Mental health policy and practice across Europe: an overview

Housing and employment 287
comprises four ordinary flats in different areas of the city. Each of the flats can
accommodate three tenants, all of whom have individual bedrooms with their
own keys. The flats have been fully furnished by Estuar to create a normal
domestic environment. The tenants have mental health problems and are supported
by trained workers who help with social activities and domestic tasks,
and offer counselling to develop coping skills. The tenants are permanently
supported in their learning processes and in their efforts to manage everyday life
(Freyhoff et al. 2004).
In many EU countries, public policies have strongly supported the development
of supported housing, leading to a significant change in the amount,
type and range of housing support options. The European Commission’s Joint
Report on Social Inclusion (2003d) highlights developments in Denmark, France,
Germany, the Netherlands, Sweden and the United Kingdom, although there
also appears to be a concentration of such options in urban areas (Edgar et al.
2002) or in the big cities in new member states (European Commission 2004).
Fakhoury et al. (2002) report that in Berlin the number of places for mentally ill
people in supported housing rose threefold in the 1990s, and in the United
Kingdom numbers in supported housing appear to have increased ‘enormously’
(Priebe and Turner 2003), although precise data on numbers and duration are
largely not available.
New Zealand’s Mental Health Commission assessed the need for supported
housing as being relatively low (6–7 per cent) among the whole population of
users of mental health services; but the numbers appear to be increasing in
Europe. In a review of both European and non-European experience – and
acknowledging the limited level of research – it seems that residents in supported
housing are likely to be older, less educated and unemployed compared
with those living in independent or semi-supervised settings; they are more
likely to include people with schizophrenia but less likely to include people with
behavioural problems including violence and antisocial behaviour (Fakhoury
et al. 2002).
The benefits of supported housing were identified by Middleboe (1997) for a
group of long-term mentally ill people in group homes in Copenhagen. Over a
period of a year, 83 per cent of individuals remained in the programme and
showed a significant improvement across the dimensions of subjective quality
of life, social integration and hospitalization. Fakhoury et al. (2002) likewise
conclude that supported housing can improve functioning, facilitate social
integration and offer a more satisfactory environment for residents than hospital
care. It appears that most people prefer the more independent living
arrangements and less restrictive regimes, and appreciate the privacy offered.
Many reports refer to a lack of suitable supported housing in the community.
However, concerns also have been voiced about the possible isolation and
loneliness of more independent living, of risks of dependence on professional
support (Chilvers et al. 2003), of reinstitutionalization (Priebe and Turner 2003),
and of failure to promote independence over time, while others have pointed to
the high costs and the need for a well trained workforce (Sainsbury Centre for
Mental Health 1998).
Altogether, there is a lack of systematic information on the factors affecting
the outcomes of supported housing and the necessary skills or resources for