Mental health policy and practice across Europe: an overview

Housing and employment 289
treatment requirements. Many offer free assistance with clothing and provide
a meal as well as access to laundry facilities. The large direct access hostel is
still the prevalent model across the EU although SMES-Europa (2002) reports
the development of smaller, more homely shelters as well as the emergence of
specialized shelters for groups such as young people. The quality of emergency
hostels is very variable, as are their financial and staff resources (Edgar et al.
2000). However, all member states describe efforts in place to improve emergency
reception and temporary housing of homeless persons (European Commission
2003d).
In principle, emergency hostels are intended for a short length of stay, but
there is a widespread lack of longer-term, safe and suitable move-on accommodation.
Temporary housing in bed and breakfast accommodation is not very
suitable, but the Social Exclusion Unit (2004) found that stays of five years and
more were now common in temporary accommodation in London. Many
homeless people with severe mental illness are in need of long-term shelter
and rehabilitation, and emergency hostels are not well equipped to help with
resettlement or longer-term health care. Developments in longer-term residential
care embrace a wide range of care philosophies ranging from an explicit
focus on treatment and rehabilitation to accommodation free of any specific
therapeutic goal. Again, to take an example from the report of SMES-Europa
(2002: 24) – the Lunghezza project in Rome:
It provides care for homeless ex-psychiatric hospital patients. Twenty places
are available in a number of apartments. It is part of a care and treatment
programme of the Rome B Local Area Health Authority. Its users are
patients suffering from serious and enduring mental illness, some of whom
come from long-term stays in psychiatric hospitals or clinics and who have
neither family support nor fixed abode. Other patients have come from
difficult family situations.
Many such projects aim to help residents to develop skills to live more
independently – time management, financial prudence, interpersonal skills –
but move-on rates appear to be low. Nevertheless, they can provide a relatively
secure environment although there may be a lack of meaningful daily activity.
Research on the effects of providing supported housing to formerly homeless
people with serious and persistent mental illness indicates that long-term residential
stability can be achieved for many (Lipton et al. 2000) and cognitive
functioning can be improved (Seidman et al. 2003). In Lipton’s study older age
was associated with longer tenure and a history of substance abuse with shorter
tenure; referrals from a state psychiatric centre had a higher risk of shorter
tenure. Other research (e.g. Dickey et al. 1996) has underlined the housing
disruption caused to formerly homeless people when they are admitted to
psychiatric care.
Summing up
The housing needs of people with mental illness have been a relatively low
priority of policies in both the mental health and housing fields. Increasing