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Out of area placements
The National Development Team for Inclusion (NDTi) has just published its report ‘Close to Home’, reviewing out of area placements for adults with mental health conditions. Its findings are concerning, showing that these placements can often go on for long periods of time, with home care coordinators finding it increasingly difficult to monitor care or manage discharge. it was found that 25%-50% of adults with mental health problems stay in out of area placements much longer than necessary, and people with learning disabilities and autism can be placed in locked rehabilitation units far from friends, family and support. The Care Quality Commission (CQC) specifically found locked rehabilitation units to cause isolation, poor care experiences and impaired outcomes.
It is said that the increase in out of area placements is due to the national crisis in the availability of mental health beds, but NDTi found that often it is the lack of other services that is the problem, and key to this is the shortage of provision of social care, housing and support.
Research by Mencap found that the majority of people with learning disabilities and autism do want to live independently, and they told Mencap that one of the biggest barriers to being able to live the kind of lives they would like to is housing. It was also one of the biggest concerns of their parents.
Earlier this month the Equality and Human Rights Commission (EHRC) launched a legal challenge against the Secretary of State for Health and Social Care about the failure to meet targets to move people with learning disabilities and autism out of secure hospitals into appropriate accommodation. These are often out of area placements in both private hospitals, and people can be kept there for long periods of time against their will, sometimes suffering frightening levels of abuse such as those exposed at Winterbourne View in 2011 and Whorlton Hall in 2019.
Supported living is better value
NDTi found that out of area placements are much more expensive than social housing, costing up to £3,500 per week, whereas high level supported housing is approximately £500-£1,200 per week, although funding is complicated as it crosses NHS and local authority budgets. The BMA reported that people stay twice as long on private wards compared to the NHS therefore doubling the cost, and has described this process as ‘warehousing’. Both the BMA and NDTi talk about many of these placements being contracted as ‘spot purchases’, unplanned and therefore more expensive. The BMA said that two NHS trusts kept no records of where ‘spot purchased’ beds were, so it is unclear who is reviewing the care those people are getting.
Mencap found that those who face the most problems with finding appropriate housing are people with multiple learning disabilities (who might have complex health needs) and those with challenging behaviour. In both cases specific housing adaptations may be required, as well as more support and specialised support. The lack of social housing and resources means that local authorities can find it difficult to make placements in the community, however as Mencap and PMLD have pointed out, the high levels of support required would be necessary whatever setting people live in.
At Zetetick Housing we provide supported living to mainly learning disabled and autistic people, including people with complex needs and challenging behaviour, and many of them have come to a Zetetick house direct from a secure hospital. We are able to facilitate multi-disciplinary teams with our partners in the NHS, local authorities and care providers to place people in what is often the first home of their own, with a place in their local community.
EHRC is looking at a legal model to incorporate living in the community, with service users involved in decision making. Similarly the NDTi approach is that rather than looking at services we should be looking at how we can meet people’s needs. Their focus is on ‘coproduction’, that is involving the people who use the services and their families at the centre of the process. This can only help to improve services and outcomes for individuals. In the meantime if you are struggling with out of area placements do find information and support from local and national mental health organisations.
Zetetick Housing operates in South London and Sussex. If you are looking for the right kind of supported living ask your local authority to contact us.