Mental health policy and practice across Europe: an overview

Housing and employment 285
relatively little policy attention. When the Cochrane Library (Chilvers et al.
2003) sought to establish the value of regular visits by professional outreach
workers to people with severe mental disorders living in ‘ordinary’ private or
rented accommodation they were unable to identify any acceptable randomized
or quasi-randomized trials. Likewise, the Centre for Housing Policy in York
(England) reports (Quilgars 2000) that there has been little consideration of
the value of low intensity services to enable people to live independently in
ordinary housing. However, these critiques are to some extent research problems
as a range of authorities have been developing more and less intensive
support schemes, ‘tenancy sustainment services’, ‘community resettlement
teams’ or other forms of support in housing – albeit many appear to be local
initiatives.
Watson et al. (2003) have examined the planning and development of the
United Kingdom’s ‘Supporting People’ initiative between 1998 and 2003. This
initiative commenced in April 2003 with the aim of providing housing related
support to vulnerable tenants and households, specifically including people
with mental health problems. This support involves helping individuals to
obtain suitable accommodation, to sustain their accommodation and to develop
skills and self-confidence as required. Local authorities, housing associations,
health bodies and voluntary agencies contribute as strategic partners in developing
and providing services. A wide range of services is funded by Supporting
People including: community-based advice centres (mediation and dispute
resolution, form-filling and benefit entitlement); visiting people at risk of
homelessness; and drop-in centre support to combat isolation.
The identification and involvement of people at risk of exclusion or housing
difficulties is a major issue, with an important role for primary care personnel
in referral – assuming housing difficulties are seen as relevant. Supportive or
‘benevolent’ landlords can also make an important contribution, working in a
public/private sector partnership with local agencies. In one example, the landlord
agrees to provide and maintain accommodation in return for rent guarantees
and management of support (Watson et al. 2003); there are examples where
this has worked well for people with long-term mental health problems. In New
Zealand (Mental Health Commission 1999), the ‘benevolent’ landlord concept
entails the owner or primary tenant of a dwelling providing advice, security,
materials and services; however, there was concern about whether the funding
of such schemes should be a health or housing sector responsibility.
Support to people living in their own private accommodation has attracted
less attention than the experience of people in rented accommodation (Social
Exclusion Unit 2004). There are, of course, specific issues about finding a mortgage
and insurance cover, as well as dealing with mortgage arrears. In the new
member states very many people are owner-occupiers but the issue is about
funds to maintain and repair properties (EFILWC 2004). In some cases there
may be issues about charging for or means-testing support services to people
who own their own homes – and some such owner-occupiers may be reluctant
or concerned about the stigma of being drawn into the support ‘system’ (Watson
et al. 2003).
Ill health or long periods in care may diminish the individual’s capacity for
self-care or application of basic skills for living independently. Support may be