Mental health policy and practice across Europe: an overview

290 Mental health policy and practice
recognition of the importance of decent and stable housing and of the nature
and scale of housing problems calls for the development of more defined policies
and integrated approaches, as well as the provision of new services and
facilities. Although such provision is widely regarded as under-resourced, particularly
in view of decades of deinstitutionalization, this chapter has presented
some positive initiatives and practices from EU member states. These examples
demonstrate the importance of strategies for the prevention of housing problems
and homelessness, but also of the need for health, social protection,
employment or other daytime activity, and other services to provide comprehensive
and coordinated support in the face of multi-faceted needs. At the
same time, the responsibilities of different services must be clear and well
defined (Pillinger 2001).
Housing policies are, and should be, principally concerned with the availability
of permanent homes in both mainstream and supported developments
(Social Exclusion Unit 2004); but there are needs for better temporary and rental
accommodation, as well as important issues concerning the protection of tenure
and improving the quality of accommodation. Housing quality in the enlarged
Europe is a growing problem, especially in rural areas.
Various authors have argued for more choice and flexibility in housing provision
for people with mental illness. Watson et al. (1998, 2003) have argued
for more development of self-contained flats and networks of flats or houses,
reflecting the need for some forms of purpose-designed housing and also the
need to access support services. In general, there is a need to combat discrimination
in access to housing and, in a complementary manner, to avoid
segregation of people with mental illness, whether in mainstream housing or
in supported accommodation – for example, for people who have been homeless.
Perhaps, in new developments, consideration could be given to allocating
one or two units to people who have been discharged from mental health
services.
What do people with mental illness want or prefer for housing? For the vast
majority it will be to live in their own home, with their family, without stigma
or social isolation. Evidently, support in housing, if required, is the most attractive
strategy for most people – and for their families who need support – to
prevent the hospital admissions or loss of income or failure to manage a tenancy
that precipitate a housing crisis. Among people with more severe mental illness
there is some suggestion that people enjoy better outcomes in settings with
fewer occupants (Newman 2001) and that most people will choose to live as
independently as possible, perhaps because sharing accommodation with others
who have mental illness can seem institutional or lacking in privacy (Chilvers
et al. 2003).
Housing and services for people with mental illness are being provided by
public, private and non-governmental or voluntary organizations. Civil society
and housing associations appear to have played an important role in the development
of innovative housing schemes (Edgar et al. 2002) and in the provision
of accommodation and services to particularly disadvantaged groups (SMES-
Europa 2002). However, the numbers of people with mental illness who live in
ordinary housing underlines the need to be attentive to mainstream provision,
and its maintenance, in the public and private sectors. In the case of private