Fringe or Not Fringe? Strategies for Localizing Supported Accommodation in a Post‐Deinstitutional Era

Finding suitable locations for supported accommodations is crucial both for the wellbeing of individuals with psychiatric disabilities (PD) and to achieve the objectives of the mental health care reform in order to create opportunities for social inclusion. This article explores municipal strategies for localizing supported accommodations for people with PD. In a multiple case study, interviews with 20 municipal civil servants from social services and urban planning were conducted. Three strategies were identified and further analyzed with a public location theory approach: (1) re‐use, i.e., using existing facilities for a new purpose, (2) fill‐in, i.e., infilling new purpose‐built facilities in existing neighborhoods, and (3) insert, i.e., inserting new premises or facilities as part of a new development. The article shows that the “re‐use” strategy was employed primarily for pragmatic reasons, but also because re‐using former care facilities was found to cause less conflicts, as residents were supposedly used to neighbors with special needs. When the “fill‐in” and “insert” strategies were employed, new accommodations were more often located on the outskirts of neighborhoods. This was a way to balance potential conflicts between residents in ordinary housing and residents in supported accommodations, but also to meet alleged viewpoints of service users’ need for a quiet and secluded accommodation. Furthermore, ideas associated with social services’ view of social inclusion and urban planning’s notion of “tricky” tenants significantly influenced localization strategies. Finally, this article is also a call for more empirical research on the decision‐making processes, use of strategies (intended or not) and spatial outcomes, when localizing supported accommodation for people with PD and other groups in need of support and service.

A Systematic Review of the Characteristics and Efficacy of Recovery Training for Mental Health Staff: Implications for Supported Accommodation Services

Evidence suggests a link between recovery-oriented practise and service user outcomes in supported accommodation settings. Current clinical guidelines recommend recovery training for supported accommodation staff, however evidence relating to the effectiveness of this type of training is unclear. This review aimed to describe and compare the characteristics and efficacy of existing recovery training packages for mental health staff. The appropriateness and applicability of the interventions was considered in relation to UK supported accommodation services. Initial search processes returned 830 papers. After duplicate removal, inclusion and exclusion criteria were applied to 489 papers, leaving a final sample of seven papers. Data were reviewed using a narrative synthesis approach. The reviewed papers showed variation in the aims, frequency, and duration of the training interventions, although all included content consistent with the five-domains of the CHIME model. All interventions used direct, in-person teaching, and prioritised interactive, experiential learning, however a number were limited by the absence of feedback, the use of one-off, rather than repeated/follow-up sessions, and a reliance on classroom-based, rather than in-vivo, training. There was limited evidence to suggest a consistent effect of training on staff or service user outcomes, and there was no clear association between the delivery and design characteristics of the interventions and reported outcomes. In considering the development of recovery training for supported accommodation staff, little guidance can be taken from the reviewed literature. Any training package must be developed with consideration of the unique contextual and organisational characteristics of these services. The authors recommend viewing training as one component of a broader goal of service transformation.

The level of formal support received by people with severe mental illness living in supported accommodation and participation: A systematic review

Aim: The review aimed to identify and explore the association of level of support received by people with severe mental illness in supported accommodation and participation. Method: The authors conducted a systematic search in MEDLINE, PsychINFO, PsychARTICLES, CINAHL Plus and ASSIA. Searches were restricted to articles published in English and participants aged 18 years and over with severe mental illness. Articles were included based on level of support received in mental health supported accommodation, classified according to the Simple Taxonomy for Supported Accommodation, and three factors of participation: social participation, daily living functioning and personal empowerment. Studies of in-patient settings and nursing homes were excluded. The review protocol is registered on PROSPERO (registration number: CRD42019161808). Results: Six articles were included in the review from USA, Australia, Sweden and Taiwan. Factors of participation for people living in accommodation with moderate support and accommodation with high support were explored. Data indicated an association between level of support and participation showing that people living in accommodation with moderate support had increased participation compared to people living in accommodation with high support. Conclusion: This review identified an association between level of formal support and participation. People with SMI living in accommodation with medium support participated in more community occupations, more activities and had a higher level of personal empowerment than people living in accommodation with high support.

The Effectiveness of Mental Health Rehabilitation Services: A Systematic Review and Narrative Synthesis

Introduction: Mental health rehabilitation services provide essential support to people with complex and longer term mental health problems. They include inpatient services and community teams providing clinical input to people living in supported accommodation services. This systematic review included international studies evaluating the effectiveness of inpatient and community rehabilitation services.Methods: We searched six online databases for quantitative studies evaluating mental health rehabilitation services that reported on one or both of two outcomes: move-on to a more independent setting (i.e. discharge from an inpatient unit to the community or from a higher to lower level of supported accommodation); inpatient service use. The search was further expanded by screening references and citations of included studies. Heterogeneity between studies was too great to allow meta-analysis and therefore a narrative synthesis was carried out.Results: We included a total of 65 studies, grouped as: contemporary mental health rehabilitation services (n = 34); services for homeless people with severe mental health problems (n = 13); deinstitutionalization programmes (n = 18). The strongest evidence was for services for homeless people. Access to inpatient rehabilitation services was associated with a reduction in acute inpatient service use post discharge. Fewer than one half of people moved on from higher to lower levels of supported accommodation within expected timeframes.Conclusions: Inpatient and community rehabilitation services may reduce the need for inpatient service use over the long term but more high quality research of contemporary rehabilitation services with comparison groups is required.Review registration: This review was prospectively registered on PROSPERO (ID: CRD42019133579).

(How) Will it end? A qualitative analysis of free-text survey data on informal care endings

The health and social ‘after-effects’ of caring are well established, yet the way carers experience pathways out of caring remains under-researched. In this article, we analyse qualitative free-text responses (n = 1,746) from a national survey of Australian carers to explore current and former carers’ concerns, opportunities and preferences around care endings. Our thematic analysis derived three key findings: (1) anticipation and fears for the care recipient; (2) prospects for life after caring; and (3) responsibility, recognition and loss. We engage with scholarship on the moralities of caring to discuss carers’ precarious relational and social positions, and their uncertainties around how caring ends.<br /><br />Key messages<br /><ul><li>Carers worry about how care recipients will be looked after in the future in the carer’s absence, especially in situations where the carer is frail or ageing.</li><br /><li>Carers also worry about their own futures and life after caring, including fears about re-entering the workforce, housing and superannuation, as well as issues of loss and loneliness.</li><br /><li>For some carers, the imagined care ending does not ultimately constitute the end of their caring responsibility in practice; for example, many carers continue to provide considerable care for those in supported accommodation.</li><br /><li>Understanding how carers experience and make sense of care endings is important for improving support for current and former carers.</li></ul>

Preventing homelessness among women prison leavers in Wales

Under the Housing (Wales) Act 2014, prison leavers are among those who are no longer considered a priority need. This article draws on interviews conducted with 17 women prison leavers and 10 professionals that formed part of a Welsh Government funded evaluation of homelessness services to adults in the secure estate (Madoc-Jones et al., 2018). The findings in this study lend support to previous research that indicates women who come into contact with the criminal justice system often have multiple and complex needs. The findings of the study support the need for gender-specific services and more availability of supported accommodation to ensure the effective resettlement of women prison leavers.

Individualized Apartment Accommodation for People With Intellectual Disability: Protocol for a Qualitative Study Examining the Well-Being and Support Outcomes Linking Housing and Health

Background Understanding the outcomes associated with both receiving and providing support to people with intellectual disability in specific settings can facilitate the alignment of health providers, community care providers, architects, and urban planners to strengthen levels of autonomy and community participation of people with intellectual disability living in the community. This study explores the impact of providing support (available 24 hours a day) for people with intellectual disability in a high-density apartment. It seeks the perspectives of people with intellectual disability who have moved into an apartment from a group home (where 4-6 people with disability live), their families, and support staff. It will enable comparison between two models of supported accommodation, group homes and individualized apartments, in a community setting. Objective The aims of this study are to explore the impact of an individualized apartment model of supported accommodation in a high-density setting on the well-being, autonomy, and participation of people with intellectual disability living and receiving support; the experience of providing care or support; and how this setting impacts the logistics of how quality support is provided. Methods Qualitative research methods were employed as the primary means of collecting and analyzing data. There are two main sources of data in this study: (1) semistructured interviews with participants in up to 3 waves (pre, post 1, and post 2) and (2) pre- and postoccupancy evaluation data on the design, layout, and location details of the built environments. Coded interview data will be paired with pre- and postoccupancy evaluations of the two accommodation settings. Results As of May 2020, we have recruited 55 participants. There have been 96 interviews conducted in 2 waves with people who have moved into supported accommodation, families, and staff. Collected data are currently being analyzed. We expect the results of the trial to be published in a peer-reviewed journal in late 2020. Conclusions This paper sets out a study of an alternative housing and support model for people with intellectual disability. It will capture personal experiences of people with intellectual disability receiving support in an apartment compared to their experiences in a group home. It will also capture the experiences of support staff working in the new setting and reveal how this differs from a group home setting. The inclusion of pre (group home) and post (apartment integrated into a community setting) measures addresses evaluative and comparative questions around the nature and impacts of the small-scale apartment and support model for both those who live and receive support, and those who support them. International Registered Report Identifier (IRRID) DERR1-10.2196/18248

Resettlement and the case for women

This article is about women caught in the cycle of persistent offending, breach and recall. We consider the resettlement challenges faced by this group of women and the extent to which these challenges can be met by the criminal justice system. We reflect on the impact of the Offender Rehabilitation Act 2014 and of statutory post-sentence supervision on the speed of the revolving door between custody and the community. The article draws on some data from an ongoing evaluation of a supported accommodation project for women leaving prison to illustrate its argument. We also question the extent to which the probation service alone has the tools needed to reduce the likelihood of recall and return to prison and identify the importance of factors such as sentencing law and policy and the provision of housing and health services.