After 18 months in Forest Lodge, a mental health rehabilitation unit, Nyoka Mitchell* stepped towards independence by moving into a new home arranged, in unusual fashion, by SHNFT (Southern Health NHS Foundation Trust), Southampton.
She had arrived on the unit feeling helpless, suffering badly with anxiety, and left ‘blessed by the gods’.
‘I have come through a lot of trauma but I feel safe, finally,’ she says. ‘I have been given a second chance. Not everybody gets that.’
It’s a foundation for their mental wellbeingDr Groves
While it isn’t uncommon for mental health hospitals to help find patients somewhere to stay before leaving, SHNFT’s approach for Ms Mitchell and four other patients is.
Instead of waiting months for the right accommodation to come up, SHNFT lines it up in advance.
It’s just one of several ways some trusts use to shrink unnecessary stays, bring patients home from far-off private hospitals, and to offer an alternative to clinical wards to the acutely unwell.
Bricks and mortar
So why is the NHS moving into housing? What’s in it for the service and its patients?
One reason is financial. Mental health trusts spend more than £1m a month keeping patients stuck on wards, waiting for housing with the right kind of support attached, The Doctor analysis of NHS Digital figures shows.
Millions more could be saved by bringing back home patients from private beds, a report last month by the Centre for Mental Health and the Mental Health Network claims. Most trusts just lack the know-how, it adds.
So-called delayed discharges can leave patients stuck on wards for weeks, months, even years, making it harder to settle back home. ‘It’s like Humpty Dumpty fell off a wall,’ says Ms Mitchell, who has had multiple admissions to acute wards. ‘You have to rebuild yourself each time you leave.’
SHNFT clinical lead for rehabilitation services Mike Groves says secure housing can help make the rehabilitation admission the last one – a chief aim of his specialty.
‘Knowing they have somewhere warm to stay is key,’ Dr Groves adds. ‘It’s a foundation for their mental wellbeing. It means they can put down roots, stretch themselves, move out of their comfort zone.’
By arranging the housing and support itself, SHNFT can pick properties on bus routes to friends and family, the hospital, and away from areas they need to avoid.
Flats are found by Abri, a housing association and managed by The Society of St James, a charity. More intensive support is provided initially by the trust’s rehabilitation outreach team.
The society’s light-touch support is covered by housing benefit, leaving no extra cost to cover.
Other trusts which work in like fashion with different housing associations include BEHNT (Barnet, Enfield, and Haringey NHS Trust), ELNFT (East London NHS Foundation Trust), and Sheffield Health and Social Care, where NHS England’s national clinical director for mental health, Tim Kendall, is consultant psychiatrist for the homeless.
Knowing they have somewhere warm to stay is keyDr Groves
Sheffield’s mental health trust has worked with South Yorkshire Housing Association for years to return patients home from locked wards in hospitals far away.
One patient spent years between hospitals in Bradford and Nottingham before being found somewhere back in the city.
ELNFT and BEHNT work with Look Ahead Housing and Care, a major provider of mental health alternatives to the NHS.
Among other services, it supports people in ‘crisis’ or ‘recovery’ houses, as alternatives to hospital wards, and finds homes for patients in ELNFT’s forensic service.
According to a recent report on its work by Europe Economics, the NHS could save £1bn if arrangements similar to its own were rolled out across England.
From the outside, such arrangements seem sensible, even simple. Yet they take months, even years, to agree.
Doctors want patients to be safe, funders their money well spent. Associations must agree to use homes from a limited pool, largely reserved for the homeless.
The bureaucratic barriers are legion.
SHNFT’s model was brought off the ground by the Keep Well Collaborative, an organisation commissioned to get heads and organisations together by the Hampshire and Isle of Wight sustainability and transformation partnership.
Internally, it’s driven by Jon Pritchard, perhaps the first and only director of housing in a mental health trust.
He believes other housing associations, many of them charities, could make similar arrangements but that trusts must take the lead. Unlike the NHS, associations have access to billions of pounds of investment.
‘But no housing association, or local authority, is going to come to the NHS and say, do you want some properties?’ Mr Pritchard says.
‘This needs to be driven by the NHS because it serves our purpose. We can’t do it on our own and we can’t pay for it.’
BMA mental health policy lead Andrew Molodynski says: ‘These alternative arrangements, however successful, are exceptions to this rule: most trusts in our national health service seem reluctant to move into housing to the detriment of patients.
‘With rising pressure on beds, little sign of extra investment to increase them, and a move toward more care in the community, it’s a rule that many will soon have to break.’
* Name changed to protect the patient’s identity