Originally posted in the HSJ blog Leadership in Mental Health,  16 December, 2011

Two recent reports have drawn attention to an issue to which mental health services too often pay insufficient attention yet which is fundamental to the health and wellbeing of every one of us. Having somewhere safe and secure to live is one of the basic requirements of human life. Yet too many people with mental health problems, and particularly those who end up in the criminal justice system, do not have somewhere to live and as a result their health suffers enormously.

An NHS Confederation Mental Health Network briefing, Housing and mental health, examined the many ways in which addressing people’s housing needs is critical to the success of mental health care. These range from broad questions about the importance of having somewhere settled to live to enable recovery and social inclusion to more specific requirements such as discharge planning and risk management.

Shortly after, a Centre for Mental Health briefing, A place to live, focused on the links between housing instability, mental ill health and offending. It showed that for too many people, poor mental health, a lack of somewhere to live and involvement in the criminal justice system reinforce each other. Figures from St Mungo’s, for example, show that 70 per cent of their hostel clients who have slept rough have a mental health need while 48 per cent of their clients were ex-offenders or had been to prison. Being in prison can be both a cause and a consequence of homelessness and mental ill health. And the impact of housing instability appears to be particularly dramatic among children: the Youth Justice Board having reported that 40 per cent of children in custody had already sought housing support, often from the ages of between 13 and 15.

In recent years there have been many different attempts to address the causes and consequences of homelessness, mental ill health and offending. Most resources, however, have remained in services that tackle single issues or at best two needs at a time. There are of course some outstanding exceptions to this rule. The Supporting People programme offers housing support to people with mental health conditions, learning difficulties, substance misuse problems or offending histories. Sadly, as a result of the programme’s budget losing its ring-fence at a time of extreme financial pressure on councils, many local authorities are now cutting their housing support budgets by up to 40 per cent. So one of the few means of supporting people with multiple needs to maintain their independence is being lost despite growing evidence of the need for this kind of intervention.

The Health and Social Care Bill could help to address some of these issues. By placing directors of public health in local authorities and boosting the role of Joint Strategic Needs Assessments, it could create better conditions for linking health and housing services. Yet without a requirement in the Bill to include housing services on Health and Wellbeing Boards, it will be up to local initiative to make those links work. And with mental health issues barely registering in the Government’s new Housing Strategy for England nor stable accommodation appearing as a major outcome for health services, there are few incentives from the centre to join up on the ground.

For mental health services, though, the evidence is clear. Failing to address people’s housing needs and aspirations is self-defeating. While the evidence base in this area is less well developed than in some others, taking action to form partnerships, to intervene early and to address multiple needs is among the keys to success in mental health care that can no longer be ignored.