Sound advice: Addressing housing and social stressors to reduce patient anxiety

Here at Southern Health, we continue to lead the way by innovating how we deliver support to our service users, particularly in relation to their social stressors. Even after three years in this post, I’m still one of only two Associate Directors within the NHS that are focused on housing.

COVID, the housing crisis, and the cost of living pressures have all taken their toll on the amount of housing that is available – particularly social housing. I was at an event recently where one of our Local Authority partners presented some stark statistics that highlighted the challenges they face as a housing authority. Some of the data they shared was:

• They have 50 people in temporary accommodation.
• They have 20 people on a waiting list for a place in a hostel (ideally hostels should be able to take people immediately).
• They have over 8,000 applicants on their social housing waiting list.
• Over 4,200 applicants on the waiting list had been accepted for a 1-bedroom home.
• Even if they are deemed to be in priority need, these people will be facing a wait of around 6 months for a 1-bed home.

All of these statistics have been driven much higher following the pandemic – some as high as 40% higher! It’s no wonder that people are growing more anxious about the security, cost and sustainability of their housing, especially when coupled with pre-existing or enduring mental health conditions.

The good news is that we, as a Trust, are doing some fantastic work to help address these issues. For the past year we have been piloting a new solution with Citizens Advice who have been working with our service users in one of our hospitals, which is not only addressing some often-long-standing stressors but is also creating a real sense of hopefulness within the service users.

We recognised that people were often coming into hospital because of things that were happening in their lives – things that were having a negative impact on their mental health, albeit were separate from their mental health. That might have been debt, issues at work or with family, relationship breakdown, problems with landlords, or legal disputes.

Colleagues in our hospitals are not equipped to deal with that. Traditionally, their only real option is to signpost somebody to the likes of Citizens Advice (CA) in the community post-discharge. The evidence tells us that people don’t go.  Perhaps they lack confidence or don’t know what to ask for, don’t like the formality of the setting, have legitimate concerns about being stigmatised against, or perhaps are embarrassed or don’t want to tell their story again. Ultimately, whatever the reason, they go home and hope that the problem will go away.  Of course, it doesn’t.  It gets bigger and more out of control until their mental health is impacted and they end up back in hospital to start the cycle again.

Our in-reach pilot with Citizens Advice sees one of their Case Workers supporting our service users on the ward for 2 days a week. They spend a further day acting on the service users’ cases or supporting discharged patients in the community. The outcomes are truly phenomenal.

In the first 12 months of the pilot, CA worked with 64 people, who each had an average of 6 distinct advice needs. They have helped to address a total of 388 distinct advice need areas during this time. The amount of advice needs that have been addressed by this one Citizens Advice colleague is truly amazing in such a short space of time.

As expected, the main advice areas have been around finances (debt, benefits, financial capacity) and housing (homelessness, family mediation, understanding housing options, work with landlords).  But they have also supported people with issues around hate crime, safeguarding, legal issues, utilities, employment, transport. All sorts – the whole range of Citizens Advice services have been accessed.

The most impressive outcome, which has such a massive impact on the service user’s life, is that their advice has resulted in a total of £115,106 of financial benefit for these people. Around £88,000 of that is maximising income – getting people on to appropriate benefits or the right level of benefit, meaning they are more financially stable and secure and better placed to lead a settled live once discharged. The remainder is debt or expenditure reduction – such as Mental Health Breathing Space orders.

Arguably, more importantly than how powerful the statistics are which show a quantitative impact, is the qualitative benefit it has on the lives of our service users (and staff). By making this solution available to our inpatient population we have enabled a new support mechanism that was very difficult for them to engage with at the time they most needed it.

Understanding and addressing these areas of stress creates a real sense of hopefulness and accountability in the service users. They can see that life can be different – and better – following this admission. They start to understand and acknowledge how much these areas of stress are impacting on their wellbeing and actively engage to address them.

Knowing this support is available to them for the duration of their inpatient stay, and more importantly that it will still be available to them following their discharge from the ward has a huge impact on the levels of anxiety people experience as they near discharge. Consequently, anecdotally, we are seeing better levels of engagement in treatment, shorter lengths of stay and therefore more sustainable discharges.

These comments from service users, who have resolved their current advice needs, confirm the strength of feeling:

• “I felt it was helpful to have the advice and information whilst I was on the ward.”
• “It gave me extra weight in resolving queries that I had from accommodation to PIP.”
• “Supportive and helpful in sourcing solutions and helping me on my ongoing mental health recovery, which I am grateful for”

The impact of this collaboration is incredible and so much more powerful than I ever thought it could be. The case to expand this solution is so compelling and I’m equally pleased and excited, therefore, that we are investing in its expansion/continuation to all of our inpatient sites. 

As I said at the beginning, Southern Health really are leading the way nationally in supporting our service users in new and different ways that move beyond a purely medical model of health and wellbeing to a social model which embeds health.This latest investment from our Board demonstrates that commitment.

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If you found this of interest, check out a variety of other resources on the Housing LIN’s Health and Housing Intel pages.