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

More, better, faster: the potential of service design to transform public services

Découverte

For government at all levels – national, regional and local – the year ahead promises even greater challenges.  The need to provide more, better and faster services, using fewer resources, while responding to unprecedented levels of technological, demographic, and social change is greater than ever.

Increasingly, public sector organisations are taking an interest in the concept of service design as a means of responding to these challenges and developing better public services.

In this blog post, we provide an overview of service design and consider how it can contribute to public service innovation.

What is ‘service design’? 

Initially a private sector concept, ‘service design’ is an innovative approach that has successfully been applied to the public sector in order to ‘do more with less’.

The Service Design Network defines it as:

“the activity of planning and organising people, infrastructure, communication and material components of a service in order to improve its quality and the interaction between service provider and customers”

Some of service design’s key principles include:

  • the creation of services that are useful, useable, desirable, efficient, and effective;
  • the use of a human-centred approach that focuses on customer experience and the quality of the service encounter;
  •  the use of a holistic approach that considers in an integrated way strategic, system, process, and ‘touch-point’ (customer interaction) design decisions;
  • an implicit assumption of co-crafting services with users (e.g. co-production).

Approaching service design in this manner has a number of advantages, including improved knowledge of user requirements, lower development costs, improved service experience, and improved user satisfaction.

Indeed, in 2012, the UK Design Council has estimated that for every £1 invested in the design of innovative services, their public sector clients have achieved more than £26 of social return.

Service design in the public sector

How should service design be applied within the public sector?

A report by the Service Design Network, drawing on research by public service designers around the world, identified five areas of the public sector that are particularly relevant for service design:

  • policy making
  • cultural and organisational change
  • training and capacity building
  • citizen engagement
  • digitisation

The report presents a number of examples of the successful application of service design in the public sector.  Two such examples are highlighted below.

Case study: Transforming mental health services in Lambeth

The London borough of Lambeth was under pressure to cut mental health budgets by more than 20%, at the same time as experiencing double the average rate of prevalence of mental health issues in England. In response, it employed a service design approach to transform its model of care for people suffering mental health problems.

The transformation was achieved over several years. Lambeth incorporated the use of service design by introducing a social networking site called Connect&Do, employing in-house service designers and prototyping new services through a multi-agency hub for community-based wellbeing.

These have all contributed to making Lambeth an award-winning pioneer in participation and innovative, collaborative commissioning.

Case study: Transforming services for vulnerable people in Brent

Brent Council worked with a design partner to support the review of three areas: employment support and welfare reform; housing for vulnerable people; and regeneration.

The council also wanted to strengthen its internal capacity by developing an innovation hub and training a cohort of managers and officers in service design methods.

Three reviews were conducted in parallel by a multidisciplinary team of designers, researchers and managers. They conducted extensive research, including ethnographic interviews, observations, focus groups, pop-up community events, expert interviews, data analysis and visualisation. At key points, the teams came together to share insights and critique each other’s work as they progressed from research into idea-generation and prototyping.

The new innovation hub aimed to build staff capability, hold idea-generation events and provide an accepting environment for rule-breaking experimentation. It also included leadership development for innovation through specialist guidance of the senior management team.

Thinking outside the box

Service design encourages people to get alternative perspectives and develop creative solutions that go beyond their usual comfort zones. By doing so, it has the potential to positively transform public sector service delivery and improve efficiency. In effect, service design is all about viewing things from a different angle, which – as Albert Einstein observed – can often open up new possibilities:

“The significant problems we have cannot be solved at the same level of thinking with which we created them”


If you found this article interesting, you may also like to read our previous blog on service design.

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Understanding the value of public money could be key to council tax reform in Scotland

This week saw the publication of a report by a cross party commission on the state of local government funding, specifically examining the council tax in Scotland. For many years the council tax has been declared as unfit for purpose by politicians in Holyrood. However little has actually been done in the way of reform. As things stand, following John Swinney’s budget announcement, council tax bills remain frozen for the 9th successive year.

The need for reform

The system has been  called regressive, ineffective, and anti-poor (among other things). But while most agree that the council tax in Scotland cannot continue in its current form, there is much disagreement about the new direction for the council tax, and about local government funding more widely.

The council tax freeze in Scotland has meant that in addition to budget cuts, councils have also been under pressure from reduced income. This is not to the advantage of the worst off, as some might assume. Instead, the uneven banding system means that while middle band payers spend 4% of their wages on council tax, those in the highest two bands only spend 2%

Houses-on-coins-by-Images-MoneyThe impact of the freeze

Despite the council tax only making up 2% of council income, it is estimated that the freeze has cost local government in Scotland more than £500m in the last year, and over £2bn since the freeze was introduced. That’s £2bn, commentators argue, which has not been spent on hospitals, schools, policing or community investment at a local level.

However a visible rise in tax bills while services are being cut back would be a difficult one to spin. As observed during a seminar I recently attended,  people feel council tax increases more acutely than other tax increases because they receive the bills through their door. Other taxes are less visible, or happen before the point of cost. VAT rises or stamp duty rises, for example, are not regarded with quite as much hostility by the general public as council tax rises.

At the same time, people don’t seem to realise what they are getting for their council tax, or how much public expenditure actually costs. This needs to change if politicians are going to be truly allowed to reform council tax and to replace it with any number of the other options outlined in the commission’s report.

Alternative options include:

  • a more equal income-based system, only partly based on house value
  • a more localised option, where local authorities are afforded the freedom of selecting numerous smaller local taxes, which would increase accountability and transparency of where the money is going
  • a re-investment model where income taxes are increased, but the value is redistributed to services within a person’s local area, so people know the money they are being taxed on is going directly local services.
  • cutting costs and reallocating tax fund distribution by relocating services, to reassess which services fall under the remit of local government and which should be taken back under national control and adjusting the money given to local government accordingly

Participative budgeting models have also been mooted, but how this would work in practice is not clear at the moment.

Discussion today, or dysfunction tomorrow

One thing is for sure: council tax needs to be reformed, and the report appears to suggest there are two choices:

  • discuss it openly and robustly now to come to a sensible conclusion with appropriate implementation frameworks and a timetable to transition; or
  • wait until local government is not financially functional and the choices are made out of necessity, as a quick fix, with short term goals and outcomes which potentially make the situation worse rather than better.

Value, cost, framing and how people view taxation will be key to these strategies.


Our popular Ask-a-Researcher enquiry service is one aspect of the Idox Information Service, which we provide to members in organisations across the UK to keep them informed on the latest research and evidence on public and social policy issues. To find out more on how to become a member, get in touch.

Follow us on Twitter to see what developments in public and social policy are interesting our research team.

Co-production in the criminal justice system

Community concept word cloud background

By Rebecca Jackson

Co-production in criminal justice was the core theme of a conference held last Wednesday by the Scottish Co-Production Network.

The speakers were invited to showcase their organisations as three examples of best practice. All the organisations have integrating partnerships and co-production at the heart of their values, and they spoke of the benefits and challenges they had faced, as three very different organisations, all looking to use co-production in the context of criminal justice.

Startup Stock Photos

Startup Stock Photos

Supporting vulnerable women

Tomorrow’s Women Glasgow, is part of a national pilot which aims to develop community- based justice options for people who are offenders. This specific pilot focuses on vulnerable women with complex needs who are in, or have recently been involved in, the criminal justice system.

The women-only centre offers a safe space for women to come and spend time and to work with mentors to address the barriers and issues which prevent them from leading positive, healthy lives. In addition to this, the women are invited to contribute ideas towards the running of the centre, planning activities, contributing to a newsletter and hosting open days.

“The scheme gives vulnerable women a choice, a voice, a direction and opportunities”

The project is run in association with the social enterprise Outside the Box. There are some examples of Outside the Box’s other projects here.

woman hands isolated on sky background

Improving transitions from prison

Pete from Positive Prison? Positive Futures… delivered an inspiring and thought-provoking presentation about his experiences as a person with a conviction who had served time in prison and how that drove him to help others upon their release from prison. He helped to set up the organisation Positive Prison? Positive Futures… (PP?PF) which seeks to “improve the effectiveness of Scotland’s criminal justice system so as to reduce the harms caused by crime and to support the reintegration of those who are or have been subject to punishment”.

He was keen to stress that the charity is not a service provider; rather it is an initial point of contact to help direct people with convictions to the available and relevant services which already exist.

“We’re kind of like in space when you use the gravitational pull of an object to slingshot you in the right direction (Apollo 13 reference anyone?!). People are coming to us going one way, we come into contact with them, build their speed and send them in another, safer, hopefully better direction!”

In addition to this, the charity engages regularly with the Scottish Government as part of committees looking into reform of the prison service, the redesign of community justice and have, among other things, influenced policy decisions around the release of individuals from prison including transitional care.

The charity works with recently released, or soon to be released people with convictions, looking at building relationships during the vulnerable first few weeks ‘on the outside’ where re-offending and suicide rates are high. They also offer mentoring to help prepare people for the transition from prison life.

Two adult education students studying together in class.

Co-production and young people

Space Unlimited is a social enterprise based in Glasgow, which offers a creative space for young people to become involved in the planning and review of the criminal youth justice system. It encourages young people from vulnerable backgrounds, as well as young people who have served time in prison, to use their experiences to change how offending and criminal justice is viewed by young people.

The scheme aims to provide a space to show how young people can use their views to influence how the system can work best for them, to avoid re-offending and help integrate them back into society. The young people interact with adult stakeholders from across the local authority and criminal justice sector, as well as charities and third sector organisations.

“We promote and encourage children and young people to view themselves as experts in their own right, using their own experiences to promote positive change in the youth criminal justice system”

Category Picture Community Development

Creating new spaces for dialogue

What all of the case studies sought to highlight were the key elements of co-production:

      • Assets
      • Capacity
      • Mutuality
      • Networks
      • Shared roles
      • Catalysts

The speakers discussed their learning and experiences, as well as the challenges they face, but all highlighted the fundamental belief underpinning co-production – that service users and service providers can learn from one another. We create better services by engaging service users – creating services with people, not for them.

Co-production is an approach which is widely spoken about in health and social care, but as the conference and its speakers highlighted, the application and remit of co-production could be rolled out over other areas of policy too. It is all about finding groups of people willing to engage and to listen – creating a space for an exchange of dialogue, knowledge and learning. And the results could potentially be hugely beneficial for both service users and service providers. This video from the New Economics Foundation (NEF) highlights some of the benefits of co-production in practice.


Co-producing Positive Futures learning event: how co-production, learning and partnership building can improve community experiences and engage people in the criminal justice system. Scottish Co-production Network, Glasgow, 28 October 2015.

Dementia’s impact on those who care

Old man

By Alan Gillies

Recent research has suggested that the rate of growth in the prevalence of dementia may be levelling out as the general health of the population increases. While such findings are encouraging, commentators have pointed out that increasing rates of obesity and diabetes, as well as the fact that people are living longer, means they have to be treated with caution.

Whether we face a continuing increase, a stabilisation or a decline in dementia, for those who are affected it will continue to have a devastating impact. And this includes not just the person with dementia, but also their loved ones and those who care for them.

A recent enquiry to our Ask a Researcher service asked for our help on this very question. As a social worker needing to understand the broader impacts of the disease on the family in order to be to provide appropriate help and support, the enquirer came to us looking for the available research evidence on the impacts of dementia on those caring for them. Our researcher was able to provide a comprehensive roundup of the current literature, highlighting the variety of issues facing carers of those with dementia.

Carers’ working lives

Not all the issues covered were ones that might be immediately obvious, like the practicalities of caring and the emotional impact of seeing a loved one affected. For example, one piece of research we were able to flag up examined the impact on carers’ working lives and workplace relationships.

Over half of respondents to a survey (53%) said that their work had been negatively affected due to their caring responsibilities. The survey highlighted the pressure on those in the prime of their working life, most often women, who are combining care for an older relative, often at a distance, with a range of other family responsibilities.

Minority ethnic carers

We also highlighted research on the way dementia can affect different sectors of the population. One recent study we identified, examined how the migration experiences and life histories of Sikhs living in Wolverhampton impacted on their experiences of caring for a family member with dementia and the barriers to accessing services.

It found that, rather than cultural differences, it was migrants’ experiences and perceptions of social exclusion, their perceived and actual social position as migrants, that affected the ways in which they accessed services.

Communicating with family members who have dementia

As well as drawing together a range of research on carers’ experiences and difficulties, we were able to include examples of initiatives, such as Talking Mats, which can help to improve the experience of caring for a loved one with dementia.

Talking Mats are a simple communication tool, developed at the University of Stirling, to help people with communication difficulties to express their views. It uses a simple system of picture symbols that allow people to indicate their feelings about various options relating to a topic.

Research for the Joseph Rowntree Foundation looked at their use for people with dementia and their family carers. It found that, unexpectedly, although the people with dementia and the family carers both felt more involved in discussions using Talking Mats, the increased feeling of involvement was significantly higher for the carers. Carers repeatedly reported feeling ‘listened to’ by the person with dementia and felt that their loved one could actually ‘see’ their point of view. It found that many family carers said they often choose not to say something that is going to inflame a situation, so instead they say nothing at all. Whereas the Talking Mats tool allowed them time and space to have their say, and helped to organise and structure their conversation with the person with dementia for whom they cared.

Our response to the enquiry provided our member with a speedy and concise roundup of the currently available literature on the issues and difficulties facing those who provide vital care for people with dementia.


Our popular Ask a Researcher enquiry service is one aspect of the Idox Information Service, which we provide to members in organisations across the UK to keep them informed on the latest research and evidence on public and social policy issues. To find out more on how to become a member, get in touch.

Follow us on Twitter to see what developments in public and social policy are interesting our research team.

Digital transformation: rethinking the plumbing of government

Last summer, the Daily Telegraph reported on the Home Office decision to abandon its flagship immigration computer system. One respected IT contractor told the newspaper:

“I just don’t think the UK government should be allowed to buy IT at all. Maybe give them abacuses, but they could still get those wrong.”

Which might seem comical. But ditching one £350m system and commissioning another at taxpayers’ expense is no laughing matter. As Margaret Hodge, chair of the Commons Public Accounts Committee observed:

“Given its poor track record, I have little confidence that the further £209 million it is spending on another IT system will be money well spent.”

Unfortunately, the Home Office is not alone in its difficulties managing IT initiatives. And while private companies such as banks can encounter technological problems, public sector technology projects seem especially prone to failure. From the BBC to the NHS to the Department for Work and Pensions, publicly-funded organisations have acquired an unenviable reputation for implementing and managing IT.

According to the authors of a new book, Digitizing Government, the underlying challenge facing the public sector is to view digital transformation as being less about technology and more about organisational change. In short, they contend, it’s about “rethinking the very plumbing of government.”

In reviewing three decades of visions, strategies and initiatives, the authors attempt to understand why government has struggled to achieve technology-based public service transformation. The answer, they conclude, lies in “outdated management culture, processes, capabilities, an idiosyncratic procurement model and a supply chain that discouraged innovation and impeded competition.”

The book contrasts the closed, top-down, bureaucratic and paper-based approach of governments with commercial digital services that have emerged to provide an increasingly digitally-savvy public with fast, customised and personalised interactions.

The book’s authors go on to propose a “new normal” to remake public services for the digital age. Once again, they stress the importance of taking a broad view of digital transformation that requires: “…redesign and re-engineering on every level – people, process, technology and governance.”

Some of the proposed ideas take a common sense approach:

  • Use ‘lean thinking’ to move away from meetings, paperwork, discussions, bureaucratic rivalries, and towards more efficient and effective ways of delivering high-quality, timely relevant services to citizens and businesses.
  • Break down the silos separating services, such as policing, courts, the probation service and housing, to enable clustering of similar components together.
  • Bring in and cultivate the right skills.

Smart digital thinking applies not only to central government departments, but to local councils, our closest and most common interaction with government. According to the book’s authors, by adopting common ways of doing things – along the lines of Google, Apple and Toyota – local authorities, their residents, partners and suppliers would all benefit.

The book provides an example of this approach already being practised by the London borough of Hounslow. Rather than embedding new technology into old processes, the emphasis is on standardising processes, an approach that offers opportunities for process improvements and for information sharing across councils. Culture change is also at the heart of the support that Idox offers to the local authorities which buy its software and managed services – in areas such as online planning, environmental health and licensing – as efficiencies are unlikely to be achieved if existing processes are just replicated for an online world.

The authors acknowledge that the journey to digital transformation will not be easy, especially for organisations that are complex, use security concerns as barriers to agility, and have low levels of understanding of digital ethos.

But they make a strong case for digitising government, arguing that it offers the prospect of citizens benefiting from a more seamless approach to government services, and less wasteful administration and duplication of resources.


Members of the Idox Information Service benefit from access to a range of research and intelligence support, including a library of books on public sector policy and practice.

World Alzheimer’s Day: can we reduce dementia risk?

Older woman with Alzheimer's in a chair

Image courtesy of Flickr user Vince Alongi using a Creative Commons license

By Steven McGinty

On the 21st September, Alzheimer’s organisations across the world will be carrying out events to raise awareness about Alzheimer’s and dementia. The event, a key part of World Alzheimer’s Month, was launched by Alzheimer’s Disease International (ADI) in 1994, with the aim of highlighting the tremendous work carried out by Alzheimer’s organisations.

Each year, a new theme is selected for World Alzheimer’s Month, and this year the focus will be on how we can reduce the risks of developing Alzheimer’s and dementia. In support of this event, I’ve decided to look at some of the statistics on dementia, as well as review the latest evidence on reducing the risks.

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Are Local Authorities the saviour of the UK high street?

“High streets are the heart of towns and communities. They have been for centuries. People are passionate about high streets.” Mary Portas (2011)

As the quote from Mary Portas above suggests the British high street is something cherished by communities around the country. Built up over hundreds of years in towns and cities the country over they are a quintessentially British thing. Yet despite this fondness high streets have struggled to keep pace with the rapidly evolving economy of the 21st Century. They have been withered away by the enormous growth in online shopping and the near omnipresent out-of-town retail developments which are more accessible and free of many of the physical constraints of town centres. This is demonstrated through government statistics which show a clear decline in high street sales since the turn of the millennium. Continue reading