In 1995, Home-Link, an interagency initiative, was set up in the East Riding of Yorkshire to provide permanent housing and low level, practical support to people with enduring mental health problems. The service offered ongoing individual tenancy support and also aimed to encourage a mutual support network by housing users within walking distance of each other. An evaluation, undertaken by the Centre for Housing Policy, University of York, found that Home-Link represented a successful model for providing support to people with mental health problems in the community:

• The Home-Link workers were able to provide practical assistance and general support to users in a flexible and responsive manner. The workers were intentionally not qualified in mental health, to avoid a medical focus, and user-worker relationships were characterised by informality, trust and respect.
• The mutual support network was slow to develop, although once organised, social gatherings and lunches were well attended and welcomed by most users. Nonetheless, few users met with each other outside these meetings as had been hoped, unless they lived very close to each other or knew each other previously.
• Most users felt that Home-Link had made an appreciable difference to their lives, helping them to attain and maintain independence. Users felt the most valuable aspects of the services were the provision of good quality housing, the support with household finances, the personal contact of visits and knowing that there was someone there to call on. All users wanted the support to continue on a long-term basis.
• The scheme appeared to offer health benefits to users. Many users explained that the support helped to reduce anxiety and that, overall, their mental health had improved since joining the scheme. Others felt that Home-Link played a role in maintaining health.
• The scheme offered a number of benefits to agencies, including: the freeing-up of mental health professionals to concentrate on higher level interventions; reduced housing management input; and significant improvements in joint working, particularly between health/social services and housing agencies.

The policy problem

"I don't want hospital life, I want my life."

(Home-Link user)

It is widely recognised that people with mental health problems often face a range of difficulties securing appropriate housing and support services. Replacement facilities following the closure of long-stay psychiatric hospitals have not been adequate to meet the needs of new long-term mental health service users. Social services and health services increasingly concentrate on the provision of crisis, high-need services, and housing providers do not have sufficient resources to provide housing-related services to the increasing numbers of people living unsupported in ordinary housing. As a consequence, people often experience a 'revolving door' situation where they are admitted to psychiatric hospital when at crisis point, but services are withdrawn when they appear to be well, only to leave people unsupported, and vulnerable to further readmissions to hospital.

The Home-Link model

The Home-Link service was set up by health, housing and social services agencies in the East Riding of Yorkshire in 1995 to provide secure tenancies and ongoing, low-level support to people with enduring mental health problems. Based on the KeyRing model for people with learning difficulties operating in London, the service also attempted to facilitate the development of an informal system of mutual social support, by allocating tenancies in close proximity and introducing tenants to each other. Two schemes were established with Joseph Rowntree Foundation funding, with part-time workers providing services to between 10 and 12 people.

Home-Link client group

Home-Link was targeted at people with a history of using mental health services over a number, if not many, years. Users were living in a range of accommodation at referral, most prominently hostels and institutional provision, but also with parents, and a few people were struggling to manage in their own independent accommodation. Users ranged in age between 22 and 72, with an equal number of men and women being accepted onto the scheme.

Providing housing

The housing department agreed to allocate secure tenancies, on a priority basis, to users. Accommodation was arranged within weeks or a few months of referral and the properties were generally of a good standard. Tenancies were usually successfully allocated in close proximity to each other, although this was dependent on stock availability and user preferences on location. Users were most satisfied living in a quiet location, within easy access of town. Many properties were connected to a 24-hour Lifeline service, which was valued by users.

Individual support from the Home-Link workers

The Home-Link workers were able to provide assistance with any task related to running an independent household. Most users required assistance with managing their household finances (benefits, budgeting, bills, etc.). The support was very practical in nature and could include diverse activities such as helping people redecorate or taking the cat to the vet. The workers appeared to enjoy greater flexibility than professionals, doing things for people as well as enabling people to undertake tasks themselves.

The workers also provided much general support, company and reassurance to users. The support workers were intentionally not qualified as mental health professionals to avoid a medical emphasis, and both users and agencies perceived the worker as being closer to a friend than a formal worker. Relationships between users and workers were easy ones, characterised by mutual respect and trust.

On average, the Home-Link worker spent approximately 5 to 6 hours with each user a month. Whilst this fluctuated according to people's health situation, there appeared to be a need for long-term support over a number of years. Everyone expressed a desire to continue receiving support from the worker on an ongoing basis.

Developing a mutual support network

The Home-Link scheme attempted to address the isolation which can be an unintended consequence of living alone, by introducing people to each other and organising social occasions like lunches and outings. This aspect of the scheme was slow to develop due to an initial reluctance by agencies, for fear of invading people's privacy. However, when organised, social activities were well attended and welcomed by most users, providing opportunities for conviviality and the company of people in similar situations as themselves.

It was also hoped that, as users lived relatively close to each other, they would meet up outside the organised occasions, and perhaps some friendship would develop. However, few users did see each other outside the organised social activities, unless they knew each other previously or lived very close to each other. There appeared to be further scope for promoting the 'good neighbour' aspect of the scheme.

Working with other agencies

Home-Link complemented rather than replaced professional mental health services. The Home-Link workers, in most cases, were working alongside other agencies to deliver support to users. The Home-Link support workers appeared to provide a central or pivotal role in client care:

"I think her job is vital, because she has all the
links and knows all the clients, probably better
than we do..."

(Mental health professional)

Making a difference: the user perspective

The majority of Home-Link users felt that the service had made an appreciable difference to their life, helping them attain and maintain independence.

The opportunity to live independently

A number of people thought they would have found it very difficult to have made the transition to living independently without the assistance of Home-Link, both because they would have otherwise found it hard to secure suitable housing and because they may not have had the necessary confidence to move on without support.

"If I'd have had to set up on my own, I might not have managed it, I might not have made the move."

The potential for Home-Link to offer stability in terms of housing appeared considerable. All but one person expressed a desire to continue living in their accommodation.

Assistance with household affairs

For many users, having somebody to help with budgeting, bills and other household matters really 'took the pressure off' and made a difference to their ability to cope and ultimately sustain living independently. Most people did not have anyone else they could have asked for help on a regular, ongoing basis.

"She's [the Home-Link worker] really a lifeline...I think it's stopped me from losing my flat and not getting cut off by the electric or water board."

The value of personal and social contact

Visits by the Home-Link worker provided convivial company to people and helped some users counteract loneliness. The social gatherings organised by the scheme were also welcomed as an opportunity to get out of the house and meet people. Both played an important role in keeping people 'connected' to the world.

"You do need, on odd occasions, people visiting because you do get down."

Being able to call on someone

For some people, the most important part of the scheme was that there was someone they could call on for assistance at any time. Users found the service accessible and would contact the workers freely between visits for advice or reassurance.

"Before this came along, you thought you were on your own, just someone to turn to, think it's great, it is a good thing."

Positive effect on mental health

Over half of people interviewed felt that they had seen an improvement in their mental health since joining the scheme. In addition, a few people whose health had not changed explained that Home-Link may have played a role in maintaining this. Only one person felt their health had become worse since joining the scheme.

Home-Link, however, did not offer a 'miracle cure'; for example, three of the 20 users had a hospital admission during the evaluation period. However, both users and key players believed that the scheme, as well as helping some people to maintain and improve health, played a positive role in managing relapses and helping those concerned
to rebuild their lives on returning home.

Benefits to agencies

The scheme offered a number of benefits to agencies. Health and social services felt that Home-Link freed up some professional time to concentrate on higher level tasks or people with more severe needs. Housing staff felt that there had been housing management benefits: for example, no complaints had been received about any of the Home-Link
users nor any complaints made by Home-Link users about neighbours, and there had been no cases of rent arrears.

The project also brought improvements in joint working, despite some early operational challenges. In particular, communication and relationships had been built up between housing agencies and health/social services. Mental health professionals were more aware of the role of housing by the end of the scheme, and similarly, housing staff had a better understanding of mental health issues.

Value for money issues

Finally, an analysis of the costs of the scheme indicated that Home-Link represented good value for money, especially compared to more institutional forms of provision for people with mental health problems. Some users were successfully being supported in a preferred setting at a lower total cost than their previous accommodation, and it was also likely that savings were made from fewer and shorter hospital admissions.

Developing future services

Persuaded by the benefits and cost-effectiveness of the scheme, local agencies, supported by Mental Health Specific Grant monies, have extended the Home-Link service throughout the East Riding of Yorkshire. However, pressures on resources and tighter eligibility criteria will make the emphasis on continuous, low-level support difficult to sustain. Funding mechanisms need to change if long-term provision of preventive services like Home-Link are to continue.

About the study

The evaluation was undertaken by Deborah Quilgars at the Centre for Housing Policy, University of York between 1995-1998. In-depth interviews were carried out with Home-Link users after three months and at the end of the scheme. Two sets of interviews were also conducted with key players. Daily worksheets, filled in by the community support workers, and routine project documentation were also analysed.

How to get further information

A full report, A life in the community: Home-Link: supporting people with mental health problems in ordinary housing by Deborah Quilgars, is published by The Policy Press and Community Care magazine in association with the Foundation (ISBN 1 86134 117 2, price £13.95 plus £2 postage and packing).

Click on the 'order report' icon in the left margin to order online.