ten of the 

19 Supports Facilitators returned completed 

questionnaires. 

2.4.5 Housing and Homelessness Services — 

procedure for data collection 

Data from Housing and Homelessness Services staff 

were collected using individual interviews and or focus 

group interviews. Questionnaire data was not collected 

due to the small number of HHS staff involved with 

HASP. Twenty-six (n=26) HHS staff from 14 Housing 

Service Centres across Queensland participated in 

either individual or group interviews. 


2.5 Data analysis 

2.5.1 Scale data 

The outcome of interest in the present study was 

the impact of HASP on the community adjustment of 

clients following entry into the program. As outlined, 

client outcomes data was downloaded from CIMHA 

and entered into the electronic statistical package — 

SPSS for Windows (Version 14). Following cleaning and 

checking of the data for errors, items in each scale were 

recoded in the direction outlined by the developers of 

the individual scales. Sub-scale and total scale scores 

were computed and used in the analysis of data from 

that point onwards. Descriptive statistics (means, 

standard deviations, etc) were used to summarise the 

data. Repeated measures analyses of variance (ANOVA) 

were used to explore change on the different scales over 

the study period (i.e. 12 months, three months prior to 

HASP and three months and 12 months post-HASP). 

Given that a large number of tests were performed, 

Bonferroni correction of the alpha level was carried 

out to adjust for risk of Type I error (i.e. declaring a 

difference when one does not exist). 

2.5.2 Focus group and interview data 

The individual interviews enabled the participants 

to describe, in their own words, how they felt about 

a topic specifi c to the program. It is diffi cult to estimate 

the actual number of individuals to be included in 

interviews prior to commencing data collection. 

One usually continues data collection until a point 

of ‘saturation’ has been achieved (Rice and Ezzy, 

1999). This is the point where no new information is 

forthcoming and it would be pointless to continue 

interviewing new people beyond this point. It is 

common practice when reporting qualitative fi ndings 

to provide a section of the transcript (i.e. verbatim 

text) to support a given theme. It should be noted that 

generalisations cannot be made to a broader population 

of individuals from interviews (with a sample of the 

broader population). Nonetheless, while fi ndings can 

only be generalised to those interviewed, fi ndings are 

likely to have relevance for the broader study group. 

For example, if loneliness is a recurrent theme in the 

interviews with the majority of those interviewed, 

it is likely that loneliness is an issue for all people 

in the program.

All focus group discussions and individual interviews 

were audio-taped and transcribed by a research 

assistant for analysis. All transcriptions were then 

checked for errors against the taped version to ensure 

an accurate and authentic reproduction. Content 

analysis (Morse & Field, 1996) was then employed 

to guide analysis of the transcripts. The transcripts 

were reviewed several times to generate units of 

information that referred to common themes of the 

program. The fi ndings were then discussed with other 

members of the evaluation team who had read the 

transcripts. Agreement was then reached on the fi nal 

set of themes. 

2.5.3 Discussion of fi ndings 

As noted, the evaluation team was asked to investigate 

four key areas/objectives of interest. These included: 


established across government agencies 

the process of providing clinical, non-clinical and 

housing services to clients 



in community life. The focus here will be on social, 

recreational, educational and vocational activities 





In addition, we were asked to examine the cost 

of maintaining the program and how this compares 

with other residential and non-residential programs. 

Each objective is discussed in separate sections 

of the report as follows: 

Section 3 examines the effectiveness of the 

collaborative process established across government 

agencies and the governance arrangements 

established to support ongoing development and 

delivery of HASP. 

Section 4 explores the process of providing clinical, 

non-clinical and housing services to clients and the 

extent to which HASP has been effective in delivering 

timely and coordinated clinical, non-clinical and 

housing services. 

Section 5 examines the opportunities available 

through the program for clients to maximise their 

recovery and participate in community life. The main 

focus of this section is client involvement in social, 

recreational, educational and vocational activities 

in the community. 

Section 6 assesses the ability of the HASP 

to maintain clinical functioning and provide 

an acceptable quality of life for those supported 

by the program 

Section 7 provides an assessment of the cost 

of maintaining the program and how this compares 

with other residential and non-residential programs. 


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24 

Section 3 

The effectiveness of the collaborative process 


The main issues discussed in this section of the report include the effectiveness of the 

governance arrangements established to support ongoing development and delivery 

of HASP, and the extent to which the program has been effective in delivering timely 

and coordinated clinical, non-clinical and housing services to clients. These issues are 

addressed, in large part, through the interview data collected from the staff and clients 

who participated in the individual interviews. 

3.1 Collaboration between government agencies 

There was overwhelming support for HASP. 

This support came from both staff and clients: 

We’re very pro HASP, I think I have to say that. Those 

individuals who have been fortunate enough to get 

a HASP package have gone really well and we think 

it’s a good process. Of course, like all processes, 

it can be refi ned and improved, but we’d hate to see 

it disappear. 

CCU worker 

Both clients and staff appreciated the holistic 

approach of HASP. It was identifi ed that the 

collaboration between the agencies enabled the 

program to meet the needs of individuals and assist 

them to adapt to life in the community: 

The best thing about HASP is the support. And 

the fact of being able to set myself up… if I had no 

support I would, oh mate… I’d be in that hospital 

quick as! Yeah it’s totally changed my life! 

Female client 

and 

HASP is just fantastic… there are people living now 

in the community that would still be in hospital if it 

wasn’t for the agencies working together… working 

at providing the things that people want and need to 

keep them in the community. 

Case Manager 


The majority of those who contributed to the 

evaluation (staff and clients) felt that an effective 

process of collaboration had been established 

between the different government and nongovernment 

agencies involved in HASP: 

…in terms of a network between agencies, and that 

is part of HASP, I think that is a great thing, and it’s 

a great thing for the clients, because generally there 

is more than one focus in their life and that involves 

other agencies, they need a house, they need health 

and support, so it allows them to have a team that 

works together, rather than giving them this, and 

they have to sort the rest out on their own, and 

that’s really hard, so I think that certainly that part 

of HASP is great. 

Metropolitan Supports Facilitator 

Housing, Health and us, we work really closely 

with XX, the agency that currently has the funds, 

we have respect for one another’s roles, and there’s 

a willingness of people to get together and work to 

achieve the best outcome for the person. 

Regional Supports Facilitator

However, it was clear that the development of a close 

working alliance between agencies took time and 

effort to achieve. In some districts, relationships were 

diffi cult to develop and a lot of effort was required to 

establish these: 

We’ve tried to work really hard with the mental 

health unit to develop relationships so there is more 

trust between Disability Services and Queensland 

Health, and I have to say I think it has improved 

over the last three years or so, but that would be our 

biggest challenge and we’ve got some processes 

now in place that certainly help. 

NGO Service Coordinator 

The challenge for any program requiring interagency 

collaboration is to determine which agency is 

responsible for specifi c components of the program. 

Failure to do this can lead to misunderstandings and 

disputes between agency staff: 

We’ve sort of sat down and nutted out who’s 

responsible for what step in the whole process and 

who takes the lead in certain parts, because in the 

early days it was a turf war… probably too strong 

a term, but there were some misunderstandings 

in terms of whose responsibility was which, so we 

really had to do almost a formal process here… 

to determine joint understanding of what the 

process would involve and who takes responsibility 

and who does the communicating and all that sort 

of stuff, it just didn’t fl ow easily at all, for the fi rst 

couple of years… 

Regional Supports Facilitator 


25

26 

Section 3 The effectiveness of the collaborative process 


3.2 Governance arrangements established to support ongoing development 

and delivery of HASP 

While those interviewed felt that the level of 

collaboration between the agencies was satisfactory, 

a number of concerns relating to the governance of 

HASP were identifi ed. These included (i) communication 

fl ows, (ii) the nomination process, and (iii) ongoing 

review of support packages. 

3.2.1 Communication fl ows 

Participants from all agencies highlighted problems 

arising from poor communication between the agencies, 

and individuals within agencies. This is not surprising 

given the complexity of the agencies involved with 

HASP. A range of barriers to good communication 

was identifi ed by those interviewed. 

These are discussed below. 

Moving between treating teams 

Clients transitioning to the community are likely to 

move between a number of care coordinators and 

Case Managers. Case mangers can often be diffi cult 

to reach as they are often away from their desks and 

many do not work standard 9–5 hours. In addition, 

some have days off mid-week, while others work 

across different services: 

In most cases, Qld Health are good, but if they 

change staff, and we don’t know who is in the new 

role, and it comes to HASP verifi cations and all of 

a sudden the person who did it last year, has been 

asked not to do it, and you think, oh, I had a great 

contact last year, now who do I ring? So it can be 

a little bit disjointed at the start of picking that piece 

of work up. 



Agency structure 

All of the organisations involved with HASP have 

hierarchical structures that make it diffi cult to fi nd the 

right person to talk to when a crisis situation occurs. 

Even within the NGOs sector, there can be several 

layers between the person who works directly with the 

client and the manager or coordinator who liaises with 

the government agencies. Respondents appreciated 

having an identifi ed responsible contact at each 

agency, especially in the initial stages of moving 

a client into HASP: 

I think what worked well was to have that one 

person contact. And we found that out recently too, 

to have that liaison person— ‘Who do you contact? 

Oh you contact this person’. If you’re having 

problems with Dept of Housing, contact this person. 

If you’re having problems with the NGO, not getting 

one, or DSQ — contact this person. So that worked 

really well having that one contact person and to 

know who it was…sometimes we wouldn’t know 

who it was! 

Rural mental health facility staff member 

In some areas, the Service Integration Coordinator acts 

as a ‘bridge across the silos’ so as to bring the relevant 

stakeholders together: 

Health, Housing and MHS, we meet regularly, email 

regularly and talk regularly on the phone. It makes 

things run smoothly, for example one of the clients 

went up north, and when she came back, I knew 

before she was coming, so I got back in touch with 

the Case Manager, and we were able to manage it 

all very smoothly. If there are any issues, like with 

neighbours or anything, Housing will contact me 

very early in the confl ict and we set up a round-table 

meeting and talk over the problem, and talk with 

the client and we are able to sort things out before 

things go too far. 

Service Integration Coordinator

Importance of the Supports Facilitator Role 

There was a perception amongst all stakeholder 

groups that the move within DCCS to change the 

Supports Facilitator role as described in the reforms 

outlined in ‘Growing Stronger’ (2007–2011), may 

impact on communication and accountability: 

And I think the other thing with Disability Services 

is where you had a dedicated bunch of Supports 

Facilitators, now it appears it’s the same team that 

we deal with for all our other clients who have also 

taken a HASP client as well. So we don’t seem to 

have that dedicated bunch of Supports Facilitators. 

I don’t know how that will work because we don’t 

know the [other] Supports Facilitators very well 

so that’s a rough start. Whereas before there was 

a core group of Supports Facilitators who were 

involved with HASP. 

Housing Offi cer 

3.2.2 The nomination process 

A number of issues concerning the nomination process 

were raised amongst the different stakeholders 

interviewed. These included expanding the eligibility 

criteria, the arduous application process, the due 

date of applications, and the length of time between 

nomination and allocation of housing. 

Expanding the eligibility criteria 

Staff from both Housing and Homelessness Service 

and DCCS felt that there would be benefi ts from 

broadening the criteria to include those with diffi cult 

tenancies. There was a perception that inclusion of 

this group in HASP would provide early intervention 

and possibly prevent loss of housing and the 

subsequent need for hospitalisation: 

To also help those people who may already be 

tenants of Queensland Housing and they’re facing 

eviction, and we have to say, ‘oh, we can’t have you 

in HASP, because you’re not eligible’ we have to have 

people completely decompensate, get re-admitted, 

at huge cost to the taxpayer, and, then we might be 

able to nominate you for HASP. I mean, I mean it’s 

insane, because we’re putting the ambulance down 

the bottom, rather than the fence on top in that 

regard, when we do have unspent (funds). 

Supports Facilitator 

Arduous application process 

Many people noted the arduous nature of completing 

the paperwork to nominate clients for HASP. The 

number of forms to be completed and the amount 

of supporting documentation required were diffi cult 

for some services to organise. Even relatively simple 

requirements, such as the need for a birth certifi cate 

in certain circumstances to apply for housing, can 

generate a number of phone calls and visits to a 

client’s home to locate such a document. In smaller 

teams, it can be diffi cult to fi nd an occupational 

therapist to do an assessment and get all the 

paperwork prepared: 

Unfortunately it does fall back to the allied health 

teams — certainly in our workplace — in completing 

the whole application, which everyone will know 

is a massive document ’cos not only is it the HASP 

application and the allied health reports that come 

with it, it’s also the DS application as well, so we 

normally have a relatively short timeframe to do that 

and it’s an enormous amount of work on top of all of 

our clinical duties. 

Mental Health Worker 

Due date of applications 

Applications are usually due at the end of January. 

Districts usually have an earlier timeframe for local 

processing applications so that they are ready for the 

January deadline. The period mid-December to mid- 

January is a time when many staff take leave, and some 

services operate on reduced staffi ng numbers over the 

Christmas and New Year period. It has been suggested 

that the due date for applications could be brought 

forward, possibly to the end of November, to alleviate 

this problem. 


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28 



Length of time between nomination 

and allocation of housing 

An important issue for all participants is the length 

of time between the submission of the application 

and the client actually moving into the community. 

Many mental health workers described how clients 

fi nd this extremely frustrating and a major source 

of stress: 

I would say that there perhaps needs to be a quicker 

processing and turning around so that once you 

get the package there’s a…there are movements 

straight away…because otherwise it becomes a bit 

like pie in the sky and it’ll never happen, kind of 

thing. And I think that’s what’s happened in a few 

cases where it’s been such a long drawn out process 

that people have actually gone ‘oh stuff it’. And I’m 

talking about consumers actually disengaging and 

saying ‘uhh, you know you promise the world, but 

you come up with nothing, I’m not interested’. 

Mental Health Worker 


3.2.3 Ongoing review of support packages 

It was identifi ed that a regular review of support 

packages was required to ensure that the support 

provided by NGOs was in keeping with client needs. 

The HASP process fl owchart suggests that Supports 

Facilitators (SFs) in regional offi ces provide a review 

‘when required’. However, it is unclear how this will 

work in the future given the changes to the Supports 

Facilitator role under the reforms outlined in 

‘Growing Stronger’ (2007–2011). 

Until recently, Supports Facilitators were able to 

review the level of support being provided and ask 

or alterations in support (increase or decrease) 

if deemed necessary: 

The beauty of the role of the Supports Facilitator 

is I can go in and ask really hard questions, and 

if they hate me, it doesn’t matter, I can come in as 

the Big Bad wolf, and say “Well… what’s stopping 

you going and doing your shopping, by yourself?” 

whereas the support services saying it, or Qld 

Health saying it, [clients] can get a bit ‘oh, I don’t 

like you, and I’m not talking to you anymore’. You 

don’t want to have them in that position, so I mean, 

that has been one of my roles here at times, 

is getting called in as the Big Bad Wolf to say ‘No, 

that is not happening’. Like people wanting to get 

driven all over the place and all that sort of stuff, 

because I can go in and say ‘No, sorry, that is not 

the purpose of this expenditure’. 

Regional Supports Facilitator

Accountability 

There was a perception among Supports Facilitators 

that there needs to be more accountability and 

transparency around the levels of support provided. 

Supports Facilitators cited situations where support 

shifts/hours were not being fi lled and were asking 

who was overseeing the process: 

Say someone gets verifi ed for 30 hours a week, 

that’s really nice, but they may not need 30 hours 

a week ongoing, but there is no mechanism in place 

whereby we really look at that regularly, like how 

much support is a person using, are they being over 

supported, making them more dependant, and are 

we entrapping them? 

Supports Facilitator 

There were also concerns around the transfer of clients 

between agencies. It was pointed out that under 

‘block’ funding it was much more diffi cult for clients 

to move from one agency to another. The agency 

transferring the client keeps the funding for that client 

so that the receiving agency has to have enough 

funding capacity to support the new client. As a result, 

it can be diffi cult for clients on large packages to move 

between agencies. 

Care Planning 

Care planning is an important component in the 

provision of a coordinated approach to the delivery 

of services. A number of stakeholders noted that 

some clients can have three care plans — a transition 

plan, a plan developed by clinical services and a plan 

developed by the support agency: 

We have a situation where some of the clients have 

three care plans – I know that sounds unusual and 

it would be better if we had one… and all used that 

as a reference point. It appears that each provider 

prefers to have their own plan 

Case Manager 

It was suggested by a number of the staff interviewed 

that it would be much more effective for each individual 

to have a single care plan which is developed with input 

from all stakeholders including the client. This care plan 

should be used to guide interventions with the client 

and be reviewed and updated on a regular basis — 

at least every three months. 

Transport costs 

Approximately two-thirds of clients indicated that 

their support agency/support workers provide them 

with transport. The payment of support agencies/ 

workers for this service does raise some concerns. 

In some situations, it was noted that the client pays 

the support worker directly for the transport. In others, 

support workers transport clients free of charge and 

claim the cost in their annual tax return as a work 

related deduction. Finally, some agencies take 

funding from the client’s HASP package to fund 

transport costs. Clarity needs to be provided on the 

most appropriate approach for managing transport 

costs/reimbursement. 


29

30 



3.3 Perceptions of agency collaboration — 

Case Manager, support workers and Supports Facilitators 

One of the questions included in the surveys 

completed by Case Managers (n=40), support 

workers (n=58) and Supports Facilitators (n=10) 

asked about their perceptions of how well the 

government agencies work together. 

Participants were asked to rate the statement 

‘Agencies such as Housing and Homelessness 

Services, Disability and Community Mental Health 

Services work well together to support HASP clients’. 

Their responses are summarised below (Fig. 3.1). 

Fig. 3.1 Agencies work well together to support 

HASP clients 

Percent 

100 

80 

60 

40 

20 

0 

Legend 

Strongly 

agree 

Almost 63% of Case Managers and 52% of support 

workers and 90% of Supports Facilitators agreed that 

all the agencies worked well to support HASP clients. 

In response to open-ended questions, Case Managers 

identifi ed that communication between all key 

stakeholders was of paramount importance and 

in most instances it works well. 


Agree 

Case 

Managers 

Neither 


workers 

Disagree 

Strongly 

disagree 

Supports 

Facilitators 

3.3.1 Factors impacting on the ability of 

Case Managers, support workers and 

Supports Facilitators to work with clients 

Clinical and support staff were also asked to respond 

to the statement ‘There are things that I would like 

to do for my HASP clients, but I am unable to’. The 

responses from the groups are compared in the 

graph below. 

Fig. 3.2 Ability of staff to work with HASP clients 

Percent 

100 

80 

60 

40 

20 

0 

Legend 

Strongly 

agree 

Agree 

Case 

Managers 

Neither 


workers 

Disagree 

Strongly 

disagree 


Facilitators 

Overall, 29% of case mangers and 44% of support 

workers agreed that there were things they wanted 

to do for their clients, but were unable to provide these. 

In the additional comments received, Case Managers 

highlighted the impact of time constraints, increased 

workload and lack of staffi ng on their ability to provide 

more support to their HASP clients. Some of them 

noted that the HASP clients were at the severe end 

of the disability scale and that many of these required 

additional support with medication supervision, 

emotional support and symptom management. 

Others noted that many clients had physical conditions 

that required signifi cant time and attention.

Support workers highlighted issues with transport, 

lack of money, and lack of motivation in their clients. 

Lack of motivation in clients was mentioned by 

most of the support workers. Some support workers 

described how they frequently try to encourage clients 

to exercise, become involved in the community, and 

introduce clients to a new hobby/activity, but the 

clients showed little or no motivation. 

3.3.2 Case Manager and Supports Facilitator 

views of HASP support 

Case Managers and Supports Facilitators were asked 

to rate the statement ‘client needs are currently met 

through HASP’. (The statement was rated in the 

negative, and responses have been reversed). 

It should be noted that there were only 10 Supports 

Facilitators who responded to this question. 

Fig. 3.1.3 Client needs are currently met by HASP 

Percent 

100 

80 

60 

40 

20 

0 

Legend 

Strongly 

agree 

Agree 

Case 

Managers 

Neither 


Facilitators 

Disagree 

Strongly 

disagree 

Some 58% of Case Managers agreed that client needs 

are currently met through HASP. However, only 40% 

of Supports Facilitators agreed with the statement. 

Case Managers reported that HASP had met most of 

their clients’ needs, although some reported that basic 

domestic, self-care and budget management skills 

were lacking in many HASP clients. Some of the Case 

Managers commented that most support workers were 

excellent and provided ‘assistance to a group of people 

with severe problems on a daily basis’. 

However, there were some who were perceived as not 

being consistent in their approach to service provision. 

Some tended to have considerable sick leave and 

others seemed ‘to do too much for the clients which 

may give rise to dependency’. 

3.4 Section summary 

All of those interviewed expressed very positive views 

of HASP. The overall model of having key government 

agencies (HHS, DCCS, and QH) and NGOs working 

in collaboration appears to be effective in providing 

the infrastructure to support community adaptation 

for individuals with psychiatric disability. However, 

it is clear that government agencies come to the 

project with different philosophies, different 

backgrounds and understandings of what constitutes 

the most effective approach for providing mental 

health and support services. While those interviewed 

felt that collaboration between the agencies had 

improved over time, there were a number of issues 

around the governance of the program that require 

attention. These issues include communication 

between agencies and individuals, the nomination 

process for entry into HASP, and ongoing review of 

support packages. 


31

32 

Section 4 

The process of providing clinical, non-clinical 


This section of the report examines service provision and the extent to which HASP 

has been effective in delivering timely and coordinated clinical, non-clinical and housing 

services. The costs and benefi ts of providing coordinated clinical and non-clinical support 

and appropriate housing to clients through HASP are also examined. 

4.1 Process of providing clinical services 

Clinical services within HASP are largely provided by Case Managers employed through Queensland Health. 

(Only a small proportion of the HASP clients had a GP as their primary mental health provider). Forty Case 

Managers responded to a questionnaire which gathered data on their background and perceptions of HASP. 

A greater proportion of Case Managers from Queensland Health’s Metro North and Metro South Districts 

responded to the questionnaire. This is in keeping with the greater proportion of HASP clients settled 

in these regions. 

Fig. 4.1.1 Location of Case Managers 

Percent 

30 

25 

20 

15 

10 

5 

0 

Metro 

North 


Metro 

South 

Cairns 

Gold 

Coast 

Sunshine 

Coast 

Toowoomba 

Townsville 

Central 

Queensland 

Approximately 61% of those who completed the questionnaire were female and 31.6% were in the 41–50 age group. 

The average length of time they had been employed in the mental health fi eld was 12 years and they had been 

working in the role for an average of 5.7 years. They had been working with HASP for 2.4 years. The group was 

made up of nurses (52.6%), occupational therapists (21.1%), social workers (18.4%) and psychologists (7.9%). 

4.1.1 Number of Case Managers in the past 12 months 

Stability in service provider was also assessed. Clients were asked to outline the number of Case Managers they 

had had in the previous 12 months. As outlined in the graph below, only 6% of clients had the same Case Manager 

for the entire 12 months. While 43% had two Case Managers, 31% had three Case Managers in the previous 

12 months. However, it should be noted that some clients may have had two or more Case Managers due to 

their permanent Case Manager taking annual leave, etc. 

Fig. 4.1.2 Number of changes in Case Manager in past 12 months 

Percent 

50 

40 

30 

20 

10 

0 

One 

Two 

Three 

Four 

Five 

Six 

Seven

4.1.2 Client perceptions of support received from case manger 

We invited clients to rate a number of statements concerning their interactions with their Case Manager. 

These cover areas such as perceptions of Case Manager role, Case Manager understanding of client, 

amount of time spent with Case Manager, and medications (see Table below). 

Table 4.1 Client perceptions of support received from Case Manager 

Statement Strongly 

Agree % 

a. I can get in contact with my Case Manager 

if I have a problem. 

b. My Case Manager helps me 

with my symptoms. 

c. My Case Manager helps me to 

function better. 

d. My Case Manager understands 

my problems. 

Agree 

% 

Neither 

% 

Disagree 

% 

Strongly 

Disagree % 

41.6 47.2 5.6 5.6 – 

18.3 43.7 18.3 16.9 2.8 

21.1 43.7 19.7 14.1 1.4 

31.4 47.1 8.6 11.4 1.4 

e. My Case Manager treats me with respect. 34.7 55.6 2.8 4.2 2.8 

f. I would like my Case Manager to spend 

more time with me. 

12.5 29.2 27.8 20.8 9.7 

g. I know what my medications are for. 45.1 46.5 1.4 5.6 1.4 

h. I know the side-effects of my medications. 30.6 44.4 8.3 12.5 4.2 

Overall, while there was considerable dispersion in the data, responses indicate that clients hold positive views 

of their Case Manager. Most clients (89%) indicated that they could get in contact with their Case Manager if they 

had a problem and 62% believed that their Case Manager helped them with their symptoms. Over 78% of clients 

felt that their Case Manager understood their problems, and 91% claimed to know what their medications were 

used for. While over 40% of clients wanted their Case Manager to spend more time with them, over 30% felt that 

they had enough time with their Case Manager. 


33

34 

Section 4 The process of providing clinical, non-clinical 


4.1.3 Case Manager involvement with Support Services 

A key focus of the evaluation was the working relationship and coordination between service providers. 

Case Managers (n=40) were asked to rate a number of statements concerning their interactions with support 

workers (Table 4.2 below). These statements related to information transfer, perceptions of support worker 

contribution, support worker involvement in the development of care plans, and issues around recovery. 

Table 4.2 Case Manager interactions with support workers 



Agree 

(%) 

a. Support workers give me as much information 

as I need. 

b. I am comfortable questioning support workers 

about information they give me. 

c. I would like to have more say in the support 

services provided to HASP clients. 

d. I feel that support workers should have more 

training to be able to work effectively with 

HASP clients. 

e. I wish that I knew more about the concept 

of ‘recovery’. 

f. I generally engage support workers 

in the development of treatment plans 

for HASP clients. 

g. Support workers have an important role 

to play in the treatment planning process. 

h. I ensure that support workers are familiar 

with treatment goals for each HASP client. 

i. Generally, I fi nd that support workers are 

familiar with the principles of ‘recovery’. 

j. Housing staff are easy to contact when I need 

to discuss client accommodation issues. 

Agree 

(%) 

Neither 

(%) 

Disagree 

(%) 

Strongly 

Disagree 

(%) 

30.0 47.5 17.7 5.0 – 

37.5 50.0 12.5 – – 

20.0 35.0 42.5 2.5 – 

40.0 42.5 12.5 5.0 – 

7.5 15.0 25.0 40.0 12.5 

22.5 57.5 17.5 2.5 – 

37.5 55.0 7.5 – – 

30.0 60.0 10.0 – – 

7.5 52.5 25.0 15.0 – 

10.0 32.5 35.0 15.0 7.5 

k. I value the support worker role. 55.0 40.0 5.0 – – 

l. I trust the information support workers give me. 37.5 50.0 10.0 2.5 – 

m. I wish that I knew more about the rehabilitation 

of people with psychiatric disability. 

– 15.0 42.5 25.0 17.5

In general, Case Managers expressed positive views 

of support workers and the services they provide. 

Over half of the Case Managers (55%) wanted a greater 

say in the support services provided to HASP clients. 

In addition, 82.5% of Case Managers felt that support 

workers should have more training to be able to work 

effectively with HASP clients. Ninety-fi ve percent 

outlined that they valued the support worker role 

and that support workers have a valuable role to play 

in the treatment planning process (92%). Finally, 

42% of Case Managers felt that housing staff were 

easy to contact when they need to discuss client 

accommodation needs. 

4.1.4 Client views of clinical service provision 

As outlined previously, 12 clients participated in 

individual interviews to assess their perceptions of 

the program. Clients expressed mostly positive views 

of their Case Manager. Most linked improvement in 

their mental health to skills of their Case Manager: 

I still have contact with her. Yep. And she’s the only 

one that I ever really, umm, made any progress 

and things just progressed from — from when I met 

her and I just got weller and weller and it was with 

her support. 

There was also a perception that clients have some 

say in the amount of contact they have with their 

Case Manager. Most clients get a visit from their Case 

Manager once every two weeks. As clients improve, 

the frequency of visits tends to decrease: 

My Case Manager pops around and asks me how 

I’m going and do I need anything. She said ‘How 

often do you want me to come around?’, I just sort 

of said, oh probably once a month’s fi ne. 

Regional male client 

4.1.5 Support staff views of clinical service provision 

Consistency in Case Manager was seen as important 

for continuity of care. Having a regular Case Manager 

seemed to reduce confusion and provide a more stable 

approach to clinical service provision: 

We’ve got some long-term Case Managers though 

here in XX (town), that certainly helps, a lot of 

our HASP individuals have maintained their Case 

Manager for two or three years, and that always 

helps to have that consistency there. 


Support workers expressed a desire to have more 

contact with Case Managers and felt that they had 

a lot to offer since they spend much more time with 

clients than any other group. However, some felt 

uncomfortable discussing clients in the co-ordination 

meetings: 

Yeah, I would defi nitely like a bit more of a chat with 

the Case Manager and stuff – ’cos the care 

co-ordination meetings…it’s just like once every three 

months…. I just don’t necessarily think that there’s 

that sort of cohesiveness that there needs to be for 

people to be able to effectively work together. You 

know it’s all well and good us meeting every three 

months, but yeh, you know it’s…I guess we’re all 

looking at it from different angles as well … 

I’m the one who’s going to see the client on a day-today 

basis and see him in his home environment and 

everything. I know him better than anyone else. 

Metropolitan support worker 


35

36 



4.2 Process of providing non-clinical 


Each client returning to the community received a 

package of care consisting disability/lifestyle support 

services in keeping with their needs. Fifty-two nongovernment 

organisations from across the state have 

been engaged to provide these disability support 

services to all of the clients in HASP. (It should be 

noted that 32 agencies provide services to the subsample 

of 80 clients enrolled in the evaluation). 

4.2.1 Preparation for role as HASP support worker 

Support workers were asked about their level of 

training for their role as a support worker. Almost 

40% indicated that they required more training 

for their role as a support worker. 

Fig. 4.2.1 Perceptions of training for role 

as a support worker 

Percent 

100 

80 

60 

40 

20 

0 

Strongly 

agree 


Agree 

Neither 

Support workers 

Disagree 

Strongly 

disagree 

Thirty-four support workers provided details of 

the additional training that they felt was required. 

The topics suggested were categorised under 

fi ve key areas: 

(i) information/training on clinical issues — 

(psychiatric conditions, symptoms, 

medications, side-effects). 

(ii) skill development in strategies to deal 

with behaviours, such as anger, aggression, 

substance misuse, etc. 

(iii) information/skills for dealing with crisis situations, 

such as self-harm, suicide and self-neglect. 

(iv) training in basic counselling skills and 

interventions to promote client motivation 

(e.g. motivational interviewing). 

(v) information/training in the concept of recovery 

and how this could be applied when working 

with HASP clients.

4.2.2 Client perceptions of the amount of ‘help’ they receive from support workers 

Clients (n=80) were asked to consider a number of activities and rate the amount of assistance they receive 

from support workers for each activity. Three response options were available — ‘a lot of help’, ‘some help’ 

and ‘no help’ (see Table below). 

Table 4.2.1 Rating of help received from support workers 

Activity 

Amount of help clients receive 

from support workers 

A lot of 

help % 

Some 

help % 

No 

help % 

a. Personal hygiene/care (e.g. showering, brushing teeth) 10.4 3.9 85.7 

b. Diet (food purchasing and preparation) 10.4 40.3 49.3 

c. Exercise 20.8 36.4 42.8 

d. Taking medication 24.7 23.4 51.9 

e. Cooking 15.6 29.9 54.5 

f. Cleaning 19.5 44.2 36.3 

g. Shopping 37.7 37.7 24.6 

h. Laundry 15.6 32.5 51.9 

i. Transportation (i.e. getting to places) 50.6 27.3 22.1 

j. Budgeting /banking 20.7 32.5 46.8 

k. Use of community services (e.g. library, Centrelink) 24.7 50.6 24.7 

l. Making appointments 23.4 59.7 16.9 

m. Social /community activities 28.6 48.1 23.4 

n. Accessing training or education 15.1 28.8 56.2 

o. Finding work (paid or unpaid) 17.3 25.3 57.3 

p. Acts as a companion 35.1 48.1 16.9 

The results indicate that clients continue to require considerable assistance with basic chores, such as cooking, 

cleaning, shopping and making appointments. Over 50% indicated that they receive a ‘lot of help’ from support 

workers with transport. Shopping was the next activity with high input from support workers, with almost 

38% of clients indicating that they required a ‘lot of help’ with shopping. Finally, 35% of clients felt that 

support workers offer a lot of help in providing companionship to clients. 


37

38 



Turning to low support activities, 86% of clients indicated that they required ‘no help’ with hygiene. 

Other activities for which clients required ‘no help’ included fi nding work (57%), accessing education (56%), 

cooking (54%) and taking medications (52%). 

It should be noted that the list of activities was rather task-orientated and support workers provide a range 

of emotional support and advocacy interventions that were not captured. 

4.2.3 Support worker involvement in decision-making around service provision 

From our previous evaluation of the ‘Project 300’ Program, we found that the services provided by support 

workers were instrumental in maintaining clients in their chosen community (Meehan et al., 2011). However, 

for support workers to be effective, they must be engaged in decision-making around key aspects of the 

services provided. The Table below provides support worker ratings of their involvement in decision-making 

around client care. 

Table 4.2.2 Support worker involvement in decision-making (n=58) 



Agree 

(%) 

a. From my interactions with Case Managers 

I feel that I have an important role in the 

treatment process. 

b. Case Managers have given me as much 

information as I have needed. 

c. I am comfortable questioning Case 

Managers about advice they give me. 

d. I would like to have more say in the 

services that my HASP clients/receive. 

e. I need more training to be able to work 

effectively with my HASP clients. 

f. I often wish that I knew more about mental 

illness when I talk with Case Managers. 

g. I am asked to be involved when the 

treatment plans for my HASP clients are 

being developed. 

h. I am familiar with the principles 

of ‘recovery’. 

i. I am familiar with the treatment goals 

for each of my HASP clients. 

j. I need more training in the concept of 

‘recovery’. 

k. It is often harmful to have too high 

expectations for clients. 

Agree 

(%) 

Neither 

(%) 

Disagree 

(%) 

Strongly 

Disagree 

(%) 

31.0 48.3 13.8 5.2 1.7 

17.2 37.9 19.0 19.0 6.9 

19.0 58.6 8.6 12.1 1.7 

15.5 46.5 32.8 5.2 – 

8.7 37.9 24.1 27.6 1.7 

6.9 32.8 20.7 36.2 3.4 

3.4 31.0 19.0 34.5 12.1 

25.9 60.3 6.9 6.9 – 

24.1 65.6 6.9 1.7 1.7 

3.4 34.5 37.9 19 5.2 

22.4 34.5 19.0 17.2 6.9

Support workers felt, as a result of their interactions 

with Case Managers, that they had an important role 

to play in the treatment process. However, just over 

half (54%) agreed that Case Managers had provided 

them with as much information as they needed. Six in 

every 10 support workers expressed a desire to have 

a greater say in the services provided to HASP clients. 

Almost half (45%) felt that they needed more training 

to be able to work effectively with their HASP clients. 

Only one-third of support workers indicated that they 

were involved in developing treatment plans for clients. 

4.2.4 Client satisfaction with the activities provided 

by support workers 

Overall, 85% of clients were satisfi ed/very satisfi ed 

with the activities that support workers do for/with 

them. Most highlighted the important role played by 

support workers and acknowledged that they would 

not be able to survive in the community without the 

interventions provided by support workers (Fig. 4.2.2). 

Fig. 4.2.2 Satisfaction with support workers 

Percent 

60 

50 

40 

30 

20 

10 

0 

Very 

satisfied 

Satisfied 

Neither 

Satisfaction with support workers 

Dissatisfied Very 

Dissatisfied 

A small number of clients were dissatisfi ed with 

support workers/agencies for not providing transport. 

They felt that they should not have to pay for support 

workers to transport them to places of interest. Others 

outlined that they had no time to themselves because 

support workers were constantly ‘coming and going’. 

4.2.5 Lack of support and activities 

Clients were asked to consider the amount of support 

provided to them and indicate how frequently did lack 

of support prevent them from doing things that they 

would like to do. Three response options were available 

— ‘almost always’, ‘sometimes’ and ‘never’. Responses 

are provided in the graph below. 

Fig. 4.2.3 Lack of support and activities 

Percent 

50 

45 

40 

35 

30 

25 

20 

15 

10 

5 

0 

Never 

Sometimes 

Prevented from doing activities 

Almost always 

The fi ndings indicate that 16% of clients felt that lack 

of support prevented them from doing things that they 

would like to do. However, a much larger proportion 

(47%) indicated that lack of support prevented them 

from doing things ‘sometimes’. 


39

40 



4.2.6 Changes in support workers in the 

past 12 months 

Clients were again asked to provide information about 

the number of different support workers that they had 

had in the past 12 months. Almost one-third had no 

change in support staff in the previous 12 months 

(this was 6% for Case Managers). However, one client 

claimed to have had eight changes of support worker 

in the past 12 months (see Fig. 4.2.4). 

Fig. 4.2.4 Change in support workers during the past 

12 months 

Percent 

40 

30 

20 

10 

0 

No 

Change 

One 

Two 


Three 

Four 

Five 

Six 

Seven Eight 

Change in support workers in past 12 months 

4.2.7 Change in support intensity (support hours) 

between entry into HASP and follow-up 

Data concerning the number of hours of disability 

support allocated to each client, on a weekly basis, 

was collected from support agencies. Support 

agencies were asked to provide the number of hours 

of support allocated to each HASP client for two timepoints 

— when they commenced in HASP, and again 

at the time of follow-up (Mar–July 2010). Change 

in the weekly support hours was assessed using 

Paired t-tests. Data for this variable was available for 

56 clients across the two time-points (see Table below). 

Table 4.2.3 Change in support hours provided over 

study period (n=56) 

Weekly 

support hours 

on entry into 

HASP (n=56) 

Mean = 27.62 

(sd. = 15.78) 

(range = 3.0 

to 87.5) 

Weekly 

support hours 

at follow-up 

(n=56) 

Mean = 20.49 

(sd. = 14.06) 

(range= 0 

to 77.0) 

Test 

statistic 

Paired 

t = – 4.46, 

df = 55, 

p=.001 

There was a statistically signifi cant decrease in the 

number of hours of disability support provided each 

week (Paired t= – 4.46, p=.002). Support hours 

provided each week decreased by an average of 7.13 

hours from a mean of 27.6 hours on entry into HASP 

to a mean of 20.4 hours at the follow-up time-point. 

Indeed, the range in support provided decreased 

from 3–87.5 hours on entry into HASP to 0–77 hours 

at follow-up.

4.2.8 Amount of support required in the future 

Clients were asked to think about the amount of 

support they currently receive from their support 

workers and indicate the amount of support they 

would require in the next 12 months. The options 

were ‘more support’, ‘less support’ or the ‘same 

amount of support’. The responses are summarised 

in the graph below. 

Fig. 4.2.5 Perceptions of support required 

in the future 

Percent 

50 

40 

30 

20 

10 

0 

More 

Same 

Amount of support in future 

Less 

Over one-third (37%) indicated that they would require 

more support in the next 12 months, while almost 

one-fi fth (19%) felt that they would require the same 

level of support that they currently receive. However, 

over 40% felt that they would require less support in 

the future. 

4.2.9 Client perceptions of non-clinical 


Clients were very satisfi ed by the support services 

provided by the NGO sector. They felt that their 

success in community living was, in part, attributed 

to their support agency. There was a perception that 

support agencies encouraged clients to participate 

in community activities: 

Since my last time in hospital, I’ve been here [in 

own home] for two years now, I haven’t had a 

hospitalisation yet, and there was one year I was in 

hospital nine times. I was pretty lost and since then, 

being involved with [XX support agency], they pushed 

me along, to get back…got me back to being involved 

in the community, be my friend, and helping me feel 

a lot better about my life now. 

Male consumer 

It is clear that while support workers assist clients 

with a number of activities necessary for daily living, 

they also provide social support to many clients: 

No I wouldn’t be able to do it without the support 

workers. Just the social interaction, like having a 

cuppa, talking about the day’s events and what I’m 

doing for the next week. Even to just watch a DVD 

or share a meal it’s just the social side of it… Yeah… 

So that’s very important. 

Female consumer 

4.2.10 Case Manager perceptions 

of non-clinical support services 

Case Managers were appreciative of the support 

provided by the NGO sector. There was a perception 

that HASP in general, and the input from support 

workers in particular, had resulted in a more stable 

lifestyle for clients. Refl ecting on the benefi ts of the 

program, a Case Manager detailed how HASP had 

assisted one of his clients: 

It seems to take a signifi cant load off, because 

the client is a much more stable, gets an awful lot 

of input from the NGO that is working with him… 

they put a lot of work in with training, job training 

and social skills training, the client has actually 

gone from someone who was an alcoholic, drugusing 

street person, to someone who is settled in 

a unit, and is going out regularly to a place where 

he is doing some proper type work, cut down on 

the alcohol, got rid of the drugs, cleaned himself 

up, so that takes away a lot of stuff, we’d normally 

be chasing him, he’s on a depot, and he comes 

in on the dot, every two weeks, instead of being 

chased all around the place, it’s vastly improved his 

lifestyle, and the way he mixes in the community, 

he’s got much more stuff he does outside now, than 

he used to, so I think it’s good. 

Case Manager 


41

42 



4.3 Process of providing accommodation 

The downsizing of state hospitals and the shift to 

community care for people with mental illness have 

raised questions about how to best accommodate 

people with mental illness in the community 

(Carling & Ridgway, 1987; Burdekin, 1993; Queensland 

Department of Housing, 2000). The importance of 

housing and its contribution to wellbeing cannot be 

overstated (Carling, 1995). A living situation that feels 

like home is a primary source of stability and security 

in the lives of all people — those with or without a 

mental illness. Indeed, much time and physical effort 

are spent establishing and maintaining one’s preferred 

living space (i.e. home) in the community. 

The provision of housing for people with mental illness 

is currently undergoing signifi cant change, with three 

essential principles now increasingly recognized — 

consumer choice (Ridgway, 1988); normal integrated 

housing (Hogan & Carling, 1992); and fl exible, 

integrated support (Carling, 1990). These principles 

form the basis for the ‘new paradigm’ approach 

promoted in the USA by Ridgway and Zepple (1990) 

(see Table below). 

Table 4.3.1 Changes in the way housing is considered 

Old Paradigm New Paradigm 

Residential treatment 

setting 


A home 

Staff control Client control 

Grouping by disability Social integration 

Learning in transitory/ 

preparatory settings 

Learning in permanent 

settings 

Standard service Individualised service 

Least restrictive 

environment 

(independence) 

Most facilitative 

environment (supports) 

The housing provided should also encourage the 

development of skills associated with normal social 

roles and exposure to and participation in the life 

of that community. Moreover, the housing option 

should include the provision of individualised support 

services and skills training that occur in the person’s 

home. These support services should be fl exible 

to meet the changing needs of the individual. 

4.3.1 Housing within HASP 

The provision of accommodation to HASP clients 

is managed by the Department of Communities – 

Housing and Homelessness Services (HHS). Every 

effort was made to ensure that each client entering 

HASP was provided with accommodation in keeping 

with their needs. All clients received an ‘establishment 

grant’ of $5,000 from Disability and Community Care 

Services to buy white goods and other furnishings 

required to establish their new home in the community. 

The majority of HASP clients were living in mediumsized 

unit blocks. While 37% of residences had one 

bedroom, 45% had two bedrooms and 15% contained 

three bedrooms (Fig. 4.3.1). 

Figure 4.3.1 Type of accommodation provided 

Percent 

40 

30 

20 

10 

0 

Unit 

in large 

block 

Unit 

in med 

block 

Unit Townhouse Duplex 

in small 

block 

Type of housing 

House 

(Note on Unit Blocks: Small Block = up to 6 Units; 

Medium block = 7-16 Units; Large Block = More than 

16 Units)

4.3.2 Living arrangements 

The majority of HASP clients (80%) lived on their own. 

However, 22% felt that they would like to live with a 

roommate or friend in the future. Four clients were still 

in hospital (in transition – spending more than four 

nights in their own home) when they were interviewed. 

Indeed, seven individuals (8.7%) outlined that they 

would like to live in a mental health unit/hospital 

in the future. 

Fig. 4.3.2 Current living arrangements 

and desires for future living 

Percent 

100 

80 

60 

40 

20 

0 

Alone 

Friend 

Legend Current 

situation 

4.3.3 Features of housing 

Some 91% outlined that public transport was 

convenient and 94% felt safe in their present 

accommodation. In addition, 91% claimed to 

have suffi cient space and 90% were comfortable 

in their accommodation. Overall, 87% rated their 

accommodation as being highly appealing/appealing 

(see Fig. 4.3.3). 

Fig. 4.3.3 Rating of housing 

Percent 

60 

50 

40 

30 

20 

10 

0 

Highly 

appealing 

With Parents Partner Hospital 

their 

children 

Appealing 

In the 

future 

Neutral 

Attractiveness of housing 

Other 

Unatttractive 

4.3.4 Overall satisfaction with housing. 

Satisfaction with housing was high with almost 

90% of HASP clients claiming to be very satisfi ed/ 

mostly satisfi ed with their housing (Fig. 4.3.4). 

Fig. 4.3.4 Rating of satisfaction with housing 

Percent 

70 

60 

50 

40 

30 

20 

10 

0 

Very 

satisfied 

Mostly 

satisfied 

Neutral 

Satisfaction with housing 

Mostly Extremely 

dissatisfied dissatisfied 

4.3.5 Clients who had moved since joining HASP 

Fourteen of the 80 clients (17.5%) had moved house 

since joining HASP. Eleven of these had moved once, 

one had moved twice and two had moved thrice. There 

were three main reasons cited for moving — noise from 

neighbours and or unable to get along with neighbours 

(n=8), dislike of the area in which they lived (n=3), and 

to be closer to family (n=3). 

4.3.6 Client perceptions of their accommodation 

From interviews with clients it became clear that 

housing forms an important component of their 

recovery. The fi ndings support previous work by 

Baker & Douglas (1990) which suggests that clients 

who remained in adequate and appropriate housing 

improved, while those in poor housing remained 

the same or deteriorated in their level of functioning. 

Similarly, clients who moved from poor-quality housing 

to better housing improved in their global functioning. 

The authors concluded that the quality of housing 

had a clear impact on the outcomes for people with 

mental illness. 

It is clear from the interviews with HASP consumers 

that housing provides a feeling of security and a place 

of ‘asylum’ where, as one client put it, ‘my home is 

my escape from the madness of the world’. Three key 

themes emerged: housing — essential for recovery; 

a sense of home; and a sense of freedom. 


43

44 



Housing — essential for recovery 

There was a perception among those interviewed that 

stable housing formed a key element of the recovery 

process. Most believed that housing provided stability 

and had far greater implications than simply providing 

a roof over one’s head: 

I don’t think people realise how much 

accommodation changes your life. I’d still be using 

speed if I didn’t have this house, it’s changed my 

life. Just having responsibility and just the good 

feeling of coming home, and you’ve got a nice house 

to come home to and, you’re not behind in your 

rent, or, stuff like that, it’s massive, a lot of people 

take it for granted…I was on and off the streets 

for eight years. 

40-year-old male consumer 

When I got the HASP package I was so happy, I got 

a brand new property and I’ve got it for 10 years, 

and 10 years after that, I asked housing. I don’t 

know where I’d be if I hadn’t got this, it came at the 

right time – I got out of hospital, ready to get a job. 

34-year-old female consumer 

A sense of ‘home’ 

Almost all of the clients interviewed indicated that 

they felt their new accommodation in the community 

was ‘home’: 

Yes, I consider this to be my home now. 

51-year-old male 

Yeh, I feel at home with myself and my cat and my 

painting. Sometimes the neighbours get a bit agro, 

not with me, but with each other. 


Two clients suggested that it was home only for the 

short-term, and these clients indicated that the home 

in which they grew up, and which was still owned by 

a family member (usually a parent) would always be 

their ‘real’ home. 


A sense of freedom 

There was also agreement among those interviewed 

that they could do ‘their own thing’ in their new home 

in the community. The responses are further indication 

of positive adaptation — indicating that clients 

perceive themselves as having real choices available 

to them in the community: 

Yes, I can do what I want to do, because I want to, 

not because I have to. 

24-year-old male consumer 

…moving to this house has been the best thing that 

has ever happened to me, I feel independent and 

free, and even though I’ve got the support workers, 

I can go outside and do my garden, I can mow my 

own lawn now… everything has just fallen so well 

into place. But yes, so moving into this house, it’s 

just like being given some other second chance. 

I haven’t been back to hospital since 2006, so that’s 

good, and [my psychiatrist] said to me that I might 

not have to go to hospital again. 


While some clients acknowledged their freedom, they 

also expressed reservations about the responsibilities 

associated with independent living, including an 

acknowledged respect for property – 

You can do what you want to a point — you don’t 

go wrecking the place or anything.

4.3.7 Housing in HASP — comparison with international standards 

The Supported Housing Approach in the United States has developed a framework for assessing accommodation 

provided to individuals with psychiatric disability (Carling, 1995). The key principles for this are outlined below. 

We assessed the provision of housing in HASP against these principles (Table below). 

Table 4.3.2 International principles in the provision of housing 

Principles HASP Housing 

1. Housing is a home rather than a residential treatment service. ✓ 

2. The housing is based on what the consumer rather than the mental health worker 

considers to be appropriate. 

3. Consumers are seen as normal community members rather than mental health 

program residents. 

4. There is a shift in the locus of control from mental health worker/staff to client. ✓ 

5. There is social integration rather than grouping people by disability. ✓ 

6. Training and support is offered in vivo permanent settings rather than 

transitional, preparatory settings. 

7. Individualised fl exible support is offered rather than standardised levels 

of service in short-term settings. 

8. The environment which best facilitates development is sought rather than the 

least restrictive and most independent. 

While the housing provided to HASP clients clearly meets the principles described, care must be taken to ensure 

that there is no erosion of the principles with the passage of time. For example, in the case of principle ‘4’, it would 

be very easy for control of the housing environment to gradually shift from client to staff. 

✓ 

✓ 

✓ 

✓ 

✓ 


45

46 




Case Managers were held in high regard by clients. 

Many clients attributed improvements in their health 

to their Case Manager. Indeed, over 60% of clients 

believed that their Case Manager had helped them 

with their symptoms. Consistency in the same Case 

Manager was valued by clients and support staff. 

However, only 6% of clients had the same Case 

Manager for the entire 12 months prior to interview. 

Notwithstanding this, most clients (89%) indicated 

that they could get in contact with their Case Manager 

if they had a problem. Over 78% of clients felt that 

Case Managers understood their problems and 

91% claimed to know what their medications were 

used for. 

Both Case Managers and support workers expressed 

satisfaction with the collaborative working 

relationships they had developed. Ninety-fi ve percent 

of Case Managers outlined that they valued the 

support worker role and 92% felt that support workers 

had a valuable role to play in the treatment planning 

process. However, support workers raised concerns 

about Case Manager involvement in HASP and felt 

that Case Managers could play a greater role in the 

overall program. Reasons highlighted for the perceived 

lack of involvement included the high caseloads that 

some Case Managers were expected to carry and the 

presence of support workers in the lives of the clients. 

Case Managers carried out their role in the knowledge 

that support workers would contact them should they 

observed changes in client functioning. This fi nding 

supports earlier work in New South Wales that found 

Case Managers had less involvement with clients 

supported by NGOs due to the auxiliary services 

provided by support workers (Muir et al., 2006). 


Thirty-two different support agencies (n=32) provide 

services to the 80 clients enrolled in the evaluation. 

All of these agencies have different levels of 

experience in the provision of support to individuals 

with mental illness. Nonetheless, consumers see the 

interventions provided by support workers as being 

instrumental in maintaining them in their chosen 

community. Overall, 85% of clients were satisfi ed/very 

satisfi ed with the activities that support workers do 

for/with them. 









were involved in developing care plans for clients. 

However, in most support agencies this task 

is managed by the Supports Coordinator who passes 

on relevant information to the support workers. 

The training of support workers was raised by Case 

Managers (and support workers themselves). Both 

groups felt that support workers required more 

training in a range of areas so as to be more effective 

in the provision of services to clients with complex 

needs. Almost half of the support workers (45%) who 

participated felt that they needed more training to be 

able to work effectively with their HASP clients. 

Finally, the level of support required by clients seems 

to decrease with the passage of time. Support hours 

provided each week decreased by an average of 7.13 

hours from a mean of 27.6 hours on entry into HASP 

to a mean of 20.4 hours at the follow-up time-point.


However, 22% felt that in the future, they would like 

to live with a roommate or friend. The evaluation team 

notes that while HASP clients are not prevented from 

sharing a house should they prefer this option, they 

are unable to share the support services they receive. 

It may be worth exploring how the program can better 

facilitate shared accommodation for a small sub-group 

of clients who may prefer this option. 

Fourteen of the 80 clients in our sample moved 

accommodation since joining HASP. Eleven of these 

moved once, one moved twice and two moved thrice. 

There were three main reasons cited for moving — 

noise from neighbours and or unable to get along with 

neighbours (n=8), dislike of the area in which they 

lived (n=3), and to be closer to family (n=3). While this 

could be viewed as a negative for the program, it is 

reassuring that clients can ask to be relocated to a new 

neighbourhood and relocation appears to be feasible 

when the need occurs. 

Themes that emerged from the interviews with clients 

suggest that stable housing plays an important role 

in one’s recovery. Clients viewed their housing as 

being important in providing stability and it offered 

a platform from which to undertake other elements 

of the recovery process (fi nding a job, etc). Two other 

themes included a ‘sense of freedom’ and a ‘sense 

of home’. 


47

48 

Section 5 

The opportunities available through the program for clients 

to maximise their recovery and participate in community life 

The focus here was on social, recreational, educational 

and vocational activities in the community 

This section of the report discusses how client participation in HASP has supported their 

recovery. In addition, overall functioning is discussed in terms of the proportion of clients 

experiencing improved functioning, the need for hospital admission following entry into 

HASP, and the proportion of clients that have sustained tenancies since entry into HASP. 

5.1 Client perceptions of HASP 

and how it supports their recovery 

There was overwhelming support for the program 

from the clients who we interviewed. Many provided 

examples of how HASP had helped them to reconnect 

with their community: 

It felt good coming back to my home town and 

stuff… bit like that…after being away for so long… 

to get back into the community, like you need 

a leg up sort of thing. HASP was just great. 

Consumer who had spent 18 months in a long stay unit 

One of the key aspects of the program was the support 

provided by support services. Support workers were 

perceived as providing support, motivating clients 

to achieve more from life and linking clients into the 

community: 

The HASP support workers… well they’re here to 

egg me on, bit of support, and bit more courage 

to get going because, you know I’m on pretty strong 

medication, but it has dropped, but they sort of egg 

me on for exercise and get me out in the community 

and talking to people. 

Male consumer 

Each client entering HASP received an establishment 

grant of $5,000 to buy ‘white’ goods and enable 

clients to pay for phone connection etc. This practical 

component of HASP was recognised by many of those 

interviewed: 

HASP has helped me a great deal, it’s brought me 

a fridge, a washing machine, furniture, TV, that was 

the $5,000 for the household stuff. Yes, I bought 


a brand new washing machine and a brand new 

fridge, the lounge suite and the TV cabinet and me 

bed and the lawnmower, it’s just sort of set me right 

up, so I would have been sort of buggered without 

it. It’s been great. 

Male consumer 

There was also a view that HASP was instrumental in 

assisting family members to cope with the burden of 

caring for a loved one. Families frequently struggle in 

the caring role because they may have to give up work 

to support their loved one. 

I’ve seen HASP clients helped so much. Like I’m 

working with a young fellow now… and I mean his 

mother had to give up work and everything to try 

and look after him and we’ve come on board and 

the family’s so happy — I mean she’s saying ‘oh now 

I can try and get my life back together and try and 

go back to work and all that’ So we aren’t only…the 

HASP packages aren’t only helping the client it’s 

helping their families and extended family and that, 

those that are normally stuck with the responsibility 

of caring for someone. 

Regional support worker 

It should be noted that this is not an isolated case. 

Clients provided numerous accounts of how HASP 

has helped them to move from a life fi lled with despair 

and isolation to one of hope and stable living in their 

own home.

5.2 Satisfaction with key life domains 

Much of the questionnaire data collected as part of 

the evaluation supports the views expressed above. 

Clients were asked to rate their satisfaction with a 

number of life domains on a seven-point scale ranging 

from 1 = ‘very dissatisfi ed’ to 7 = ‘very satisfi ed’ (thus 

a higher score represents higher levels of satisfaction). 

The items focused on a number of different domains, 

such as the way clients spend their time, their housing, 

mental health services they receive, the services they 

receive from the support agency, the neighbourhood 

as a place to live, personal safety, and access to 

transportation (see Fig. below). 

Fig. 5.1 Satisfaction with life domains 

Score 

7 

6 

5 

4 

3 

2 

1 

Spend 

time 


Neighbourhood 

Support agency 

Mental health 

service 

Transport 

Domain (1 = least satisfied to 7 = most satisfied) 

Personal 

safety 

The participants rated all domains as being positive, 

with many of the domains rated close to ‘6’ (out of a 

possible score of ‘7’). They were most satisfi ed by the 

services provided by the relevant support agency 

(mean score = 6.05) and least satisfi ed by the way 

they spent their time (mean score = 5.37). 

5.3 Involvement in vocational activities 

Clients were asked to outline their involvement 

in fi ve activity areas — paid employment, volunteer work, 

TAFE/study, Clubhouse/Rehab, and craft/leisure. Clients 

who claimed to have no involvement in any of these 

activities were classifi ed as having ‘no structured activity’ 

(Fig. 5.2). While eight of the 80 clients interviewed (10.0%) 

were in paid employment, the hours worked ranged from 

four to 60 per week with a mean of 18.06 hours worked 

per week. One client had two part-time jobs that required 

him to work 60 hours per week. They worked in industry/ 

factories (three), construction (two), pamphlet delivery 

(two), and newspaper delivery (one). 

In addition to paid employment, 13 (16.2%) clients 

indicated that they participated in volunteer work 

(such as bookshop, garden centre, shop assistant, 

sorting clothes with St Vincent de Paul, etc). The mean 

number of hours spent on volunteer work was 8.15 hours 

(range= two to 24 hours). Finally, eight clients (10%) 

indicated that they attended TAFE and other training 

programs. On average, clients spent 7.81 hours per week 

in education (range = one to 28 hours). 

Fig. 5.2 Main activity of HASP clients 

Percent 

60 

40 

20 

0 

Paid 

employ 

Legend Current 

situation 

Volunteer TAFE/ 

Training 

Clubhouse/ 

Rehab 

Desire 

for future 

Craft/ 

Leisure 

No 

structured 

activity 


49

50 

Section 5 The opportunities available through the program for clients 


Clients were asked to describe what they would like 

to have as their main activity. A large proportion 

(43.4%) indicated that they would like paid employment 

as their main activity in the future. This suggests that 

there is considerable scope for clients to focus on 

employment. Another 21% outlined that they would 

like to have craft/hobbies as their main activity. 

5.4 Involvement in activities 

Clients were also asked to rate how they felt about their 

level of involvement in the activities described above. 

They were asked to indicate whether they were engaged 

in activities ‘less than they would like’, ‘more than they 

would like’, and ‘as much as they wanted to be’. 

Overall, 60% of clients were happy with their 

engagement in activities. However, almost one-third 

of the clients indicated that they would like to be 

involved in activities more than they were at present. 

Further analysis of this data indicated that 67% of 

those who wanted more activities were the same group 

that indicated they wanted employment as their main 

activity (see graph below). 

Fig. 5.3 Client perceptions of level of engagement 

in activities 

Percent 

80 

60 

40 

20 

0 

Less than 

I would like 


More than 

I would Like 

Involvement in activities 

As much 

as I like 

5.5 Number of friends 

The number of friends one has can be one indicator 

of community integration. We asked clients to tell 

us about the number of people that they would call 

friends. While 7% of HASP clients claimed to have 

‘no friends’, over one-third indicated that they had 

more than fi ve friends. It is clear from the information 

collected that many clients included family members 

as their friends. 

Fig. 5.4 Number of friends 

Percent 

40 

30 

20 

10 

0 

None 

1–2 friends 

3–5 friends 

Number of friends 

5.6 Satisfaction with the number 

of friends they have 

The majority of clients were either very satisfi ed 

or moderately satisfi ed with the number people they 

called friends. 

Fig. 5.5 Satisfaction with number of friends 

Percent 

50 

40 

30 

20 

10 

0 

Very 

satisfied 

Moderately 

satisfied 

Neither 

Satisfaction with number of friends 

More than 

5 friends 

Moderately Very 

dissatisfied dissatisfied

5.7 Depth of friendships 

We explored ‘depth’ of friendships by asking HASP clients additional questions around key areas, such as support 

from friends if they were sick or feeling lonely (see table below). Note that clients were asked not to include 

support workers and mental health staff when considering the statements. 

While 86% of the HASP clients claimed to have between one to fi ve friends, 39% of the sample felt confi dent that 

they would be able to fi nd someone to ‘put them up’ if they needed somewhere to stay for a few days. However, 

45% felt that they would have trouble fi nding someone to drive them to hospital if they were ill. Indeed, over 

one-fi fth of clients indicated that they did not have ‘one person they could trust’. 

Table 5.1 Depth of friendships 

Statement Completely 

True % 

If I needed a place to stay for a few days, 

I could easily fi nd someone to put me up. 

If I was sick and needed someone to drive 

me to a doctor/hospital, I would have 

trouble fi nding someone. 

If I had to go into hospital for a couple of 

weeks, I could fi nd someone to look after 

my house (water plants, feed pet). 

When I need help to deal with a personal 

problem, I know someone I can turn to. 

When I feel lonely, there is someone I can 

call or talk to. 

There is at least one person in my life that 

I can trust. 

Somewhat 

True % 

Somewhat 

False % 

Completely 

False % 

38.7% 24.0% 10.7% 26.7% 

44.6% 12.2% 12.2% 31.1% 

37.2% 18.4% 8.2% 36.2% 

44.0% 28.0% 5.3% 22.7% 

60.8% 18.9% 4.1% 16.2% 

61.6% 16.4% 6.8% 15.1% 

The fi ndings indicate that over one-third of those who completed the survey had poor support from family and 

friends. For example, 36% outlined that if they needed a place to stay for a few days, they would not be able 

to fi nd someone to put them up. 


51

52 



5.8 Satisfaction with family relationships 

Most of the clients were satisfi ed with the relationships 

they had been having with their families. While 

15% were very dissatisfi ed with family relationships, 

65% were moderately satisfi ed to very satisfi ed 

(Fig. 5.6). 

Fig. 5.6 Satisfaction with family relationships 

Percent 

40 

30 

20 

10 

0 

5.9 Satisfaction with money 

Access to suffi cient money and control over money are 

important factors in being able to maintain life in the 

community. Overall, HASP clients were satisfi ed with 

the amount of money they had to spend. Moreover, 

they were also happy with the level of control they had 

over their money (Fig. 5.7). 

Fig. 5.7 Satisfaction with amount of money 

and control over money 

Percent 

40 

30 

20 

10 

0 

Very 

satisfied 

Very 

satisfied 


Moderately 

satisfied 

Neither 

Satisfaction with your family 

Moderately 

satisfied 

Legend Amount 

of money 

Neither 

Control 

over money 





The high satisfaction rating provided by clients 

for ‘control over their money’ is unusual given that 

51 of the 80 clients in the study (63%) had their 

fi nances managed by the Public Trustee. 

5.10 Lack of money 

The issue of clients not having suffi cient money 

to achieve their goals was also explored. Clients 

were asked to consider how often the lack of money 

prevented them from doing things that they would like 

to do. Some 75% of clients indicated that the lack of 

money prevented them from doing things frequently/ 

sometimes (Fig. 5.8). 

Fig. 5.8 How often does lack of money 

stop you from doing things? 

Percent 

40 

30 

20 

10 

0 

Never 

Sometimes 

Lack of money 

Frequently

5.11 Community involvement 

Clients were also asked to consider a number of activities that relate to community involvement and outline 

if they had participated in the named activity in the past month. The results are provided in the table below. 

Table 5.2 Activities carried out in the past month 

Activity ‘YES’ Did anyone help you? 

Number (%) 

a. Gone for a walk 63 (78.7%) Support worker/family 

b. Gone to a movie or play 58 (72.0%) Family/friends 

c. Watched TV or DVD/video 75 (93.7%) Self 

d. Played a sport 31 (38.7%) Support workers 

e. Gone to a social club 32 (40.0%) Family/friends 

f. Gone to church 22 (27.5%) Self 

g. Gone to a library 36 (45.0%) Support workers 

h. Gone to a coffee shop 48 (60.0%) Family/friends 

i. Gone ‘window’ shopping 35 (43.7%) Family/Support workers 

j. Played a computer game (e.g. Wii) 20 (25.0%) Support workers 

k. Gone to a friend’s place 30 (37.5%) Friends 

The highest-ranked activity was watching TV, which was carried out by over 93% of individuals. Eighty-fi ve 

percent claimed to have gone to a movie or a play in the past month. Going to church (27.5%) and playing a sport 

(38.7%) were low-participation activities. Clients received assistance with these activities from either support 

workers or family members. 


53

54 



5.12 Client goals 

Clients were asked to provide their main goal (i.e. What is your main goal at the moment?). A range of goals 

was provided and these were categorised under four main themes that seemed to cover the content (Table below). 

The most commonly mentioned goal concerned work and ‘getting a job’. Of the 56 consumers who provided 

a response to this question, 15 made comments that related to fi nding a job. 

Table 5.3 The main goal of clients at follow-up 

Themes Examples of Content 

Finding 

a Job/Training 

(n=15) 

Staying 

Healthy 

(n=12) 

Travel 

(n=10) 

Family 

Contact 

(n=8) 


Further my education and get a job 

Get a job and get married 

Get a job and make some money 

Eat well and exercise 

Get a stronger body 

Stay out of hospital 

Keep the illness under control 

Go to America 

Visit England 

Have a holiday in Cairns 

Get a girlfriend and get married 

Get my family back together 

See more of my daughter 

Get part-time work 

To fi nd work 

Do a TAFE course 

Become a support worker 

Get fi t 

To fi nd happiness and joy in my life 

Stay alive 

Leave it all behind me and move on 

Visit family up north 

Get a car 

Get my ‘learners’ and a car 

Get the family up to visit 

Write a letter to mum 

Clients were asked if being involved with HASP had helped them to work towards their goals. Of the 73 clients 

who completed this question, 60 (82.2%) indicated that involvement in HASP had helped them to achieve 

their goals.


During our interviews with clients (and staff) we heard 

accounts of the way that HASP had helped clients to 

move from a life fi lled with despair and isolation to 

one of hope. All of the individuals (staff and clients) 

felt that the housing and support provided through 

HASP were essential in promoting recovery for clients. 

The clients were asked to consider a number of life 

domains. They were most satisfi ed by the services 

provided by their support agency (mean score = 2.05) 

and least satisfi ed by the way they spent their time 

(mean score = 1.37). We further explored the way in 

which clients spent their time. While eight of the 

80 HASP clients (10.0%) were in paid employment, 

the hours worked ranged from four to 60 per week 

with a mean of 18.06 hours worked per week. One 

client had two part-time jobs which required him 

to work 60 hours per week. Most worked as factory 

hands, in construction or on paper delivery jobs. 

A large proportion of clients (43.4%) indicated that 

they would like paid employment as their main activity 

in the future. This suggests that there is considerable 

scope for clients to focus on employment. Another 

21% outlined that they would like to have craft/ 

hobbies as their main activity. 

While 86% of the HASP clients claimed to have 

between one to fi ve friends, 39% of the sample 

outlined that they would be able to fi nd someone 

to ‘put them up’ if they needed somewhere to stay for 

a few days. In addition, 44% felt that they would have 

trouble fi nding someone to drive them to hospital if 

they were ill. Indeed, over one-fi fth of clients indicated 

that they did not have ‘one person they could trust’. 

Access to suffi cient fi nance and control over that 

money are important factors in being able to maintain 

life in the community. Overall, HASP clients were 

satisfi ed with the amount of money they had. 

Moreover, they expressed high levels of satisfaction 

with the amount of control they had over their money. 

This was somewhat surprising given that 51 of the 

80 clients in the study (63%) had their fi nances 

managed by the Public Trustee. Indeed, having their 

fi nances managed by the Public Trustee enabled some 

clients to purchase goods and services that they could 

never previously afford. By way of example, one client 

was able to save enough money to have a holiday in 

Cairns, while another outlined how he was able to 

buy a racing bicycle. Nonetheless, three-quarters 

of clients indicated that the lack of money prevented 

them from doing things they wanted to do either 

‘frequently’/‘sometimes’. 

Clients provided a range of goals. These were 

categorised into four themes — staying healthy, 

fi nding a job, travel and connecting with family. 

Eighty-two percent indicated that involvement 

in HASP had helped them (or was currently helping 

them) to achieve their goals. 


55

56 

Section 6 

The ability of the program to maintain clinical functioning and provide 

an acceptable quality of life for those supported by the program 

This section of the report explores factors related to clinical functioning and how these 

are maintained under HASP. Factors such as changes in clinical functioning, medication use, 

physical health, client goals, participation in meaningful activities, employment, level of 

independence and the need for inpatient care are discussed. 

6.1 Readmissions to acute 

inpatient care 

The need for readmission to acute care is one indicator 

of how well a program can maintain clinical functioning 

in individuals with high levels of disability. Of the 

80 clients in our sample, admission data (number 

of admissions and length of stay) were available for 

70 clients at 12 months prior to entering HASP and 

12 months post-entry into HASP. While 61 of the 

70 clients for which data were available (87.1%) 

required time in hospital in the 12 months prior to 

HASP, 41 of these clients spent the entire 12 months 

in hospital prior to entry into HASP. However, following 

entry into HASP, only 26 clients (37.1%) required time 

in hospital in the 12 months post-HASP. 

The average time in inpatient care for each individual 

in the 12 months prior to HASP decreased signifi cantly 

from an average of 227 days to an average of 

18.9 days in the 12 months post-HASP. This reduction 

in inpatient bed days was statistically signifi cant 

(paired t = 10.44, p=0.001). Finally, the number of 

admissions also decreased signifi cantly from an 

average of 1.22 admissions in the 12 months prior to 

HASP, to an average of .66 admissions per individual 

in the 12 months post-HASP (paired t = 3.22, 

p=0.002). 


6.2 Changes in functioning 

As noted earlier, ‘outcomes’ data were obtained from 

the Queensland Health Information System ‘CIMHA’ 

for the 77 clients who provided written consent for 

their data to be used for the evaluation. (Three clients 

refused to provide consent for their outcomes data 

to be used in this way). Having identifi ed the date 

that each individual entered HASP, it was possible to 

obtain the outcomes data from CIMHA for clients at 12 

months and three months prior to entering HASP and 

for three months and 12 months after entering HASP. 

The mean scores for the both the Life Skills Profi le 

(LSP) and the Health of the Nation Outcome Scales 

(HoNOS) are summarised in the graph below. The LSP 

provides a measure of general life skills functioning, 

while the HoNOS provides an assessment of disability 

and clinical functioning. There was a considerable 

amount of missing data for the 77 clients. HoNOS data 

were available for 33 of the 77 clients across all four 

time-points, while LSP data were available for 17 of the 

77 clients across all four time-points. 

Fig. 6.1 Changes in functioning 

Score 

20 

15 

10 

5 

0 

Legend 

HoNOS (n=33) 

12 

months 

pre 

3 

months 

pre 

LSP (n=17) 

3 

months 

post 

12 

months 

post 

Overall, the clients, as a group, demonstrated 

improvement in functioning as indicated by the lower 

mean scores (lower scores on these scales indicate

etter functioning). However, while these changes/ 

improvements approached signifi cance, they were 

not statistically signifi cant. 

6.3 Clients who improved, stayed the 

same, or deteriorated 

While some of the clients improved, others remained 

the same or deteriorated. Identifying the proportion 

of clients in each of these groups is a useful method 

of assessing outcomes. To identify those in the three 

categories (improved, remain the same, deteriorated) 

we added the two-scale scores pre-HASP (i.e. the 

score for HoNOS at 12 months pre and three months 

pre) and subtracted the combined score from the two 

measures post-HASP. This provided a range of ‘change’ 

scores. We then calculated the standard deviation for 

the change scores. One standard deviation around the 

mean was used to differentiate between clients in each 

of the groups. Thus, clients with a total scale score 

greater than .5 of a standard deviation above the mean 

were classifi ed as having highly deteriorated (since 

a higher score represented more severe problems). 

Those with scores less than .5 of a standard deviation 

below the mean were classifi ed as having improved, 

while those with scores ± .5 of a standard deviation 

around the mean were classifi ed as having remained 

the same. The data for each category is summarised 

in the Table below. 

Table 6.1 Proportion of clients who improved, 

stayed the same, or deteriorated 

Group Proportion 

of clients who 

improved, stayed 

the same or 

deteriorated 

Life Skills Profile 

(LSP Data) 

Proportion 

of clients who 

improved, stayed 

the same or 

deteriorated 

Health of the 

Nation Outcomes 

(HoNOS Data) 

Improved 51.0% 42.9% 

Stable 19.6% 33.3% 

Deteriorated 29.4% 23.8% 

It is clear from the data that just over half of the clients 

in the study group improved on measures of their life 

skills performance, while 43% showed improvement 

on clinical functioning. 

6.4 Perceptions of change in client 

functioning — Case Managers versus 

support workers 

Case Managers (n=40) and support workers (n=58) 

were asked to indicate their level of agreement with 

the statement ‘the functioning of HASP clients has 

improved in the past six months’. The responses 

for both groups are compared in the graph below. 

Fig. 6.2 Change in client functioning — 

past six months versus next six months 

Percent 

100 

80 

60 

40 

20 

0 

Legend 

Strongly 

agree 

Agree 

Case 

Managers 

Neither 


workers 

Disagree 

Strongly 

disagree 

Sixty-two percent (62%) of Case Managers agreed that 

the functioning of HASP clients had improved over the 

past six months. This is compared with 69% of support 

workers who believed that the functioning of HASP 

clients had improved over the past six months. 


57

58 

Section 6 The ability of the program to maintain clinical functioning and provide 


6.5 Perceptions of future improvement 

in clients — Case Managers versus 

support workers 

Case Managers and support workers were also asked 

to consider the statement ‘the functioning of HASP 

clients will continue to improve in the next six months’ 

(graph below). 

Fig. 6.3 Change in client functioning — 

past six months versus next six months 

Percent 

100 

80 

60 

40 

20 

0 

Legend 

Strongly 

agree 

Sixty-six percent (66%) of Case Managers indicated 

that the functioning of their HASP clients would continue 

to improve in the future. In contrast, 81% of support 

workers believed that the functioning of HASP clients 

would continue to improve in the future. 


Agree 

Case 

Managers 

Neither 


workers 

Disagree 

Strongly 

disagree 

The support workers who felt that clients would 

continue to improve suggested that clients had 

someone to talk to, they received positive feedback 

and encouragement from staff, and clients had their 

own homes in the community. Receiving a HASP 

package and the dedication of all staff/agencies 

were also seen as likely to contribute to ongoing 

improvement in HASP clients. Case Managers felt 

that while the NGO sector would continue to contribute 

to client functioning, gains in functioning would be 

limited by the severity of disability in some clients. 

6.6 Changes in Mental Health Act 

(MHA) status 

The status of clients under the Mental Health Act on 

entry into HASP was accessed using data contained 

in the CIMHA database. This information was then 

compared with the status of clients at the point of 

data collection (Mar–June 2010). Data for 76 clients 

was available for both time-points. Over the study 

period, restrictions placed on clients had been 

signifi cantly relaxed (Chi sq. = 12.59, p = 0.002). 

The proportion of clients on Involuntary Treatment 

Orders (ITOs) decreased from 46% to 22%, while the 

proportion of clients with voluntary status increased 

from 43% to 70% (Table 6.2). 

Table 6.2 Changes in mental health status 

of HASP clients 

MHA status on 

Admission to HASP 

(n=76) 

Voluntary 33 (43.4%) 

ITO 35 (46.1%) 

Forensic 8 (10.5%) 

MHA status 

at end of June 2010 

(n=76) 

Voluntary 53 (69.7%) 

ITO 17 (22.4%) 

Forensic 6 (7.8%)

6.7 Physical and mental health 

Links between mental illness and premature death 

have brought the physical health of individuals with 

mental health conditions into focus in recent times. 

We invited clients to provide a rating of their physical 

health. While 35% of clients rated their physical health 

as very good/excellent, 25% rated their physical 

health as being poor/fair (see graph below). Almost 

half of the clients (49.3%) indicated that they had a 

physical health problem and 33% claimed to be taking 

medications for physical health problems. 

Fig. 6.4 Rating of physical and mental health 

Percent 

45 

40 

35 

30 

25 

20 

15 

10 

5 

0 

Poor 

Legend Physical 

health 

Fair 

Good 

Mental 

health 

Very 

good 

Excellent 

Three-quarters of the clients (n=60) smoked cigarettes 

with a daily intake of between fi ve and 50 cigarettes 

(average daily use was 20.5 cigarettes, sd= 8.2). In the 

month prior to interview, 41 clients (53.9%) had drunk 

alcohol, with two clients claiming to have had alcohol 

on every day in the past month. One-third of those who 

had alcohol had only two drinks on the days that they 

consumed alcohol. Four of the clients claimed to have 

had cannabis in the month prior to interview. 

6.8 Overall quality of life 

An overall rating of quality of life was obtained by 

asking clients to rate their quality of life on a 10-point 

scale where ‘1’ was the worst quality of life possible 

and ‘10’ was the best quality of life possible. HASP 

clients provided a mean rating of 6.87 out of a possible 

total score of 10. 

Fig. 6.5 Rating of overall quality of life 

Percent 

25 

20 

15 

10 

5 

0 

One 

Two Three Four 

Five 


Six 

Seven Eight 

Nine 

Ten 


59

60 

Section 6 The ability of the program to maintain clinical functioning and provide 


6.9 Emotional responses experienced 

External observers frequently comment that clients 

living in supported housing models are lonely, 

bored, depressed, etc. To assess this, we asked 

HASP clients to outline how they felt about a number 

of psychological emotions that one experiences in 

everyday life. Clients were asked to think about the 

past month and indicate if they had experienced the 

emotions indicated in the past month. The responses 

are provided in the table below. 

Table 6.3 Emotional responses experienced 

in past month 

In the past month have you been… Yes% 

a. pleased about having accomplished 

something? 


85.7 

b. lonely? 40.3 

c. bored? 50.6 

d. happy that things went your way? 79.2 

e. so restless that you couldn’t sit long 

in a chair? 

f. proud because someone complimented 

you on something you had done? 

31.2 

77.6 

g. upset because someone criticised you? 27.3 

h. particularly excited or interested 

in something? 

67.5 

i. depressed or very unhappy? 31.2 

j. on top of the world? 60.5 


accomplished something in the past month. While we 

did not ask what had been accomplished, some clients 

did volunteer answers which included staying well, 

being able to stay out of hospital, making a new friend 

or getting a job or volunteer work. A further 80% were 

happy that ‘things had gone their way’ and were proud 

that someone had complimented them on something 

they had done (77%). 

On a negative note, just over 40% claimed to have 

felt lonely and over 30% indicated that they had felt 

depressed in the past month. In addition, just over 

50% felt bored. Additional analysis of these responses 

found that most of the clients who indicated that they 

were lonely, bored or depressed were actually the 

same clients. Thus individuals who indicated that they 

were lonely were also likely to indicate that they were 

bored and or depressed.


The average time spent in inpatient care for each 

individual decreased signifi cantly from an average of 

227 days in the 12 months prior to HASP, to an average 

of 18.9 days in the 12 months post-HASP. Moreover, 

the number of admissions also decreased signifi cantly 

from an average of 1.22 admissions in the 12 months 

prior to HASP, to an average of 0.66 admissions per 

individual in the 12 months post-HASP. 

In terms of functioning, there was a trend towards 

improved clinical and general functioning. While 

improvements were not statistically signifi cant, the 

clients as a group did not deteriorate following entry 

into HASP. Indeed, the fi ndings indicate that over half 

of the clients improved in general functioning and over 

40% in their clinical functioning in the 12 months since 

joining HASP. 

It would appear that support workers are more 

positive than Case Managers about the potential 

for the functioning of clients to change in the future. 

However, it should be noted that ‘functioning’ can 

have different meaning among different groups. For 

example, functioning for a Case Manager could imply 

clinical functioning, while functioning for a support 

worker could mean general/life skills functioning. 

The literature suggests that while life skills are likely 

to improve over time, improvement in clinical 

functioning, particularly in the area of symptoms, 

is much more diffi cult to achieve. 

Restrictions placed on clients through the Mental 

Health Act had been signifi cantly relaxed since clients 

joined HASP. The proportion of clients on Involuntary 

Treatment Orders (ITOs) decreased from 46% to 

22%, while the proportion of clients with voluntary 

status increased from 43% to 70%. 

Almost half of the clients (49.3%) indicated that they 

had a physical health problem, while 33% claimed 

to be taking medications for physical health problems. 

Three-quarters of the clients (n=60) smoked with a 

daily intake of around 20 cigarettes. In the month prior 

to interview 41 clients (53.9%) had consumed alcohol, 

with two clients claiming to have had alcohol on every 

day in the past month. One-third of those who had 

alcohol had consumed only two drinks on the days that 

they had alcohol. Four of the clients claimed to have 

had cannabis in the month prior to interview. 

Clients rated their overall quality of life with a mean 

rating of 6.87 out of a possible total score of 10. 

Notwithstanding these positive views, just over 

40% claimed to have felt lonely and over 30% indicated 

that they had felt depressed in the past month. 


61

62 

Section 7 

How do costs of providing care under HASP 

compare with alternative care options? 

A comprehensive economic evaluation of HASP would require considerable time and 

expertise (Lapsley et al., 2000) and, as such, is beyond the scope of this broader evaluation. 

In the absence of an in-depth economic evaluation, we have provided ‘estimates’ of the 

costs associated with both community and inpatient options. As such, a degree of caution 

is required when quoting or using the data from this section of the report. 

The costs associated with sourcing accommodation, 

locating support services and transitioning individuals 

into the community are diffi cult to quantify. Recurrent 

costs are much easier to identify since they are likely 

to be tied to each individual. An estimate of the 

recurrent costs associated with inpatient and 

community care are provided below. 

7.1 Costs associated with 

community care 

There are three major contributors to the recurrent 

cost of community care — (i) costs associated with 

non-clinical support services (support agency, support 

workers), (ii) costs associated with the provision of 

mental health services (Case Manager, GP, etc) and 

(iii) inpatient care costs for those requiring admission 

to hospital. These different cost drivers are discussed 

below. 

(i) Disability support costs 

The average cost of providing disability support was 

estimated to be $47.50 per hour. This includes the cost 

of providing ‘in-home’ support services to clients and 

the administration costs associated with supervision 

and service coordination. Given that the average client 

was receiving 20 hours of support per week at followup, 

this would equate to a cost of $950 per week or 

$49,500 per annum. 

(ii) Case management costs 

The major costs in this category include those incurred 

in the provision of mental health services (e.g. case 

management and GP services). Given that the majority 

of clients receive a visit from their Case Manager 

every two weeks, or visit to a GP every two weeks, 

the estimated average cost is $4,500 pa (i.e. 30 visits 

per year at $150 per visit). 


(iii) Inpatient care costs 

Despite the best efforts of all involved, a subgroup 

of clients will require admission to inpatient care. 

The average daily cost of an acute inpatient care 

in Queensland is estimated to be $670 per day 

(K Fjeldsoe, personal communication, Oct 2010). 

The average length of stay for those admitted to acute 

inpatient care in the 12 months post-HASP was 18.9 

days. We have allocated one admission per client, per 

year, however, this is likely to be an overestimate given 

that the majority of clients did not require hospital 

admission (only 36.6% of clients required admission 

to acute inpatient care since joining HASP). Thus 

the cost of keeping a client in hospital post-HASP 

is approximately $12,663 (based on an average stay 

of 18.9 days at a cost of $670 per day). 

Table 7.1 Estimated costs of keeping client in HASP 

for 12 months 

Disability support costs 

Case management costs 

Acute inpatient care costs 

(per admission) 

TOTAL $66,663 

$49,500 

$ 4,500 

$12,663 

In summary, the approximate recurrent cost for the 

‘average’ client in HASP (who has one admission to 

acute inpatient care in a given year) is $66,663 per 

year or $183 per day. Should the patient not require 

admission to acute care, the cost decreases to 

$54,000 or $148 per patient day.

7.2 Comparing HASP with inpatient/residential alternatives 

It should be noted that HASP clients could enter the program from a range of facilities, including acute inpatient 

units, community care units (CCUs) and extended treatment and rehabilitation units. It is reasonable to conclude 

that if clients could not access HASP, they would remain in one of these residential facilities. Thus it is useful to 

compare HASP costs with those associated with these ‘alternate’ facilities. The estimated costs of care in these 

facilities are provided in the table below. As a consequence of the additional costs associated with the provision 

of infrastructure, such as libraries and education departments at psychiatric hospitals (where two of the largest 

extended treatment units are located), the bed day cost at extended treatment and rehabilitation units is 

signifi cantly higher than at CCUs. 

Table 7.2 Cost of care — HASP versus alternative options. 

Service Type Annual/Daily Cost 

Acute Inpatient Unit 

Community Care Unit 

Extended Treatment & Rehabilitation 

Project 300 

HASP (with one acute admission) 

HASP (no admission) 

7.3 Cost of care pre and post-HASP 

Of the 80 clients in our sample, we have admission 

data (number of admissions and length of stay) for 

70 clients at 12 months prior to entering HASP and 

12 months post entry into HASP. The average time 

in inpatient care prior to HASP was 227 days and 

the average time post-HASP was 18.9 days. Most of 

the clients entered the program from an extended 

treatment and rehabilitation unit or from a community 

care unit. Given the cost estimates outlined in the 

table above, the average cost of care in an extended 

treatment unit for the 70 clients in the 12 months prior 

to HASP would be $147,550 per client (for a stay of 

227 days), while the average cost post-HASP was 

$12,663 per client (for a stay of 18.9 days). 

$244,550 pa. ($670 per day) 

$140,525 pa. ($385 per day) 

$200,750 pa. ($650 per day) 

$ 60,626 pa. ($166 per day – in 2007) 

$66,663 pa. ($183 per day) 

$54,000 pa. ($148 per day) 


It should be noted that there are considerable ‘upfront’ 

costs involved in sourcing accommodation for programs 

such as HASP. Most housing providers do not have a 

supply of surplus housing, therefore, housing options 

have to be purchased or constructed to meet the 

additional demand generated by these programs. These 

costs have not been considered in our estimate as they 

are diffi cult to estimate with any degree of accuracy. 

The recurrent costs for a client with an average of 

20 hours of support per week ($66,663) are signifi cantly 

less expensive than keeping the same client in acute 

inpatient care or in a CCU. Indeed, our fi ndings suggest 

that it would be possible to keep two clients in HASP for 

the cost of keeping one client in a CCU, or four clients 

in HASP, for the cost of keeping one client in an acute 

inpatient unit. 


63

64 

Section 8 

Discussion 

The purpose of this study was to ‘undertake an evaluation of the Housing and Support 

Program (HASP) to determine delivery and outcome effectiveness and effi ciencies, as well 

as to identify and recommend opportunities for the future management of the program.’ 

The evaluation team was asked to focus on: 



the process of providing clinical, non-clinical 




in community life — the focus here will be on social, 

recreational, educational, and vocational activities 





A degree of caution is required in attempting to 

generalise the results of this study to other settings 

or populations. The clients in our sample volunteered 

to participate when invited to do so. As such, they may 

be different from those who declined to participate 

in important ways that may have an impact on the 

fi ndings. Notwithstanding this, the 80 HASP clients 

who contributed to the evaluation from across 

Queensland are likely to represent the broader 

population of clients in the program. 


8.1 The effectiveness of the collaborative 

process established across agencies 

It was apparent from discussions with staff at the 

coalface that many were concerned about interagency 

collaboration and communication within the program. 

It was felt that a single point of contact for HASP was 

required within each district. Some aspects of this 

role have been provided by Supports Facilitators 

across the state. However, the reforms outlined in the 

Growing Stronger reforms indicate that the Supports 

Facilitator role is likely to change. Supports Facilitators 

will have less input into programs such as HASP. 

It has been suggested that the role of the current 

Service Integration Coordinator (SIC) position could 

be broadened to provide these functions. Indeed, 

many of the Service Integration Coordinators have 

been invaluable in improving coordination between the 

agencies involved in HASP. However, there is variation 

in the way in which the role has been interpreted and 

implemented. It is clear that some clarity is required 

around the role to be provided by Service Integration 

Coordinators and their involvement, if any, in programs 

such as HASP. 

Many people noted the arduous nature of completing 

the paperwork to nominate clients for HASP. The 

paperwork required and the quantity of supporting 

documentation made the application process 

cumbersome and time-consuming. It was noted that 

in smaller teams it can be extremely diffi cult to fi nd an 

occupational therapist to provide an assessment, or to 

obtain a report from a psychiatrist. As a consequence, 

many of the clinical staff interviewed suggested 

changes to the selection process at the district level. 

It was proposed that the Case Manager could complete 

a one/two-page summary for their nominated client/s 

and then present this to their District Review Team. 

The District Review Team could ask questions of the 

Case Manager and prioritise nominations. Once a client 

had been shortlisted to advance to the next level, the 

Case Manager would provide a more detailed written 

application, which could then be submitted formally 

to the statewide panel. This would increase the quality

of applications, increase Case Manager involvement 

with the process, improve the estimation of support 

needs, and may decrease the risk of inappropriate 

clients being nominated. 

Notwithstanding the above concerns, there was a 

general impression that the appropriateness of HASP 

referrals had improved in recent years. The information 

sessions provided across the state by members of 

the HASP Operational Partnership were seen as being 

useful for clinical staff in decision-making around 

client selection for HASP. Nonetheless, there was 

a perception among some support agencies that 

mental health staff were using the program to 

discharge their most diffi cult clients. Many of these 

clients were considered inappropriate for HASP as 

they required more support hours than could be 

provided through HASP. This is similar to fi ndings 

from earlier work carried out in New South Wales, 

which suggests that mental health services nominated 

their most disabled clients, many of which were 

inappropriate, for the housing and support program 

(Muir et al., 2006). 

A number of stakeholders noted that some clients have 

three care plans — a transition plan, a plan developed 

by clinical services and a plan developed by the 

support agency. It is diffi cult to see how a coordinated 

approach to service provision can be maintained when 

individual clients have up to three care plans. Each 

client should have a single care plan which has input 

from all stakeholders, including the client. This care 

plan should be used to guide interventions with the 

client and be reviewed and updated on a regular basis 

— at least every three months. 

Finally, communication at the local level can also be 

problematic when a range of staff is involved with the 

same client. We found that one agency was using a 

diary (kept in the homes of clients) to keep a record 

of appointments and other activities carried out for 

clients. All persons entering the home of the client 

were encouraged to make an entry in the diary so as a 

record of the visit was documented. The diary provides 

a record of visitors to the home (including staff), an 

audit trail of interventions carried out and the date 

the interventions were provided. It is suggested that 

all support agencies consider using a diary to improve 

communication between staff and staff, and staff 

and clients. 

8.2 The process of providing clinical, 


to clients 

Clinical Service Provision 

Clinical service provision within HASP is usually 

provided by Case Managers employed by Queensland 

Health. The primary role of Case Managers is to provide 

clinical interventions such as assessment, illness 

monitoring and treatment. Case Managers were held 

in high regard by clients. Many clients attributed 

improvements in their health to their Case Managers. 

Indeed, over 60% of clients believed that their Case 

Manager helped them with their symptoms. Most 

clients (89%) indicated that they could get in contact 

with their Case Manager if they had a problem. 

Both Case Managers and support workers expressed 

satisfaction with the collaborative working 

relationships they have developed. Ninety-fi ve percent 

of Case Managers outlined that they valued the 

support worker role and 92% felt that support workers 

had a valuable role to play in the treatment planning 

process. Despite this, some support workers felt that 

they could have greater involvement in decisions and 

planning around patient care. 

Support workers also raised concerns about 

Case Manager involvement in HASP and felt that 

Case Managers could play a greater role in the overall 

program. Reasons highlighted for the perceived 

lack of involvement included the high caseloads that 

some Case Managers were expected to carry and the 

presence of support workers in the lives of the clients. 

Case mangers were aware that support workers 

would contact them if they observed changes in client 

symptoms/behaviour. Muir and colleagues (2007), 

in a NSW study, found that Case Managers had less 

involvement with clients supported by NGOs due 

to the auxiliary services provided by support workers 

(Muir et al., 2006). 


65

66 

Section 8 Discussion 

Non-clinical Service Provision 

Support services are often essential in compensating 

for the lack of a family network and/or reducing the 

burden of care placed on carers (Oliver et al., 1996). 

They assist people to navigate the fragmented maze 

of mainstream social and disability services by 

linking people to community-based recreational and 

vocational services. Non-government organisations 

have been able to develop models of care that allow 

for the episodic and fl uctuating nature of chronic 

illness. Moreover, the community focus of the disability 

sector, which is not treatment or illness-orientated, 

offers an alternative to existing medical models. 

Many of the clients spoke about their relationship 

with their support workers and described them 

as friends, mates and companions. The issues of 

friendship between support workers and clients can 

be viewed in different ways. On one hand, support 

workers who are too successful at becoming friends 

for clients may defeat the long-term goal of reducing 

contact with clients (i.e. as independence increases). 

On the other hand, clients making friends with those 

people with whom they have most contact is not only 

a good survival strategy, but also exercises a capacity 

for friendship which can be used outside the home 

environment to widen support networks. 









were involved in developing care plans for clients. 

However, in most support agencies this task is left to 

the Supports Coordinator who disseminates relevant 

information to the support workers. 

Training for support workers was raised by Case 

Managers and support workers themselves. Both 

groups felt that support workers require more training 

in a range of areas to enable them to work with clients 

who have complex needs. Indeed, almost half of the 

support workers involved in the study (45%) felt they 

required more training to be able to work effectively 

with their HASP clients. Training in the use of recovery 

principles was identifi ed as a key area for additional 


training. While 85% outlined that they were familiar 

with the principles of recovery, 37% felt that they 

needed more training in the use of recovery 

principles in practice. 

Support workers highlighted issues with transport, 

lack of money and lack of motivation in their clients 

as key areas of concern. Lack of motivation in clients 

was mentioned by most of the support workers who 

participated in the study. Support workers found it 

diffi cult to engage clients in exercise or activities 

outside the home. One support worker described 

her client as being a ‘bit lazy… it’s so diffi cult to get 

him to do anything’. The issue here is unlikely to be 

laziness, rather a lack of motivation that is frequently 

found in conditions such as schizophrenia. Acquiring 

a better understanding of this issue (through training) 

may help support workers to appreciate consumer 

behaviours and how best to work with these. 

The disability support sector has demonstrated its 

ability to manage people with severe and persistent 

psychiatric disability in community settings. However, 

there is a danger that the disability sector will expand 

to meet needs that should be met by other services — 

a problem that has plagued the mental health sector 

for years. This could further marginalise and isolate 

people with mental illness. Onyett & Smith (2001) 

noted that the correct mix of clinical and non-clinical 

staff on mental health teams continues to be widely 

debated. Both groups of staff seem to be dependent 

on each other. Non-clinical support staff depend 

on clinical staff to ensure that adequate treatment 

and symptom control is provided to maximise the 

outcomes of support. Clinical staff, on the other 

hand, depend on non-clinical staff to provide lifestyle 

support to maximise the outcomes of treatment. 

The fi ndings suggest that support agencies were able 

to reduce the levels of support provided to clients over 

the study period. Support hours provided each week 

decreased by an average of 7.13 hours, from a mean 

of 27.6 hours on entry into HASP to a mean of 20.4 

hours at the follow-up time-point. However, fl exibility 

of funding within the model needs to be continuously 

monitored as there is potential for over-servicing. 

Strauss (1996) notes that fl exibility in support should 

form the cornerstone of any disability support program 

and stresses that disability services should be on 

tap, not on top. In other words, services should be

available when and where needed by clients. It is 

clear that the provision of support services should be 

based on some ongoing assessment of client need, 

and services should be provided to match this need. 

In relation to HASP, there needs to be greater clarity on 

how decisions are made regarding the level of support 

provided to individuals within the model. 

While support agencies have greater freedom to 

meet client support needs within the ‘block’ funding 

model, there appears to be less fl exibility for clients 

to move between service providers. Clients wishing to 

transfer to another agency have to fi nd an agency with 

suffi cient funding capacity to cater for their support 

needs (since the transferring agency retains the 

funding). This can be especially diffi cult for consumers 

with large support packages. Thus, there needs to 

be a review of the block funding model to ensure that 

there is suffi cient fl exibility to enable clients to move 

between agencies if they so desire. 

Accommodation Services 

The provision of appropriate and affordable 

accommodation was considered by the clients 

and staff interviewed to be one of the most important 

components in the success of HASP. While it is clear 

that housing has a physical component (i.e. an 

identifi ed building), it also provides people with a 

sense of identity and ‘asylum’ from the outside world. 

The quality of housing has been found in previous 

studies to impact on the rehabilitation, functioning, 

and quality of life of people with mental illness. 

Individuals living in appropriate housing that met their 

needs had better outcomes at follow-up (Nelson et al., 

1995; Baker & Douglas, 1990; Rosenfi eld, 1990). 

Having enough space was an important factor in 

overall satisfaction with accommodation. Clients 

valued having a spare bedroom for visiting family 

members. Others, with a fl air for art and other hobbies 

valued having a second bedroom which they used as a 

studio. However, some clients experienced diffi culties 

when friends of family members moved in to a spare 

room. Having people staying became a source of 

stress when these people refused to leave or began to 

demand food and money from the client. Thus, careful 

assessment of the client and their need for additional 

bedrooms needs to be carried out as part of the 

process of allocating accommodation. 


However, 22% felt that they would like to live with 

a roommate or friend in the future. The evaluation 

team notes that while HASP clients are not prevented 

from sharing accommodation, they are unable to share 

the support services they receive. It may be worth 

exploring how the program can better facilitate share 

housing for a small sub-group of clients who may 

prefer this option. 

Fourteen of the 80 clients in our sample had moved 

accommodation since joining HASP. Eleven of these 

had moved once, one had moved twice and two had 

moved thrice. There were three main reasons cited 

for moving — noise from neighbours and or unable 

to get along with neighbours (n=8), dislike of the area 

in which they lived (n=3), and to be closer to family 

(n=3). While client requests to move accommodation 

could be viewed as a negative for the program, it is 

reassuring that clients can ask to be relocated to a 

new neighbourhood and this appears to be feasible 

within HASP. 

It is clear that having one’s own home in the 

community provides a connectedness to that 

community. Themes that emerged from the interviews 

with clients suggest that stable housing plays an 

important role in one’s recovery. Clients viewed their 

housing as being important in providing stability in 

their lives and a platform from which to participate 

in the recovery process. Two other themes to emerge 

included a ‘sense of freedom’ and a ‘sense of home’. 


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68 


8.3 The opportunities available through the program for clients to maximise their 

recovery and participate in community life — the focus here will be on social, 

recreational, educational and vocational activities in the community 

During interviews with clients we heard several 

accounts of how HASP had helped them to move from 

a life fi lled with despair and isolation to one of hope. 

All of the clients interviewed felt that the housing and 

support provided through HASP were essential in 

promoting recovery. While eight of the 80 HASP clients 

(10%) were in paid employment, the hours worked 

ranged from four to 60 per week, with a mean of 

18.06 hours worked per week. However, it should 

be noted that over 40% of clients indicated that they 

would like to have paid employment as their main 

activity. Thus, there is some scope to engage with 

these clients and link them into training or other 

activities, such as volunteer work, to improve their 

chances of securing paid employment in the future. 

While 39% of the sample outlined that they would 

be able to fi nd someone to ‘put them up’ if they 

needed somewhere to stay for a few days, 44% felt 

that they would have trouble fi nding someone to drive 

them to hospital if they were ill. Indeed, over one-fi fth 

of clients indicated that they did not have ‘one person 

they could trust’. It is clear that many of the clients who 

claimed to have friends, included family members as 

friends. Indeed, over one-third of the clients outlined 

that they felt lonely and bored in the month prior to 

data collection. 

Access to suffi cient money and control over money 

are important factors in being able to maintain life 

in the community. Overall, HASP clients were satisfi ed 

with the amount of money they had to spend. Moreover, 

they expressed high levels of satisfaction with the 

amount of control they had over their money. This was 

somewhat surprising given that 51 of the 80 clients 

in the study (63%) had their fi nances managed by the 

Public Trustee. However, having their fi nances managed 

by the Public Trustee enabled some clients to purchase 

goods and services that they could never previously 

afford. By way of example, one client was able to save 

enough money to have a holiday in Cairns, while another 

described how he was able to buy a racing bicycle 

(something he had wanted to do for a number of years, 

but never had enough money to do so). 


Nonetheless, clients should be encouraged (where 

possible) to manage their own fi nances. This may 

require further education and close monitoring of 

spending behaviour until clients gain skills in money 

management. 

It is clear from the interviews with clients that access 

to transport is an import factor in their lives. While 

public transport is frequently available, many clients 

feel anxious or uncomfortable about using public 

transport. In recognition of this, some support 

agencies provide private transport for their HASP 

clients. Indeed, 66% of the clients indicated that their 

support agency/support workers provided transport. 

However, the payment of support agencies/workers 

for this service does raise some concerns. In some 

situations, it was noted that the client pays the support 

worker directly for the transport provided. In others, 

support workers transport clients free of charge and 

claim the cost in their annual tax return as a workrelated 

deduction. Finally, some agencies take funding 

from the client’s HASP package to fund transport 

costs. It is clear that there needs to be some clarity 

provided around the provision of transport and how 

the costs for transport are to be reimbursed by clients.

8.4 The ability of the program to maintain clinical functioning and provide 


Six of the 194 clients who entered HASP were 

deceased at the time of follow-up. The one-year 

mortality rate of around 0.75% is much lower than 

that reported in previous studies. Leff and colleagues 

(1997), reported that 24 of the 737 clients (3.25%) 

discharged from two large psychiatric hospitals in 

the UK died within the fi rst 12 months of resettlement. 

In one of the earliest follow-up studies of clients 

discharged from long-stay hospitals in New South 

Wales, Andrews and colleagues (1990) reported 

that 13 of the 280 (6.25%) clients discharged to group 

homes had died in the follow-up period (which ranged 

from between 3–40 months). In a recent New South 

Wales study (Hobbs et al., 2000), one of the 

40 clients discharged (2.5%) died in the two-year 

period following discharge. 

The average time spent in inpatient care decreased 

signifi cantly from an average of 227 days in the 

12 months prior to HASP, to an average of 18.9 days 

in the 12 months post-HASP. In addition, the number 

of admissions to acute inpatient care also decreased 

signifi cantly from an average of 1.22 admissions 

in the 12 months prior to HASP, to an average of 

.66 admissions per individual in the 12 months 

post-HASP. Similar reductions in the need for inpatient 

care have been reported in previous studies. In a 

seven-year follow-up of ‘Project 300’ clients, Meehan 

and colleagues (2011) found that 40% of clients in 

the program had not been admitted to hospital in 

the seven years since entering ‘Project 300’. This is 

despite the fact that most had spent the two years 

prior to ‘Project 300’ in hospital. In the NSW study, 

Muir and colleagues (2007) found a 77.6% decrease 

in the number of days spent in hospital following the 

implementation of the HASI Program in NSW. 

There was a trend towards improved clinical and 

general functioning. While improvements were not 

statistically signifi cant, the clients (as a group) did 

not deteriorate following entry into HASP. Indeed, the 

fi ndings indicate that over half of the clients improved 

in general functioning and over 40% improved in 

their clinical functioning in the 12 months since 

joining HASP. These fi ndings challenge the belief that 

conditions such as schizophrenia follow a course of 

progressive deterioration. Thus, support workers and 

others involved in the treatment of these clients must 

maintain their recovery focus and hope for the future. 

Restrictions placed on clients through the Mental Health 

Act had been signifi cantly relaxed since clients joined 

HASP. The proportion of clients on Involuntary Treatment 

Orders (ITOs) decreased from 46% to 22%, while the 

proportion of clients with voluntary status increased 

from 43% to 70%. In the absence of all other measures, 

this suggests that client functioning and compliance 

with treatment is improving. It also indicates that efforts 

are being made by clinical services to reduce restrictions 

on clients where possible. 

Physical health issues are likely to become a concern 

for this cohort of clients in the future. Almost half of the 

clients (49.3%) indicated that they had a physical health 

problem, while 33% claimed to be taking medications 

for physical health problems. Almost three-quarters 

smoked cigarettes, with an average daily intake of 

20 cigarettes per person. A number of clients stated 

that they would like to stop smoking and had tried to 

do so without success. Implementing strategies to 

reduce cigarette-smoking may need to be considered. 

In the month prior to interview, 41 clients (53.9%) had 

consumed alcohol, with two clients claiming to have 

had alcohol on every day in the past month. One-third 

of those who had alcohol had only two drinks on the 

days that they consumed alcohol. Four of the clients 

claimed to have cannabis in the month prior to interview. 


accomplished something in the past month. While 

we did not ask what had been accomplished, some 

clients did volunteer answers, which included staying 

well, being able to stay out of hospital, making a new 

friend or getting a job or volunteer work. A further 

80% were happy that ‘things had gone their way’ and 

were proud that someone had complimented them on 

something they had done (77%). Clients rated their 

overall quality of life with a mean rating of 6.87 out 

of a possible total score of 10. Notwithstanding these 

positive views, just over 40% claimed to have felt lonely 

and over 30% indicated that they had felt depressed in 

the past month. 


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70 


8.5 Program costs 

Overall, the cost of keeping the ‘average’ client in HASP 

for 12 months is signifi cantly less expensive than 

keeping the same client in a CCU or in acute inpatient 

care. The fi nding suggests that one could maintain 

two clients in HASP for the cost of keeping one client 

in a CCU and four clients in HASP for the cost of 

keeping one client in an acute inpatient unit. It should 

be noted that the costs are based on recurrent costs 

only. There are considerable ‘upfront’ costs involved 

in sourcing accommodation for programs such as 

HASP. Most housing providers do not have a supply 

of surplus housing, therefore, housing options have 

to be purchased or constructed to meet the additional 

demand generated by these programs. These costs 

have not been considered in our estimate. 

There is wide variation in the size of individual support 

packages — some packages cost signifi cantly less and 

others signifi cantly more than the average package of 

around 20 hours of support per week. This variation 

is not unexpected. It highlights the importance of 

having individual programs of support that address the 

unique needs of each individual. This is undoubtedly 

a major contributor to the high levels of satisfaction 

and improvements in functioning observed in this 

evaluation. Indeed, our individual cost estimate 

of $66,600 is similar to that obtained in the New 

South Wales ‘Housing and Support Initiative’ (HASI) 

study which reported a recurrent cost of $57,530 per 

individual in 2007 (Muir et al., 2007). 

The one major theme to emerge from all the studies, 

and from HASP, is that community care is generally less 

expensive than hospital care for the majority of clients. 

Leff and colleagues (1997) found that approximately 

10% of clients with high support needs are likely to 

cost more in the community than in hospital. Based on 

estimates for the HASP cohort, none of the packages 

exceeded $140,525 per year which is the estimated 

cost of maintaining a client in a Community Care Unit 

for 12 months. 


8.6 Conclusions 

Given the focus on community care in national 

policy, the fi ndings have implications for service 

provision. HASP is an excellent example of how 

government agencies can work together to improve 

the wellbeing of people with psychiatric disabilities. 

HASP demonstrates that given adequate support, 

stable housing and good case management, the 

accommodation needs of people with psychiatric 

disabilities can be met through ordinary/normal 

housing in the community. Indeed, those involved 

in the planning of future resettlement programs are 

encouraged to consider the HASP model. 

Assessed on any measure, our fi ndings indicate that 

HASP has been as successful, if not more successful, 

than the majority of supported housing programs 

reported in the literature. Community care within HASP 

appears to have an overall economic advantage over 

hospital care and no clear disadvantage for clients. 

Those who participated in the interviews expressed 

high levels of satisfaction with the program and felt 

that HASP was instrumental to their recovery. 

All of the clients in the evaluation demonstrated 

a strong preference for community living. The freedom 

and choice that community living offers appears to 

compensate for the increased responsibility associated 

with such living. Overall, it is clear that while some 

clients have made considerable advances in securing 

a future in the community, others have been less 

successful in taking advantage of the opportunities 

available to them. While service models continue to 

provide support, they must also allow for what Deegan 

(1992) calls the ‘dignity of risk and the right of failure’. 

Thus, the challenge for service providers is to fi nd 

the right balance between the provision of planned 

interventions for clients and ensuring that clients have 

the freedom to be self-determining individuals.

Section 9 

Recommendations 

1. More information needs to be provided to the staff 

of all agencies concerning the selection criteria 

and the characteristics of clients most suitable 

for the program. It may be useful to develop 

an information package, such as a DVD, that 

outlines the criteria, the application process, the 

verifi cation process, and issues that need to be 

addressed as the client moves into HASP. Such 

a DVD could also be useful for clients who have 

been allocated a place in HASP. It would provide 

them with a better understanding of the process 

and the timelines to be expected. 

2. It is recommended that the application process 

be reviewed with the aim of reducing the burden 

placed on staff to nominate clients for HASP. It may 

be possible that a brief application (one or two 

pages) could be reviewed at the district level and 

when a client or clients have been selected for that 

district, a more complete application could then be 

developed for review by the statewide HASP Panel. 

3. Notwithstanding the previous recommendations, 

there was a general impression that the 

appropriateness of HASP referrals had improved 

in recent years. The information sessions provided 

across the state by members of the HASP 

Operational Partnership were seen as being useful 

in keeping staff informed of developments in the 

program. It is recommended that these forums be 

continued. 

4. There is considerable variation in the contribution 

of Service Integration Coordinators to initiatives 

such as HASP. Clarity is required around the 

role and the level of involvement that Service 

Integration Coordinators should have in HASP. 

5. It was identifi ed that a regular review of support 

packages was required to ensure that the level 

of non-clinical support provided was in keeping 

with client needs and the promotion of recovery. 

Supports Facilitators (SFs) have traditionally 

provided some oversight of the program. However, 

it is unclear how this will be provided in the future 

given the changes to the SF role under the reforms 

outlined in ‘Growing Stronger’ (2007–2011). 

A system for reviewing support and related funding 

structures needs to be developed in light of the 

changes to the SF role. 

6. Communication at the local level can also be 

problematic when a range of staff is involved with 

the same client. We found that one agency was 

using a diary (kept in the homes of clients) to keep 

a record of appointments and other activities 

carried out for clients. All persons entering the 

home of the client were encouraged to make 

an entry in the diary so as a record of the visit 

was documented. The diary provides a record of 

visitors to the home (including staff), an audit 

trail of interventions carried out and the date the 

interventions were provided. It is suggested that 

all support agencies consider using a diary to 

improve communication between staff and staff, 

and staff and clients. 

7. While support agencies have greater freedom 

to manage client support needs within the ‘block’ 

funding model, there appears to be less fl exibility 

for clients to move between service providers. 

Clients wishing to transfer to another agency 

have to fi nd an agency with suffi cient funding 

capacity to cater for their support needs (since 

the transferring agency retains the funding). 

This can be especially diffi cult for consumers with 

large support packages. Thus, the block funding 

model needs to be reviewed to ensure that there 

is suffi cient fl exibility within the model to enable 

clients to move more freely between agencies 

if they so desire. 


71

72 

Section 9 Recommendations 

8. The study found that many clients rely on support 

agencies/staff to provide them with transport. 

While this is a very worthwhile service, there is 

variation in the way in which clients are charged 

for this service. Support agencies need to clarify 

how this service can be provided so as to enable 

greater transparency in the way that clients 

reimburse agencies for the service. 

9. There is little consistency in the provision 

of ongoing training for support workers. Moreover, 

there is wide variation in the provision of clinical/ 

practice supervision for support workers. It is 

recommended that a sub-group be established 

at the state level to provide direction for the 

future training and supervision needs of support 

workers. 

10. There are 52 different support agencies providing 

services to HASP clients and these tend to differ in 

respect to philosophy, models of service delivery 

and outcome expectations. To overcome this, 

the current model of service delivery needs to be 

more closely aligned to the principles of recovery. 

Indeed, almost half of the support workers who 

participated in the evaluation expressed a desire 

to know more about recovery and how this could 

be applied in practice. 

11. It was noted that clients can have a number 

of different care plans. It is recommended 

that service providers examine options for the 

development of a single care plan for each client. 

This care plan should be used by all stakeholders 

to guide client interventions and be reviewed and 

updated on a regular basis – at least every three 

months. All stakeholders, including the client, 

should have input into the development and 

review of the plan. 


12. A number of clients stated that they would like to 

stop smoking. Implementing strategies to reduce 

cigarette-smoking should be considered. Reducing 

or ceasing cigarette-smoking would result in better 

health for clients and more spending money for 

other activities. 

13. While only 10% of clients were employed, over 

40% of clients indicated that they would like to 

have paid employment as their main activity. Thus, 

there is some scope to engage with these clients 

and link them into training or other activities such 

as volunteer work to improve their chances of 

securing paid employment in the future. 

14. A system of ongoing evaluation of the services 

provided and the outcome for clients needs 

to be established. Such a system should include 

a mechanism for obtaining feedback directly 

from the clients in the program. This could take 

the form of interviews with a sub-sample of clients 

or a satisfaction survey completed by clients on 

an annual basis. 

15. It is clear from this evaluation that HASP provides 

an effi cient and effective model for enabling those 

with severe psychiatric disability to maintain 

tenancies and establish a life in the community. 

It is also clear that demand for HASP places far 

exceeds the number of packages available. It is 

recommended that the program be continued and 

expanded to better meet the growing demand for 

HASP places.

Section 10 

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Appendix 1 

HASP 2009–2010 Process fl owchart with timelines 


Information Sessions 

(Nov) 

HASP Cluster Coordinators 

forward the prioritised 

nominations to the QH Statewide 

HASP Coordinator (2 Feb) 

The HASP Interdepartmental Panel sits and considers all HASP prioritised 

nominations. The Panel approves 40 individuals to progress in HASP. 

Nomination info is forwarded to DCCS for support assessment and 

verifi cation and to HHS for OT housing assessment 

DCCS HASP Coordinator forwards nomination info 

to the appropriate DCCS Regional Offi ce (23 Feb) 

DCCS SF: 

Assess and verifi es individual’s disability support 

needs and weekly support requirements 

Assists in identifying an NGO 

Forwards completed verifi cation to MHB 

Endorses the individual inclusion in HASP (4 May) 

DCCS MHB: 

notifi es QH, HHS and 

individuals if not verifi ed 

for HASP 

collates the verifi ed HASP 

nominations 

negotiates with NGOs to 

deliver non-clinical support 

to HASP Individuals 

DCCS Minister approves funding 

to NGOs to provide non-clinical 

support 

DCCS recurrent HASP funding 

enables NGOs to deliver ongoing 

non-clinical support to the 

HASP individual 


QH District staff identify HASP 

eligible individuals and progress 

their HASP nominations 

(Dec–Jan) 

Each QH District forwards their fi nal nominations 

(with support hours balanced to equate to their district quota) 

to the HASP Cluster Coordinators for consideration 

HASP Operational Group informs 

HASP Steering Group of the 

40 endorsed HASP individuals 

QH allocates a community Case 

Manager for all endorsed HASP 

individuals to assist with their 

transition to the community 

DCCS Minister notifi es 

successful individuals 

and NGOs of approved funding 

and support provision (1 Aug) 

Individual living in the community (31 Dec) 

QH provides ongoing clinical 

support and treatment where 

required to the HASP individual 

Nominating staff communicate 

with district staff to determine 

the priority level of their clients 

QH letter informs individuals of 

HASP approval or withdrawal AND 

QH Statewide HASP Coordinator 

informs QH nominating offi cer 

of approval/withdrawal 

HHS HASP Coordinator forwards HASP nomination info 

to the appropriate Housing Service Centre (23 Feb) 

HHS OT completes a Housing Needs Assessment 

to inform Housing Service Centre of the individual’s 

housing requirements (4 May) 

HHS Area Manager forwards PEX 

request to HHS HASP Coordinator 

for replacement stock or to fi nd 

specifi c housing solution 

HHS progresses property 

searches and housing allocations 

for endorsed HASP individuals 

Housing allocation is made 

and tenancy commences 

HHS provides ongoing supportive 

tenancy management for the 

HASP individual

Housing and Support Program (HASP)

Disability and Community Care Services 

Department of Communities 

Phone: 3006 8702 

www.communities.qld.gov.au/disability

Housing and Support Program (HASP): Final Evaluation Report

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