Community residences should not be used for purposes other than support and rehabilitation. The use of beds for temporary respite, crisis care or emergency transfers in place of acute care is not in the best interests of those who live in the residences. Other provisions should be made for these groups.
All staff working in community
residences and those working with this population should be trained in the competencies and principles of recovery.
The rules and regulations of the residences should be re-visited. While some general rules and regulations are required, those regarding the freedom of the residents should be amended to meet individual needs. The residences should provide as homelike an environment as possible. The aims and functions of the community residences should be standardised so that both staff and residents are aware of their
responsibilities to meet these aims and functions. Furthermore the aims and functions of the different levels of
support should be specified and standardised throughout the country and residents informed of these. Currently the residences are providing two main functions – continuing care, and rehabilitation to more independent settings. It is debatable as to whether the alliance of two apparently
conflicting functions is the best way to meet the needs of the different
residents. The findings of the current study would suggest that the needs of those who wish to move to lower levels of support but need intensive
rehabilitation are not being met. The rate of provision of places, particularly of high support residential places (76 per 100,000), is higher than the recommended 30 places per 100,000 by A Vision for Change. The authors acknowledge that a small minority of individuals will continue to need high support care and that some of the current high support residences should be maintained for these
purposes. It is also acknowledged that, in some areas, patients still remain in psychiatric hospitals and will need relocation to alternative residences. Residents who have been relocated to community settings from psychiatric hospitals or those who have spent long periods of time in their current
accommodation should have the right to remain in these facilities, if they so wish. Newer residents or potential residents should be informed of the temporary nature of their placement and should be encouraged and supported to prepare for more independent living.
As outlined in Chapter 10, the
functions of some of the high support residences may change in line with recommendations from A Vision for Change (i.e. intensive rehabilitation places, crisis care places). Community residences that will be no longer needed for current purposes can be re- designed to provide for other functions such as intensive rehabilitation, crisis care and high support care. Mental health services should keep this housing stock in mind when addressing the
needs of future community
requirements, such as mental health centres as recommended in A Vision for Change.
The number of places in many
individual high support residences is at present above the recommended ten advocated in A Vision for Change. The number of places per residence has implications for the privacy of the occupants. All high support residences should reduce the number of places to the recommended level. No residents should have to share a room with more than one person and, if at all possible, single rooms should be provided. If the environment allows, bedrooms should be renovated to include en-suite bathrooms or shower rooms. The nursing staff resources currently employed in the residences should be evaluated in terms of the need for nursing and non-nursing staff and the current blend of skill mix. Excess nursing staff currently employed in the residences should be re-allocated to community mental health teams. The health and safety regulations and, in particular, Hazard Analysis and Critical Control Points (HACCP) should be revisited. These currently prevent residents from using kitchen facilities in high support residences, an important aspect of independence.
Evaluation and review procedures to monitor quality should be implemented in all residences. These should take account of the residents’ satisfaction and, wherever possible, the relatives’ views.
Any outstanding issues in relation to payment of rent should be finalised to avoid any distress to residents, staff and management.
Local authorities have a responsibility to provide nearly 2,000 housing places in medium and low support residences. Intersectoral and interagency
collaboration is needed to stimulate local authorities to start providing the 2,000 places identified as needed. The
Departments of Health and
Environment, local housing authorities, the HSE and voluntary agencies need to work together to set up innovative, imaginative and pilot partnerships schemes to provide accommodation for those with medium and low support needs.
The possibility of the local housing authorities taking over responsibility for the provision and management of low support residences should be discussed with representatives from relevant stakeholder groups and service users at a national level.
The possibility of voluntary agencies taking a greater role in the provision of medium support residences should be encouraged, with the setting up of pilot partnership projects involving all stakeholders.
Mental health services should contact local housing authorities to determine the possibility of setting up pilot housing projects for groups of three to four individuals. At least two pilot areas in Ireland should be selected and evaluated. The Dublin City Council has already expressed interest in such an initiative.
11.3
FUTURE PROVISION OF HOUSING
Housing for those with mental health difficulties must be provided in
mainstream housing in the community. The provision of housing is not the responsibility of the mental health services. As reported in A Vision for Change the ‘statutory responsibility to provide this housing is not within the remit of the mental health services or the HSE’.
The future provision of housing, in particular medium and low support housing, for those with mental health problems should not be the
responsibility of the mental health services. There is a need for statutory and non-statutory bodies to work in collaboration with mental health services to define their roles in relation
to the needs and support requirements of this population. Some examples have been provided in the report and these should be evaluated within the Irish context. The authors acknowledge that building effective interagency
partnerships will take time. Yet this should begin as soon as possible with those at the highest level of the HSE and governmental bodies providing leadership and direction to those at local level.
Interagency working will be most effective when the roles and responsibilities of each agency are clearly defined. In addition, agencies must have mutual trust, respect and understanding of their respective roles and responsibilities.
Voluntary agencies, working closely with mental health services and service users, have begun to provide housing and care for vulnerable groups and these existing models should be evaluated and if effective, publicly encouraged and promoted by government.
A range of housing alternatives is necessary for those with differing levels of need and support requirements. In contrast to what is currently provided, the level of support should be flexible. Provision of support by ‘recovery guides’ (as in the STEER project) should be evaluated as a possible model for the provision of low to medium levels of support.
All future housing for those with mental health problems should be designed with the principles of recovery in mind. All residents sharing
accommodation should have their own en-suite bedroom. All new housing should be life-time adaptable.
11.4 IMPLEMENTATION ACTION PLAN
To enable implementation to proceed rapidly, intersectoral action plans are needed at central and local levels. Local groups, one for each catchment area of approximately 300,000 population as recommended in A Vision for Change, should have the appropriate representation of housing and mental health interests that will draw up action plans at local level and report to the central group.
At central level an intersectoral implementation group should be formed. This group might comprise the following stakeholders - the
Department of the Environment, Heritage and Local Government, the Department of Health and Children, the HSE, Mental Health Commission, local housing authorities, local mental health services, local housing associations, and representatives of service-user groups. The group would:
• Lead on the intersectoral policy changes required to implement the recommendations and develop a central intersectoral action plan accordingly.
• Work through local groups to monitor progress towards implementation.
• Liaise in this endeavour with the implementation and monitoring bodies of A Vision for Change. • These recommendations should be
implemented without delay. Many of the recommendations are resource neutral but where resources are required they should be made available.
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