Agenda item

Clare Hopkins (Lewisham Homes), Maggie Houghton (Hyde Housing), Michael Munson (Bromley and Lewisham Mind), James Forrester (SLAM), and Peter Wood (999 Club Lewisham) introduced themselves and spoke about their work.

James Forrester (SLAM) spoke. The following key points were noted:

·         SLAM run two primary intake services in Lewisham: the Increasing Access to Psychological Therapy (IAPT) service and the Assessment and Liaison service based at Southbrook Road.

·         The Assessment and Liaison service is there to help people who may be approaching crisis point. It aims to stabilise people within 12 weeks, but it often takes much longer.

·         The main reason it takes longer is that there are often a number of other background factors that can’t be resolved within 12 weeks – for example, immigration status, not being able to speak English, having been displaced as a result of war, or having been illegally trafficked.

·         There are all sorts of problems that people are going through that aren’t necessarily to do with a particular mental disorder, but which seriously affect people’s lives and wellbeing. These are almost inevitably related to housing and tenancy, money and debt, or not being able to get back into work.

·         The service will try to help people to maintain their tenancy or find another. If people are having serious housing and money problems they’re unlikely to make a successful recovery with mental health treatment alone. The influence of people’s wider problems is a significant problem.      

·         90% of referrals to the Assessment and Liaison service come from GPs. Other referrals come from the police, probation services, and the social work team at the Ladywell Unit.

·         A clear agreement between all the relevant agencies in the borough setting out how people with low-level mental health issues should be helped is a really good idea – SLAM is not aware of anything like this in Lewisham.

Michael Munson (Bromley and Lewisham Mind) spoke. The following key points were made:

·         Mind’s Community Support service in Lewisham is a primary care service. It provides short-term interventions of around 12 weeks, but background factors like language, poverty, and chaotic situations mean it can take longer.

·         The Mind service usually sees people who either haven’t met the criteria for secondary level care or who are being stepped down from secondary level care. By intervening early on the service is able to help people feel better, but without other support there is always a risk of them sliding back.

·         27% of referrals come from secondary level services, this includes 19% from the Assessment and Liaison service. 20% of referrals come from GPs. Only a handful come from housing providers. 85% of all referrals mention anxiety and depression.

·         Last year, 32% of people referred to Mind’s Community Support Service had a housing issue. 25% of these lived in the private rented sector.

·         Most housing issues are to do with repairs and rent arears. Living in poor conditions and not feeling like you can go to the landlord, which is often the case in private rented housing, exacerbate anxiety, depression and other mental health issues. But it is often difficult to solve housing issues in 12 weeks.

·         Mind’s experience of housing providers is that that they don’t understand mental health at all. They don’t recognise mental health problems until there is a tenancy sustainment issue and they see anti-social behaviour as just that, they don’t see the underlying causes of the behaviour.

·         From Mind’s experience, by the time people get to the tenancy sustainment teams, they will have had letter after letter they’re too scared to open, been threatened with eviction and had people knocking on their door that they don’t know. Their mental health has being aggravated by the system their living within.

·         Mind said that references by housing providers to things like “working with community mental health teams” show how out of touch they are with the mental health support system – these structures don’t exist anymore.

·         Mind also said that housing providers don’t seem to have proper training or be willing to engage. Some individual housing officers are much better – these are often the ones that are aware of services like Mind and have worked with them before. Staff in supported housing are very good.

Peter Wood (999 Club Lewisham) spoke. The following key points were made:

·         The 999 Club in Deptford works with homeless people. It sees people with a range of needs, many who don’t meet the criteria for secondary care, including low-level mental illness.

·         The 999 Club provides learning activities, employability and welfare advice. It also helps people with social exclusion and housing problems. It’s non statutory funded. Referrals usually come from the police or probation service.

·         As well as mental ill health, issues like learning disabilities and poor levels of education can also make it difficult for people to access support services related to housing and more widely.

·         There needs to be access to a service for people with low-level mental health needs, and it would need to go out into the community and see people with mental health needs and other mental health support services.

Maggie Houghton (Hyde Housing) spoke. The following key points were made:

·         Hyde has recently set up a new tenancy support service – consolidating money and debt advice, employment advice and general tenancy sustainment. This was in response to the need to make severe cuts, but also an attempt to provide a more holistic service. Hyde’s own research found that the overwhelming majority of people with rent arrears and other tenancy issues have an underlying mental health issue.

·         To access Hyde’s tenancy support service someone would have to have a physical or mental impairment or illness that affects their ability to manage their tenancy. The service provides eight weeks of intensive support, but other background problems often make it difficult to stick to this.

·         Hyde frontline housing officers are picking up people’s mental health problems, but are finding it incredibly difficult to access professional support for those needs. After being consulted, nearly all frontline housing staff said they’d like to see better access to support for low-level mental health.

·         There needs to be an effective way of intervening early on. Hyde suggested that an agreement between local partners on how to deal with low-level mental health issues is a brilliant idea. It could help everyone work together to sort things out early on – a problem could cost much more in time and effort to deal with even two weeks down the line.

Clare Hopkins (Lewisham Homes) spoke. The following key points were made:

·         Lewisham Homes does not have a tenancy sustainment team. They’re noticing an increase in mental health issues among tenants, but are finding it very hard to find support for lower-level mental health problems.

·         Lewisham Homes do find that some tenants aren’t comfortable with telling them that they have a mental health issue. Sometimes frontline staff can see there’s clearly a problem, but if the person doesn’t agree or doesn’t consent to a referral it is very difficult to help them.

·         Networking and training for frontline housing staff on what is available and who provides what would be welcomed by Lewisham Homes. There have been lots of changes in the borough. It’s often obvious to housing officers that something is wrong, but don’t always know where to go.

Witnesses answered questions from the Committee. The following key points were noted: 

·         SLAM cited the management of the Brackton Medium Secure Unit as an example of good local partnership working. This was a partnership between the council, the mental health trust, Penrose Housing and Equinox Housing. Penrose and Equinox are both more than capable of making very good reciprocal arrangements with multiple partners.

·         SLAM thought that mental health training for housing officers, possibly through SLAM’s Recovery College, would be a great idea. Generally, people don’t have a good idea about what SLAM can and can’t do. Some people think that SLAM can cold call whoever they want on the basis of a concern being raised. But they can’t. Arranging contact with people over the phone or face-to-face needs to be done with the person’s permission – SLAM often have to reiterate this with housing officers.

·         To be able to better support people with low-level mental ill health in the private rented sector, it would be useful to have some sort of wellbeing network or forum where providers could share best practice and new ideas and establish relationships with other services in the borough. The 999 Club said they have found it very hard to establish a relationship with the CCG, for example.

·         General mental health training often provided by housing providers isn’t focused enough for what their officers need. They need specific training on spotting when mental ill health may be the cause of a housing problem and what to do next – similar to mental health first aid, which the council provides to commissioned organisations.

·         To support people with low-level mental ill health living in the private rented sector, Mind will intervene and speak to the landlord on the person’s behalf and try to come to an agreement. This may involve, for example, coming to a payment plan to avoid eviction or talking to the landlord about repairs that need to be done.

·         IAPT has a very high recovery rate: 50% of the people that access it get better. And around 65% of people who use the services will see a clinically significant improvement.

·         Lewisham Homes would like to provide a tenancy sustainment services, but do not have the resources. They do recognise, however, that they need to reengage with local partners so that they can signpost people to the support that is available.

·         Hyde are looking at extending their mental health awareness training to the staff that see tenants the most – repairs teams, for example.

·         Providing effective early support currently often relies on individuals building good relationships with other individuals in other agencies. But this support can collapse once people move on. There is an overwhelming lack of cohesion – an agreed way of doing things would help with this. Mapping services would also raise awareness and make early intervention easier.

The Committee made a number of comments. The following key points were noted:

·         The Committee suggested that there is a training need among housing providers around ways to encourage people suffering with low-level mental health issues to engage with help and support, and what to do if someone doesn’t want to.

·         The Committee noted the percentage of people with mental health problems living in the private rented sector is likely to increase and the sector increases as a whole, and expressed concern about the strain that this might put on mental health services.

·         The Committee noted that there appeared to be a need for more training around data protection, confidentiality and the information the providers can share to help people – including when and how to ask for consent.

·         The Committee noted that investing in early intervention is more effective and cheaper in the long run.

·         The Committee expressed concern about the lack of awareness and cohesion among housing and mental health providers, commenting that this is holding them back from providing more effective help.

·         The Committee noted that there is a gap in knowledge of what help there is available for people with mental health issues and suggested that the relevant people need to be encouraged to meet regularly to share knowledge and experience.

Resolved: the Committee noted the witnesses’ evidence.