Challenging the exclusion of people with mental illness: the Mental Health Housing and Accommodation Support Initiative

Australian Journal of Social Issues, Winter, 2008 by K. Muir, K.R. Fisher, A. Dadich, D. Abello

Introduction

With high hospitalisation rates and widespread social exclusion, mental illness is a profound health and social need that requires an integrated policy approach (Shepherd 2007). In the past, mental health models of support for people with acute mental illness have focussed on clinical symptoms, rather than addressing the multiple aspects of a person's life, such as mental health, housing stability and community participation. This article describes the NSW Mental Health Housing and Accommodation Support Initiative (HASI) model and reports the findings of an evaluation of the program. The evaluation examined housing, mental health and community participation outcomes for the people involved in the program, as well as assessing the implementation of the integration model. The article includes a discussion of the policy implications for supporting people with mental illness to improve their mental health, stabilise their tenancy and increase their participation in their community.

Transitional Housing and integrated Models of Support

The risk of people with mental illness experiencing poverty and social exclusion is an international phenomenon. People with mental illness can experience profound disability in their public and private lives. They are often excluded from employment, education and social services and are at risk of homelessness or unstable housing and limited or no social supports (ABS 2006; Bassett et al. 2003; Australian Department of Health and Ageing 2006).

Mental health policies have had limited success in decreasing the disability and exclusion of people with acute mental illness. Deinstitutionalisation was intended to improve quality of life and decrease social exclusion of people with mental illness. While the deinstitutionalisation policy and subsequent community services enabled a shift from segregated, institutional care to community based living for many people with mental illness, living in the community did not necessarily translate to stable housing or social participation (Harvey and Fielding 2003). In the early 1990s, the widely cited Burdekin Report, for example, found many people with mental illness experienced discrimination, social exclusion and a contravention of human rights (HREOC 1993).

For people with acute mental illness, housing services largely focus on offering transitional models of supported housing. After leaving hospital or institutional care, people are accommodated in different types of supported housing depending on their clinical wellbeing. As people's mental health progressively declines or improves, they are required to move through different types of housing (Hanrahan et al. 2001; Tsemberis 1999). This model is based on clinical wellbeing and it has been successful in improving mental health and decreasing hospitalisations (Rog 2004).

The transitional model of supported housing however, does not offer secure housing or ways of building participation and strong community connections. In a review of 109 studies on transitional models of support, Carling (1990) concluded that this approach potentially increases stigma, limits the development of transferable living skills and fails to effectively integrate people into the wider community.

Recent developments in support for people with mental illness focus on local, community-based, coordinated services that provide treatment at home to support both symptoms and disabilities (Thornicroft and Tansella 2003). Yet for such a model to be successful, stable housing is critical. Individualised supported housing options attempt to stabilise housing in a community setting. Support is often provided in collaboration between clinical mental health services and other sectors, such as housing and non-government organisations (Ridgway and Zipple 1990).

In Australia, many programs continue to follow a transitional model of supported housing, in which psychosocial accommodation support is provided in collaboration with clinical support (Freeman et al. 2003; NSW Health, 2002; Dadich, 2007). In only a few exceptions are individualised supported housing programs offered that provide stable, long-term housing and community and clinical support. Some of these include the Independent Living Program, Western Australia 1995, Project 300, Queensland, 1996, and HASI, NSW 2002 (NSW Health, 2002; Meehan et al. 2004; Flatau et al. 2006).

This article reports on the findings from the HASI evaluation; one of the first published comprehensive evaluations of an Australian individualised supported housing program offering housing, community and clinical support to people with high levels of psychiatric disability. (1) It describes the program, presents results about client outcomes (housing, mental health, service use and participation) and discusses the policy implications.

HASI Model

HASI is a partnership between NSW Health, Department of Housing (Doll) and non-government organisations (NGOs), and is jointly funded by the two Departments. The program follows psychosocial rehabilitation principles and has a recovery focus. HASI aims 'to assist people with mental health problems and disorders requiring housing (disability) support to participate in the community, maintain successful tenancies, improve quality of life and most importantly to assist in the recovery from mental illness' (NSW Health and NSW Doll 2005: 1).