Mental health policy and practice across Europe: an overview

284 Mental health policy and practice
experienced higher rates of unemployment and absence from work due to
illness, and were more likely to fall into arrears with payment of rent and utilities.
Altogether, the population with mental health problems were more likely
than the general population to express dissatisfaction with their accommodation,
to mention specific housing problems and to describe the state of repair
of their accommodation as ‘poor’. On the other hand, the main problems
encountered were much the same for people with and without mental health
disorders – financial difficulties; short-term leases; domestic problems; and
problems with the landlord or estate agent.
People with mental illness face the same set of housing issues as other groups
in the community – availability, adequacy, appropriateness and affordability.
However, their situation may be especially insecure or precarious, and access to
adequate, affordable housing may be especially critical to recovery from illness
and to maintaining good mental health (Mental Health Commission 1999).
Several research studies have demonstrated that living in poor quality or
inappropriate housing increases risks of deterioration in functioning, reduced
quality of life and readmission to hospital (Fakhoury et al. 2002). Housing costs
may exacerbate other financial stresses, associated, for example, with paying
for treatment, and may lead to overcrowding, inability to heat or maintain a
property and unsustainable tenure.
Most people with mental illness do not suffer loss of housing due to their
illness but some do, and the most important reason appears to be hospitalization
for an acute episode (Mental Health Commission 1999). Severe mental
illness is associated with homelessness, but this can reflect both becoming
homeless due to ill health and becoming ill due to homelessness. Although
there are narrower and broader definitions of ‘homelessness’, one review reports
that between 30 and 50 per cent of people sleeping in night shelters, in hostels
or on the street have some form of severe mental disorder (Sainsbury Centre for
Mental Health 1998). A recent study in Cork, Ireland, reported that 40 per cent
of hostel dwellers had a serious mental illness (Public Health Alliance, Ireland
2004). Homelessness is a major problem especially for those who do not engage
with mental health services, and the development of sensitive strategies to
reach these groups is part of a more integrated approach to their housing
problems.
People with housing problems and mental illness have complex needs
demanding a variety of responses. In many cases recovery requires specific housing
arrangements that combine support for everyday living (including perhaps
support in employment) with quality accommodation and a suitable social
environment. The development of appropriate community-based housing and
services is considered shortly but the next section begins by examining
approaches to ‘prevent’ housing problems.
Maintenance in mainstream housing
The goal of retaining people with mental illness in their own homes and avoiding
housing problems would appear to be very attractive. In most EU countries
this is regarded as the preferred approach (Edgar et al. 2000) but it has received