Joining up housing and mental health

The role of housing goes far beyond physical shelter and safety. It introduces people to a community to which they can belong, a space which is their own, a communal setting where they can make friends, form relationships and a place where they can go for support, social interaction and reduce feelings of loneliness and anxiety. Housing  stable, safe housing  also provides a springboard for people to begin to re-integrate with society. An address allows them to register with services, including claiming benefits, registering at a local job centre, registering with a GP, and applying for jobs.

Housing and health, both physical and mental, are inextricably linked. A 2015 blog from the Mental Health Foundation put the relationship between housing and health in some of the clearest terms:

“Homelessness and mental health often go hand in hand, and can be a self-fulfilling prophecy. Having a mental health problem can create the circumstances which can cause a person to become homeless in the first place. Yet poor housing or homelessness can also increase the chances of developing a mental health problem, or exacerbate an existing condition.”

Single homeless people are significantly more likely to suffer from mental illness than the general population. And as a result of being homeless they are also far more likely to rely on A&E services, only visiting when they reach crisis point, rather than being treated in a local setting by a GP. They are also more likely to be re-admitted. This high usage is also costly, and increasingly calls are being made for services to be delivered in a more interconnected way, ensuring that housing is high on the list of priorities for those teams helping people to transition from hospital back into the community.

Not just those who are homeless being failed

However, transitioning from hospital into suitable housing after a mental health hospital admission is not just a challenge for homeless people. It is also the case that people are being discharged from hospital to go back into settings that are unsuitable. Housing which is unsafe, in poor condition, in unsafe locations or in locations away from family and social networks can also have a significant impact on the ability of people to recover and prevent readmission.

Councils are facing an almost constant struggle to house people in appropriate accommodation. However, finding a solution to safe, affordable and suitable housing is vital. Reinvesting in social housing is a core strategy councils are considering going forward to try and relieve some of the pressure and demand. Gender and age specific approaches, which consider the specific needs of women, potentially with children, or old and young people and their specific needs would also go a long way to creating long term secure housing solutions which would then also impact on the use of frontline NHS services (by reducing the need for them because more could be treated in the community). Suitable housing also has the potential to improve employment prospects or increase the uptake of education or training among younger people with a mental illness. It would also provide stability and security, long term, to allow people  to make significant lifestyle changes and reduce their risk of homelessness in the future.

A new relationship for housing and health

A number of recommendations have been made for services. Many have called for the introduction of multi-disciplinary teams within the NHS, recruited from different backgrounds, not only to create partnerships with non-NHS teams, but also to act as a transitional care team, to ensure that care is transferred and dealt with in a community setting in an appropriate way, and to ensure housing is both adequate and reflects the needs of those who are most vulnerable.

In June 2017 the King’s Fund held an online seminar to discuss how greater integration between housing and mental health services could help accelerate discharge from hospital and reduce the rates of readmission for people suffering from mental illness. The panel included Claire Murdoch, National Mental Health Director at NHS England and Rachael Byrne, Executive Director, New Models of Care at Home Group.

Final thoughts

Increasingly the important link between housing and health is being recognised and developments are being made in acknowledging that both effective treatment and a stable environment are vital to helping people with mental illness recover and re-integrate back into their community, improving their life chances and reducing the potential for relapse.

Housing can be an area of life which can have a significant impact on mental health. It can cause stress, and the financial burden, possibility of being made homeless, or being placed in temporary accommodation can have a significant and lasting negative effect on people’s mental health. However, safe and stable housing can also have a significant positive impact on mental health, providing stability, privacy, dignity and a sense of belonging.


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If you enjoyed this blog, you may also be interested in our other articles on health care and reablement care

Smart cities … treading the line between the possible, the probable and the desirable

By Morwen Johnson

Sometimes it feels like every city in the world is now claiming to be ‘smart’. Our research team regularly add new reports on the topic to our database. And with a policy agenda riding on the back of a multi-billion pound global industry, the positivist rhetoric around smart cities can seem overwhelming.

We’ve blogged before about the disconnect between what surveys suggest the public values in terms of quality of life in urban areas, and what smart cities are investing in. And last week I attended a conference in Glasgow ‘Designing smart cities: opportunities and regulatory challenges’ which refreshingly brought together a multi-disciplinary audience to look at smart cities in a more critical light.

The conference was rich and wide-ranging – too broad for me to try and summarise the discussions. Instead here are some reflections on the challenges which need to be explored.

Every smart city is a surveillance city

Look in any smart city prospectus or funding announcement and you’ll find mention of how data will be ‘managed’, ‘captured’, ‘monitored’, ‘shared’, ‘analysed’, ‘aggregated’, ‘interrogated’ etc. And this is inevitably presented as a benign activity happening for the common good, improving efficiency, saving money and making life better.

As David Murakami Wood pointed out at the conference however, this means that every smart city is by necessity a surveillance city – even if policymakers and stakeholders are reluctant to admit this.

Public debate is failing to keep up with the pace of change

Even for someone who takes a keen interest in urbanism and the built environment, any description of smart cities can risk leaving you feeling like a techno-illiterate dinosaur. It’s clear that there is also a huge amount of hype around the construction (or retrofitting) of smart cities – with vested interests keen to promote a positive message.

Do we really understand the possibilities being opened up when we embed technology in our urban infrastructure? And more importantly, what are the ethical questions raised around sharing and exploiting data? The pace of the development and rollout of new technologies within our urban environments seems to be running ahead of the desirable cycle of reflection and critique.

An interesting point was also made about language – and whether experts, technologists and policymakers need to adjust their use of language and jargon, in order for discussion about smart cities to be inclusive. Ubicomp … augmented reality … the Internet of Things … even the Cloud – how can the public give informed consent to participating in the smart city if the language used obscures and obfuscates what is happening with their data?

Where can we have a voice in the data city?

Following on from this point, cities are not ends in themselves – to be successful they must serve the interests and needs of the people who live, work and visit them. An interesting strand of the conference discussion considered what a bottom-up approach to smart cities would look like.

Alison Powell highlighted that there’s been a shift from seeing people as citizens to treating them as ‘citizen consumers’ – I’d add that within the built environment, this goes hand-in-hand with the commercialisation and privatisation of public space – and this has profound implications around questions of inclusion/exclusion. And also where power and decision-making sits – and who is profiting.

Although some general examples of community participation projects were mentioned during the conference, these didn’t seem to address the question of how ‘people’ can engage with smart cities. Not as problems to be managed or controlled – or as passive suppliers of data to sensors – but as creative and active participants.

Conclusion

I left the conference wondering where society is heading and how we, the Knowledge Exchange, can support our members in local government and the third sector to understand the extensive opportunities and implications of smart cities. We see a key part of our mission to be horizon scanning – and our briefings for members focus on drawing together analysis, emerging evidence and case studies.

Not all towns or cities have the resources, investment or desire to lead the way in technological innovation. But the challenge of bridging the gap between professionals and their vision and understanding of smart cities, and people in communities, is a universal one.

As William Gibson observed: “The future is already here … it’s just not very evenly distributed”.


 

The Idox Information Service can give you access to a wealth of further information on smart cities or public participation. To find out more on how to become a member, contact us.

Our reading list prepared for last autumn’s Annual UK-Ireland Planning Research Conference looks at some recent literature on smart cities.

The conference Designing smart cities: opportunities and regulatory challenges was held at the University of Strathclyde on 31 March and 1 April 2015, supported by CREATe and Horizon.

The Idox Group is the leading applications provider to UK local government for core functions relating to land, people and property, such as its market leading planning systems. Over 90% of UK local authorities are now customers. Idox provides public sector organisations with tools to manage information and knowledge, documents, content, business processes and workflow as well as connecting directly with the citizen via the web.