Shelter helps millions of people every year struggling with bad housing or homelessness through our advice, support and legal services. We campaign to make sure that, one day, no one will have to turn to us for help. However, we estimate that 65,000 families will be homeless this Christmas.
Bad housing and overcrowding lead to physical health problems like asthma, respiratory illnesses and heart disease. The stress of bad housing, and the uncertainty and instability within the housing market, lead to mental health problems. Indeed, in research Shelter commissioned earlier this year, we found that one in 20 adults have visited a GP in the last year with a mental health issue related to their housing. GPs said that housing issues were both a primary cause and also an exacerbating factor in their patients’ mental health problems.
It’s clear then that there is a reciprocal relationship between housing and health. We can’t afford to tackle physical and mental health issues without thinking about or addressing housing issues and vice versa. Through my work in a service design and development role at Shelter, I’ve seen lots of great examples of services that are simultaneously helping people to address housing needs and health needs (both mental and physical). I want to shine a light on some of the good practice that I’ve seen. I hope that a) this might help others that are commissioning, designing or developing similar services; and b) other people might share their ideas too so that we develop a consensus about service design for housing and health outcomes across the housing sector.
Housing services can be designed to tackle both health and housing needs simultaneously.
1. Key worker approach
Where households are allocated with a key worker, physical and mental health needs can be met in a coordinated and sequenced way. The best key workers are:
- part asset coach: to ensure that there is a focus on the strengths that an individual has rather than seeing them as someone with needs, issues or problems
- part community navigator: to ensure that individuals gain access to all the help and activities available to them locally
- part low-level mental health worker: to help people to make sense of their situation and plan achievable goals to work progressively work through
- part advocate: for example, to get the right benefits and/or wider support in place, or to liaise with a landlord or housing provider
- part support worker: to provide the practical support that people ask for, such as help furnishing a home or attending things like appointments, community activities, training courses or house viewings
It’s important that caseloads remain manageable (we think that 15-18 at any one time is adequate for most services) so that the key worker can provide genuinely personalised support that really helps people to address housing needs and their wider physical and mental health needs. With higher caseloads it can be the case that services become a bit rigid, systematic, ‘process-y’ and mechanical. This can lead to housing needs being addressed but wider health needs being neglected or addressed in relatively tokenistic ways.
2. Integration of specialist mental health workers
Many housing support services are now psychologically and/or trauma informed. Some services have taken the further step of integrating specialist mental health workers into their services. Having a worker readily available can help to address these issues quickly and effectively.
3. Mentoring from people with lived experience
Mentoring from someone who has been through similar experiences has been proven to help people make sense of their situations and get through the challenges that they face. This informal low-level mental health support is proving to be a critical part of many housing services. The best services are making sure that there are development opportunities for volunteer mentors to become paid trainees or support workers. This embeds lived experience throughout services and strengthens the way that services can deliver mental health outcomes.
4. A practical approach to improving homes
Housing services that help people in practical ways to develop DIY skills and to improve their living conditions also have an impact on health. Physical health is improved through physical changes to the property eg carpets to insulate. Mental health is improved because people are helped to make their house feel safe, comfortable and like a home they can be proud of eg by planting plants, installing locks and putting up pictures.
5. Integration into and co-location with health services
Where housing services integrate and co-locate with health services, they can have an even more tangible impact on health outcomes. For example, housing workers in hospitals support discharge and ensure that the person’s health needs are addressed, not exacerbated by their wider surroundings on returning home. Another example is where GPs are able to prescribe housing, debt or welfare benefit advice to a housing advice provider co-located within the practice.
Another blog in this series referred to teachers, rightly, as a ‘hidden public health workforce’. I think that this concept can be applied to those working in the housing sector as well. It’s incumbent on all of us in housing to make a conscious effort to address health needs wherever we can within our services. It’s also important that health services seek to integrate and collaborate with us wherever possible so that health and housing needs can be addressed at the same time.
James Harding (@JimmyHarding) is Senior Business Development Manager at Shelter