After a mental health crisis - Mind’s review of mental health and housing

What happens when you leave hospital after a mental health crisis, at a really vulnerable and critical time? Do you get the support you need to recover and put your life back together, or are you left to cope alone? Potentially with no money and nowhere to live.

I’ve been working on Mind’s crisis care campaign for a few years and in that time there have been exciting developments, in particular the crisis care concordats in England and in Wales, in which organisations work in partnership to improve outcomes for people in mental health crisis.

Understandably, a big focus has been on getting access to care in a crisis. But what happens after crisis care, to help people recover and avoid reaching crisis point again? Does care planning and delivery match up to NICE guidance?

Our latest campaign push was about just that. Some 1,000 people completed our online survey, sharing their experiences. They paint a disturbing picture. Yes there were good experiences, but over a third of people said they were discharged from hospital sooner than they should have been; one in five were given no notice that they were being discharged. Two out of five people told us that staff did not plan for their ongoing care and support, and one in four people said they did not receive any support at all when they left hospital.

Only half of people (51%) said their accommodation needs were considered in any plans, and less than a third (29%) said that money and benefits were considered. This risks people going from hospital into unsafe or unsuitable housing; we’ve heard from people who have gone straight from the ward to their council to present themselves as homeless. Being unable to work, or not meeting benefits agency expectations, can lead to a disastrous loss of income.

As David Bryceland from Oxfordshire Mind’s Benefits for Better Mental Health service says:

“So long as you have the advice and help you need when you leave hospital, your benefits can be transitioned and protected, but, if you don’t know what you are supposed to do, who you are supposed to call and what information they need, then most people will simply assume that their benefits will continue. Unfortunately this is not the case.”

Our report Brick by brick: a review of mental health and housing includes the research evidence around hospital discharge and housing – the importance of adequate housing; how good practice guidance is often not implemented, with discharge planning rushed and people’s preferences overlooked; and the lack of assistance for people who need their accommodation to be kept safe while they are in hospital.

So in looking out for good practice we were glad to be able to highlight services that help people keep or secure these essential basics of life. They include:

• Oxfordshire Mind’s Benefits for Better Mental Health service, which can see people on the wards and get their benefits in place ready for discharge
• Connect, a partnership led by Carlisle Eden Mind, providing pre-discharge support to help with housing, income maximisation and benefits drawing on specialist provision provided by partners
• Buckinghamshire Mind in partnership with Oxford Health NHS Foundation Trust, providing one-to-one signposting and support and recovery groups, acting as a vital bridge into the community.  

We heard a lot about people being discharged too early, but people can also get stuck in hospital too long, waiting for care and/or accommodation to be arranged. This is not helped by the discriminatory exclusion of mental health hospitals from Care Act measures designed to prevent delayed discharges. The Bradford Mental Health Housing and Supported Living project shows how local partners can together enable people to access suitable accommodation – this includes having a specialist housing social worker within the NHS acute mental health team.

What do we want from the campaign? We’re calling on commissioners, providers and crisis care concordat partnerships to use our briefing to review what happens in their area and ensure that everyone leaving hospital gets the right care and support.

Getting it right includes people having choice and control – planning their own care with health care professionals. Our Planning for recovery booklet aims to help people do that and organisations can order in bulk here.

You can follow our policy and campaigns work on crisis care, benefits and housing on our website and if you’d like to campaign with us, sign up here.