The People Who Occupy the Margins

Anonymous Contribution

A piece about some of the people I have found to “fall through the cracks” within Social Housing. Warning: it’s possibly not the demographic you’re thinking of.

A bit about me

I was employed in my current role to deliver Intensive Housing Management for customers with enduring mental health issues. There were tenants of the SL where I work, who had previously been placed in General Needs (regular, standard unsupervised) properties by a Support Agency, which had then had its funding removed. The provision of IHM was still part of these customers Tenancy Agreements, even though the “support” had ended. My prior working background was 15+ years in Residential/ Social Care roles (autism, asylum, young people, mental health, homelessness, addiction, challenging behaviour, ex offenders,etc.).

For the purposes of this article – ‘my’ customers/prospective customers are adults who have a diagnosis of a mental health condition that is linked to difficulties with sustaining stable housing (either in them being able to access housing or to sustain their housing – or both), but who don’t meet the ‘Need’ threshold for Residential or Hospital accommodation.

Poor mental health does not automatically mean that a person will meet the criteria to be subject to Social Care provision or for NHS care (certainly not in a Residential setting, or on a day to day basis). The bar for who will be eligible for long term Social Services interventions is set quite high these days. This is not a criticism – I understand that it is to do with years of funding cuts impacting on all areas local government and its available resources.

NIMBY – Not In My Back Yard

I state the above because I encounter numerous scenarios where – I’ll say ‘neighbours’, for the sake of argument – witness nuisance behaviour from one of ‘my’ customers and tell me that ‘they’ (my customers) are “not living in an appropriate place” and that I should move them to Supported Accommodation. Considering that “supported accommodation” is modern vernacular for (usually homeless) ‘Hostels’ and bed spaces are in short supply. What it seems the neighbour really means it they feel that the “problem” person should be placed in a residential care setting, or sent to hospital as an involuntary inpatient (under a Mental Health section). Or just generally, moved ‘elsewhere’/anywhere else. As though this is that easy – in a country where its citizen’s have actual Human Rights and there is a huge over-subscription for housing – a HOUSING Crisis, in fact. I try not to laugh at the NIMBYs. Because that would be unprofessional.

Threesomes

(Mental Health, Substances, Housing)

Whether you agree with me or not, I have found that a person with the interlinked difficulties of mental health, substance misuse and housing problems is not a rarity within Social Housing. This is not about my, or anyone else’s moral feelings on drugs, or indeed, on a person having a mental health diagnosis.

Of ‘my’ customers, the one’s who seem to struggle the most to achieve and sustain stable accommodation are those whose coping strategies are self-medication (with drugs and/or alcohol), and/or not taking medication as prescribed (if at all). I don’t want to stereotype people. I 100% know that all my customers are not the same. But I find it is disingenuous to pretend that there is not a re-occurring theme of intertwined difficulties within ‘my’ cohort.

In Social Care, a person with a learning disability and a mental health diagnosis used to be described as having a “dual diagnosis”. I found that this descriptor also applied in addiction services – but to describe a person with a mental health condition and an addiction. I would love to get this recognised as an actual “thing” in Social Housing. Not as another little box to put a person in, but as a recognition of a person with specific circumstances that have historically or currently meant that they have struggled to be housed, or maintain housing.

Catch-22

When a ‘dual diagnosis’ is present – one can’t be assessed without the acknowledgement of the other. And yet this is how Services treat it. I understand (from grilling far, far too many mental health professionals and those who work in substance misuse) that this “is how it is” because it is very difficult to treat one thing without the other, and neither can be properly addressed while the other is an active factor.

There are few rehabs that have the facilities to manage a person with a significant active psychiatric condition and, addiction rehabilitation is expensive – especially when NHS is footing the bill. To be accepted to an NHS funded rehab facility, a person has to show a lot of commitment, over a number of months, to managing their substance/alcohol intake AND demonstrate a strong desire and understanding of why they need rehab. Therapeutic rehab (not sure that there is any other type to be honest) rarely works on a coerced person and they can expect to be in residential treatment from between 3 and 18 months (Don’t take my word for any of this – but do ask a therapist).

FYI – A person can be sent to “detox” for a week or two – if a health care professional agrees that the person is at risk if they don’t go. But a few weeks of detox can only do limited work to bring about the mental and behavioural changes needed to address the root of the addiction. Detox, as the name suggests’ main purpose is to detox the persons body of the misused substance/alcohol. I’ve had a few customers who have been very ill with substance and/or alcohol use, and who’s mental health workers get them into hospital for a few weeks, or even months – usually on the basis that the person’s mental health is very poor. The mental health condition is treated in this scenario, but the addiction is not. This forced sobriety only removes the means to self medicate, not the desire.

People more learned than I

I have posed variations on the question of prescription medications and addiction to a selection of psychiatrists and similarly highly qualified people, and I have not been able to find anything prescribed for a variety of mental health conditions whose therapeutic benefits are not reduced, in some way, by illicit substances or alcohol misuse.

I wish I had some statistics to throw around – to give weight to my observations.

There is surely some scholarly studies which show that the percentage of people in Social Housing with a diagnosed mental health issue is higher than in that of people who don’t live in Supported Living ?

I’d put money on the same kinds of figures bee n seen in Social Housing tenants with a substance misuse issue.

To clarify – I am NOT saying that all social housing tenants are “mental/ druggies” but I surely can’t be the only person to have noticed the high correlation between mental health, addiction and housing problems, within Social Housing tenants?

I sometimes wonder if the general aversion amongst educated, liberal thinkers to agree with anything that might be seen as contributing to stigma is why the elephant in the room is never able to be tackled directly?

N.B. If anybody wants to fund me to thoroughly investigate and correlate the causalities I’ve described – please contact SHM for my contact details (shameless plug?).

But everything is so long

I have found that getting a person through most aspects of the housing process can be convoluted and problematic. I’m not exaggerating when I say that I have been actively involved with the social housing of at least 2000 individuals. A handful of whom have had the help of Social Services. 75% have/had the duel issues I outlined earlier and all have struggled with at least one of the following aspects:

• being able to manage their own applications to housing,
• getting themselves through the lettings process (the amount of ‘proofs’ required!)
• being able to organise themselves enough to move into a property,
• being able to furnish a property (practically, as well as financially)
• being able to set up and manage bills for a property (practically, not just financially),
• being able to communicate with their landlords in a way that the landlord considers “right” or “normal”
• being able to cope with the standard regular issues associated with living in close proximity to other humans
• being able to manage their own behaviour and engage enough to stop ASB related evictions ,
• being able to identify and manage repairs
• being able to look after the fixtures and fittings within their home

I could go on with the different scenarios forever, and it could be argued that a fair number of the above examples are related to the person being unable to engage/co-operate/work with agencies that exist to help. And yet there does seem (to me) to be a belief that – if a person wants it bad enough, they will make the effort/suddenly be magically be able to do everything required, in the timescales required, in the manner expected. . But what happens when a desire for your own home doesn’t equate to your ability to achieve this?

A: The person keeps experiencing the same housing issues again and again.

I am not in the habit of making excuses for people, but I do believe that there is value in calling a spade a gardening implement.  I don’t expect preferential treatment for someone simply because they have a particular diagnosis or affliction – but I do think the difficulties generated by the affliction need to be recognised as reasons for some negative outcomes (not in a “blame” kind of way, more a “what lessons can be learned? ”.

A prescriptive approach to housing individuals is useful to no-one but to the people who write Policies – “We’ve got a policy for that”, “we have a process to follow”. Policies and processes are written for the majority of any given group – but what about those people who fall a little outside the group ‘norm’? Then, quite often: “Computer says NO”.

As much as Social Care gets a hard time for its short comings -, its “person-centred approach” to its customers/Service Users, is not without merit and could be easily applied to Social Housing settings.

I’m not trying to wag an accusatory finger at any particular group. What I’m trying to illustrate is that there are a whole load of people – who aren’t unusual or rare – but who just seem to slip through the cracks of the Social Housing system. It seems to me to be because the origin of their “needs” straddle Disability, difficulty and personal autonomy in such a way as to blur the lines about which services they can access and how. Humans are generally pretty messy and so will never fit into neat little boxes. The sooner the messiness is accepted, the better everyone’s situation will be (in my opinion). And by “accepted”, I mean “accepted as the reality of that person’s situation”, not that any associated “bad” behaviour should be regarded as “not their fault”.

Social Landlords are held responsible for the behaviour of their tenants (which I’m not entirely sure is fair – but that’s a different article!). Social Housing seems to be progressive in acknowledging that struggles with mental health can be debilitating for some people – but I have frequently come up against processes that indirectly exclude ‘my’ customers from becoming General Needs social housing tenants. 

I may be cynical in thinking it’s because the landlords know that ‘my’ kind of customers tick the boxes that indicate that they are more likely to cause issues and generally cost a bit more time, effort and – yep, you guessed it – money – to house?

Risk is a favourite

I’ve been accused of being reckless about risk. I have found this especially pertinent when co-ordinating repairs for inside customers homes. A question mark is placed over the safety of the operative entering the premises alone, because the tenant is a “known drug user”, or has a diagnosis of Schizophrenia. Unless the tenant is an intravenous heroin user, who has a history of leaving used needles all over their flat, any other “usage” is unlikely to pose a risk to anyone but themselves. I’m not saying I enjoy entering a flat through a fug of cannabis, or trying to have a coherent conversation with a stoned tenant, but I wouldn’t assess that I’m at any  notable “risk”, unless something in that person’s recent history has actually put another person in danger.

Schizophrenia doesn’t make a person violent, or a threat to others, it’s just that there have been some people who have been violent, who also happen to have that particular diagnosis. These kinds of crimes make it into the newspapers – with inflammatory headings like “Schizophrenic murders woman in park” (thank you, Tabloid Press), and this is the type of thing that leads to stigma and hysterical risk assessing. Again, it should never be about the diagnosis being the identified risk, it should be about that specific person’s specific behavioural history identifying a risk (PCA again).

Just because they have a mental health issue, or a learning difficulty, or a substance misuse issue, it is not ok to make other tenants life a misery. But, just because a person is often seen staggering around the area intoxicated, on their way home, does that really put anyone else at risk? It may not be very nice to witness, but is the person really posing any harm to you or your family? Or is this “harm” a perceived thing – based on a moral judgement?