Specialist and Supported Housing Needs Assessment

The intention of this assessment is to identify the housing and supported housing needs of people with significant mental health needs (who are in contact with specialist mental health services).

The assessment of need for housing and supported housing draws on a range of evidence, including:

• Demographic context: current population and projected population of people with significant mental health needs.
• Current provision of housing and supported accommodation.
• Evidence from people with mental health needs.
• Local policy context.
• Local commissioner perspectives and intelligence.

Population baseline

To provide an estimate for the number of people with significant mental health needs the following data sources have been used:

• Mental Health Services Data Set (MHSDS) from NHS Digital. Data for the Newcastle and Gateshead CCG area shows that there were 4,170 adults aged 18 to 64 years in contact with specialist mental health services (2021 to 2022). Based on Gateshead having approximately 39% of the overall population of Newcastle and Gateshead combined, it is assumed that 1,626 adults aged 18 to 64 years in Gateshead have contact with specialist mental health services.
• NHS Digital - Mental health service users on Care Programme Approach (CPA) (NHS Digital: Care Programme Approach: Mental health service users on Care Programme Approach: % of mental health service users (end of quarter snapshot); accessed via OHID Fingertips) - to provide a baseline figure of the number of adults with a significant mental health related need in Gateshead. It should be noted that this 'population' may not capture people with other support needs who may also have mental health related needs, for example some people who are or are at risk of homelessness.
• Data from Gateshead Council (Gateshead Council: Internally held data on number of individuals with a mental health related need): number of adults with a mental health related need receiving adult social care that are known to the council, including those living in supported housing, care homes and Shared Lives schemes. This is a smaller population cohort than the CPA population (as not all CPA clients will require social care or have a need for supported housing).
• Gateshead's Joint Strategic Needs Assessment (JSNA) (Gateshead Joint Strategic Needs Assessment: Information on the number of people with learning disabilities living in their own home or with family).

The data from the MHSDS indicates that there are approximately 1,625 adults aged 18 to 64 years who have contact with specialist mental health services. The data from NHS Digital shows that there were estimated to be 591(NHS Digital data for adults with a mental health related need registered on the CPA is shown for Newcastle and Gateshead CCG. The data has been adapted to estimate the number of individuals registered on the CPA in Gateshead alone, based on ONS population data (39% of the combined Gateshead and Newcastle population is comprised of Gateshead).) individuals with a mental health related need registered on the CPA in 2019 to 2020. These are adults with significant mental health needs. This is used as a baseline figure for the number of adults with significant mental health needs in Gateshead.

The data from Gateshead Council shows that there were 155 individuals between the age of 18 to 64 people with a mental health related need receiving a social care service from the council, including people living in supported housing, care homes and Shared Lives schemes in Gateshead in 2021 to 2022.

Current housing/accommodation status

The housing/accommodation status of the people aged 18 to 64 with a mental health related need is shown below, based on MHSDS data and the council's data.

1. This includes the population of adults aged 18 to 64 with a significant mental health need disaggregated by the following accommodation categories:

• No./% living in residential/nursing care.
• No./% living in supported housing.
• No./% living in mainstream housing as tenants and/or homeowners.

Table 23. Accommodation: adults aged 18 to 64 in Gateshead with a mental health need.

Source: MHSDS 2021 to 2022. Gateshead Council.

Data regarding the number of people with mental health needs, people with learning disabilities and other working age adults with care needs living in care homes and in supported living (supported housing) has been provided by Gateshead Council commissioners.

This shows that the current supply of supported housing for people with mental health needs is limited; of that which is available, over 50% is in traditional shared supported housing, for example, where people have a bedroom but share the communal facilities with other tenants. There is only one self-contained supported housing scheme for people with mental health needs, which has five self contained flats.

4% of people with a significant mental health need are estimated to be living in supported housing and 4% are living in residential/nursing care homes.

A small number of people (five individuals) have 1:1 24/7 support living arrangements; this may include people with complex needs including mental health needs along with learning disability and/or autism related needs.

Projecting future population of people with a mental health need

Estimates of population growth take account of factors such as younger people with mental health related needs becoming adults and an ageing population.

Data from PANSI (opens new window) indicates an estimated reduction of approximately 3% in the number of people aged 18 to 64 years in Gateshead who are predicted to have two or more psychiatric disorders to 2040. However, local evidence from commissioners indicates an increasing trend of adults with serious mental illness being referred to mental health services. This local intelligence is also supported by data from the NHS Digital Quality and Outcomes Framework data.

Based on data from the NHS Quality and Outcomes Framework (NHS Digital: Quality and Outcomes Framework - 2012 to 2021: Number of adults with severe mental illness in Newcastle and Gateshead CCG; accessed via OHID Fingertips (opens new window)) regarding the population with severe mental illness, a 1.8% increase per year in this population is projected.

Based on the increase of 1.8% per year, the projected adult population with significant mental health needs for each five-year period to 2040 is shown in table 24.

Evidence from people with mental health needs and local stakeholders

The evidence regarding the housing perspectives of people with significant mental health needs has been drawn from the following stakeholders:

• A small sample of local residents.
• Local community organisations such as Mental Health Concern.
• Local providers of supported housing such as Oasis Community Housing, Home Group.

The key messages from these stakeholder are summarised below.

There is no desire amongst people with a mental health need to live in residential care settings.

There is a need for an increase in supported housing across Gateshead for people with a mental health need, particularly accommodation that supports people with complex mental health needs.

There is a need for more step-down accommodation that supports people to transition from acute hospital settings to supported accommodation.

In many cases, people with a mental health need would prefer and are able to live in mainstream housing with support. If supported housing is needed, self-contained accommodation is typically preferred over shared accommodation, which builds on peoples' strengths and capabilities.

The majority of people who need supported accommodation are seeking small-scale supported housing schemes.

For people with a mental health need having access to green space is important for their health and wellbeing.

People are seeking to live in locations with good access to public transport, shops, amenities and support services.

Where people with mental health needs are living successfully independently within the community, they are often receiving regular input from a housing support worker, and they are well connected to community support services. Having access to support groups and community is important. People with a range of mental health needs report that the existing process for finding alternative accommodation, whether in the private rented sector or through choice-based lettings, is often very challenging which can cause further anxiety and stress. Often people need support with this from community organisations to help with navigating access to housing.

Evidence from discussions with Registered Providers and other housing providers indicates:

• There is a changing resident profile in older person's accommodation to include 'younger' older people (such as people aged 55 to 65 years) with mental health needs. This is thought to be due to a lack of alternative supported accommodation.
• Mental health diagnosis has increased substantially in the last five years, for example including complex diagnosis and 'co-morbidity' with autism, which has meant an increased demand for supported housing but also floating support services.
• That people with 'dual diagnosis' (such as with mental health needs and autism) find access to appropriate housing difficult. There is a need for a wider range of housing provision for these individuals.

Local policy context and local commissioner perspectives and intelligence

The council's Market Position Statement, 2020 to 2022 includes an objective of:

• "Improving the housing and support offer for people living semi-independently in the community, working alongside housing, social care and voluntary and community organisations"

The council's Specialist and Supported Housing SPD 2022 (PDF, 1 MB) states:

• "The council is committed to enabling people with short or long-term care or support needs, wherever appropriate, to choose, or be accommodated safely in, suitable mainstream accommodation that will allow them to live in their own home as independently as possible with bespoke and flexible support."

The council's vision for a housing pathway for people with mental health needs, drawing on evidence of need for specialist and supported housing, the views of local stakeholders and commissioner insights is:

• There is a desire and need to develop an accommodation 'pathway' for people with significant mental health needs (who are in contact with/supported by specialist mental health services). This includes having the following mix of housing and types of supported accommodation.

1. There is a need for reduced reliance on residential care to house people and an increased need for a range of alternative housing options.
2. There is a need for a small number of specialist supported housing schemes for people with complex mental health needs, including 24/7 support, which can also provide 'step down' accommodation for people being discharged from inpatient settings.
3. There is a need for small 'clusters' of self-contained supported housing that provides short to medium term (up to 2 years) supported housing, both for people who no longer need 24/7 supported housing and people who need a supportive environment before moving to independent housing.
4. There is a need for people with a mental health needs to have better access to mainstream general needs accommodation and to be supported with floating support to enable people to live independently in the community.
5. There is a wish to expand community support networks as a model of support as this enables people to live in mainstream accommodation as well as providing support to access community life.

Assumptions about the need for different housing/supported accommodation types (the relative percentage of each housing/accommodation type) to be applied the estimated population to 2040 to identify projected housing/supported housing need

This is based on:

• Projections in relation to population growth.
• Assumptions about trends in need for different types of housing and accommodation.

Research by the Housing LIN with people with mental health needs, including in Gateshead, indicates that:

• There is no desire to live in residential care settings.
• There is a need for supported housing that supports recovery and independence.
• There is a need for supported housing with significant support on site that enables people to 'step down' from acute hospital settings.
• There is a requirement for access to mainstream housing with support as required.

Evidence from commissioners is that there is a need to develop an accommodation 'pathway' for people with significant mental health needs (as set out in paragraph 4.30).

The following assumptions have been applied to the estimates of housing and supported housing need for people with significant mental health needs:

• The adult population with a significant mental health need is comprised of the number of service users on the CPA with a mental health need (source: NHS Digital).
• The population growth of the adult population with a mental health need is 1.8% per year. (Source: Quality and Outcomes Framework (QOF), NHS Digital).
• Nursing and residential care use is assumed to decrease by at least 50% by 2040.
• Growth in population of adults with significant mental health needs and any reduction in need for residential / nursing care, is reflected in growth in need for supported housing and mainstream housing.
• There is a modest level of increase in need assumed for Shared Lives.
• Need for mainstream housing is calculated as the difference in the CPA population and the population in supported housing, Shared Lives and residential/nursing care.

Identifying estimated future housing and supported accommodation need for people with mental health needs

This identifies changes in net housing and supported housing requirements to meet projected housing need and changes in the types of housing/supported housing required. This is based on applying the assumptions above to the current housing/supported housing provision. This is then adjusted for identified population change over time.

Table 24 shows estimated need for housing/supported accommodation for people with significant mental health needs in Gateshead to 2040.

Table 24. Estimated need for housing/supported housing for people with significant mental health needs in Gateshead to 2040

Source: Gateshead Council (2022) and NHS Digital (2019/20)

Table 25. Net additional need for supported housing to 2040

Tables 24 and 25 indicate that there is an estimated net need for approximately 30 units of additional supported housing for people with significant mental health needs by 2030 and approximately 65 units of additional supported housing by 2040.

There is a need to develop a housing and accommodation 'pathway' for people with significant mental health needs (who are in contact with/supported by specialist mental health services) as set out at paragraph 4.30.

This pathway of additional housing and supported housing options is required, in part, to reduce reliance on residential care to accommodate people. It is assumed that the number of people living in care home beds will decrease by approximately 50% by 2040. It is assumed that in future people who may have used residential/nursing care will use supported housing with 24/7 support as an alternative.

The estimated need indicates that the following 'components' of this housing pathway are required.

There is a need for of specialist supported housing for people with complex mental health needs as short to medium term accommodation (for example for up to two years) consisting of a small number of self contained flats (approximately five to six units). This is typically a small 'cluster' of flats with 24/7 support, which can also provide 'step down' accommodation for people being discharged from inpatient settings. An example of this type of supported housing scheme is the London Borough of Greenwich mental health high support scheme, which provides supported housing with 24/7 support for people with serious mental health needs, for example being discharged from inpatient settings or leaving a residential care setting.

There is a need for additional small 'clusters' of self-contained supported housing (similar to recent supported housing developments in Gateshead) that provides medium term supported housing (for example for up to three years), both for people who no longer need 24/7 supported housing and people who need a supportive environment before moving to independent housing. This the equivalent of the 'concierge' type of supported housing schemes (typically eight to 10 self contained units) that have been developed recently in Gateshead. Another example of this type of supported housing scheme is Salveson House, London. This is operated by One Housing and provides contemporary (new build) self contained one bed flats in a cluster of 12 units for people with long term/complex mental health needs.

There is a need for people with significant mental health needs to have better access to mainstream general needs accommodation and to be supported with floating support to enable people to live within the community. This could include expanding community support networks as a model of support as this would enable people to live in mainstream accommodation as well as providing support to access community life.

These supported housing requirements to 2030 are summarised below.

2023:

• one additional specialist supported housing scheme for people with complex mental health needs. Five to six s/c units. 24/7 support

2025:

• one additional 'concierge' type of supported housing scheme. Eight to 10 s/c units. Support level to be determined (less than 24/7)

2030

• one additional specialist supported housing scheme for people with complex mental health needs. Five to six s/c units. 24/7 support
• one additional 'concierge' type of supported housing scheme. Eight to 10 s/c units. Support level to be determined (less than 24/7)