Housing People,
Changing Lives
Housing Association for Integrated Living Ltd.
INTRODUCTION
T
he Housing Association for Integrated Living was founded in Dublin in 1985
by members of the Housing Committee of St. Brendan’s Mental Health
Association. Almost hree decades later the stigma of living with a mental illness
is still prevalent in Ireland and the lack of housing with appropriate support
remains. HAIL provides secure, permanent housing for families and single people.
HAIL also provides a visiting support service for tenants with mental health
difficulties.
As a Housing Association approved by the Department of Environment, Heritage
and Local Government, HAIL provides housing in each of the Local Authority
areas in the greater Dublin area. We have recently expanded the Association’s
remit outside the four Dublin Local Authority areas to Co. Kildare in partnership
with a sister Housing Association.
HAIL provides both general needs and housing with support. We provide support
based on an assessment of each tenant’s needs. HAIL provides a full tenancy
agreement to the people we house.
HAIL provides housing in each of
the Local Authority areas in the
greater Dublin area
HAIL recognises that having a safe and secure place to live is one of the basic needs
of all people. However, for people with severe and enduring mental health problems,
it is especially important and is complicated by many factors, including the following:
n Many younger single men and women, with mental health support needs are living
with family members and are not considered in need of independent housing.
n People with mental health difficulties living in private rented accommodation are
fearful of needing treatment in hospital lest they lose their tenancy and must begin
the stressful task of sourcing new accommodation on their discharge.
n People can experience mental illness for the first time when they have developed
careers, have a life partner, perhaps children and are home owners. The stress of
mental illness for the person and for the others in the family may mean that a move
to independent and separate accommodation is indicated. In Ireland it is very difficult
to move from your own home to social housing.
n Many people living in group homes and mental health hostels, are very capable of
living independently in ordinary housing in ordinary communities. Group living may
cause unnecessary institutionalisation. It is also wasteful of scarce resources as the
person is filling a place that could be filled by someone in greater and more urgent
need of in-house care.
n Often mental illness has a negative impact on a person’s career
development and pursuit of education and work. It is often the case that
the person is dependent on state entitlements and allowances.
n According to the Dublin Homeless Agency people with mental
health and/or addiction difficulties make up an estimated
50 – 70% of the homeless population. Their support needs
range across the spectrum from low to high with many
people capable of independent living in mainstream
housing once their needs have been assessed and a
support plan formulated.
SUPPORT SERVICE
HAIL provides a visiting support service to our tenants. The key sources of referral to HAIL
are the mental health teams in the locality of our housing supply. Referrers are asked to
complete a standard referral form. All people referred must be registered with the
relevant Local Authority. Referrals to our general needs housing are sought from the
relevant Local Authority. Homeless services in the greater Dublin area (particularly
Transitional Housing Services) also refer to HAIL as do other community based support
agencies. Potential tenants complete an Application Form. Each is asked to nominate a
“sponsor” i.e. someone who volunteers to be available to support the tenant when a crisis
arises – this may be something as simple as holding a key or being a contact point
outside service hours. Usually a family member or close personal friend is nominated but
occasionally a person from the referral agency is nominated. A risk assessment is
undertaken at this time. Referrals are short-listed and a HAIL panel interviews those on
the shortlist.
Those selected at interview and offered a tenancy must complete a pre-tenancy
induction. The purpose is to ensure that the new tenant and their sponsors understand
the Tenancy Agreement and are fully aware of their rights and responsibilities as a
tenant and those of HAIL as a landlord. The role of HAIL’s Housing Officer and the work of
the support service are fully explained. The Tenant is allocated a Support Worker.
ASSESSMENT & SUPPORT PLAN
The HAIL support worker provides support based on a needs assessment carried out with
the tenant in the first 3 – 6 months of the tenancy. Support is usually most intense in the
settlement phase as the tenant sets up systems to manage rent, utilities etc. An
achievable support plan is put in place based on the assessment with the full agreement
of the tenant. Actions to achieve the goals set are agreed by the tenant and the support
worker. Tenants are supported to liaise with Community Welfare Services to avail of
entitlements, assistance to furnish the accommodation and obtain rent support. A review
is carried out in the first six months to monitor progress and revise the support plan.
Usually the referral agency participates in this review. HAIL is not a medical support
agency and staff do not review medication. Part of the support plan is often to encourage
our tenant to maintain links with the mental health service and to attend for medication
reviews and therapy.
COMMON AREAS of SUPPORT REQUIRED
Although each tenant requiring support has an individualised support plan there
are some key features, which are very common.
n Setting up and managing rent payments
n Accessing welfare entitlements
n Managing the stress of leaving present living arrangements and moving to
new accommodation
n Furnishing a new apartment/house
n Setting up utilities
n Coping with new transport arrangements
n Cooking and ensuring adequate nutrition
n Managing personal hygiene
n Attending to the cleaning and maintenance of the apartment/flat
n Coping with loneliness (often severe for those coming from group
homes/hostels)
n Using time productively
n Taking personal responsibility for keeping in touch with mental
health/physical health services
n Getting used to a new mental health team and catchment area
n Worry about hospitalisation and the effect on the tenancy
n Managing medication
n Managing money – developing a budget
HAIL: Models of support in
various settings
SHARED HOUSING
HAIL has a number of shared housing units. One of these is a house with five units of
accommodation for five women. The house was conceived as a transition unit in which
the tenants would practice and develop the skills necessary for independent living. This
has worked for a number of tenants who have moved on to fully self-contained HAIL
apartments in other locations, and to mainstream accommodation with other housing
providers. HAIL’s support in the shared house is based on the needs of the tenants. Some
tenants will stay only as long as they need to. Each tenant is supported to settle into
their new accommodation and is linked to appropriate support services.
Another shared HAIL house was conceived as transition accommodation for three men
who were clients of the same mental health service. The initial support was quite
intensive around the need to develop housing maintenance and personal management
skills. As they developed and maintained capacity in these areas the need for support
lessened and became more of a monitoring function. They are now permanent tenants.
Communication between the tenants, their family supports, the mental health service,
the housing department of the local authority and HAIL’s support service in this instance
was a key facilitator of the successful transition and tenancy sustainment.
CONSORTIUM WORKING
A fundamental value underpinning the work of HAIL is the housing of people with
support needs in ordinary housing in ordinary communities. One of the strategies
employed by HAIL to achieve this is working in consortium with fellow Housing
Associations and Local Authorities to provide communities which have a mix of different
tenure types. One of our key aims is to help build integrated communities in which
people with a support need can use facilities, contribute to the development of the
community and build constructive networks with statutory and voluntary community
based services. The consortium, partnership approach makes this possible.
n In an estate in the South County area of the city, HAIL operates in a consortium. It
consists of two other Housing Associations offering floating support to women
establishing independent housing following domestic violence and families with
addiction issues and parenting – issues respectively. The lead in the consortium is
taken by a large general needs Housing Association. There is also housing provided
by the local council and houses in private ownership. HAIL housing is scattered
throughout the estate and is indistinguishable from other housing. There are many
advantages to operating in a community that has a broad mix of different tenants
and tenures. There is a variety of experience available to the tenants from various
support services and the housing and community development expertise enables
estate management issues to be dealt with promptly and efficiently.
n HAIL has a similar consortium arrangement in the north area of the City in the City
Council’s administrative area. This is a major regeneration project aimed at the
reconstruction of an area dominated physically by high rise apartment blocks built in
the 1960s. The area is also affected socially by unemployment, poverty, educational,
disadvantage, poor physical health, addiction and disadvantage. The population is
being rehoused from the old blocks into new purpose built social housing. The
regeneration project includes various forms of housing tenure to achieve a more
balanced social mix. A new town centre aims to give a civic focus to the area and to
improve the local and external identity. There is an ambitious programme to attract
employment. HAIL has both supported and general needs housing in the area. The
tenants originating in the regeneration area have priority for rehousing.
n Referrals of tenants with support needs come from the local mental health team, the
housing welfare section of the local authority and from a transitional homeless
service for single men in the area. The importance of integration in this area cannot
be overstated.
JOINT TENANCIES
In a number of developments HAIL has issued separate tenancies in the same
apartment/house to tenants referred from the same mental health service or sharing
accommodation in the same group home or hostel. Joint tenancies have demonstrated
clear advantages for tenants where they share common daytime activities and can
support each other in maintaining routines. Perhaps the best advantage is that the shift
from communal, shared living to independent living is not so intimidating and the
danger of loneliness is averted. However, HAIL ensures that it is something the
prospective tenants really want and that they understand what is involved. Close
attention needs to be paid in tenant reviews to how the arrangement is working out.
FAMILY AND GENERAL NEEDS HOUSING
Approximately one third of HAIL’s housing stock is tenanted by families and
individuals with a general housing need. HAIL considers the mixing of tenants with a
general housing need and/or a housing with support need to be an extremely
important part of its mission. Our supported tenants are very definite, especially
those who have moved from institutional care, that they have had enough of
stigmatisation and ghettoisation. It hasn’t always been possible to create the
“pepperpotting” arrangement that we would prefer but we have created
communities, notably in the South County area and the north eastern parts of the
city, where the mix is accepted and maintained by all our tenants and an integrated
development is regarded as a plus for them and the communities as a whole.
RECENT NEW DEVELOPMENT
One of HAIL’s most recent new developments in Dublin is a suite of 8 x 1 bed apartments
in the heart of the north city quays. The apartments were fully refurbished and upgraded,
with the original streetscape preserved and each apartment with its own front door
access. Referrals came from the local community mental health teams and from the
Mental Health Community Rehabilitation team attached to the local psychiatric hospital.
Our colleagues in the mental health services tell us that with the emphasis in the future
on rehabilitation and community based treatment this will be the pattern to expect.
HAIL’s experience in this new development underlines the need for good working
relationships between the statutory mental health services and the voluntary Housing
Associations. The tenant must be central to the working partnership and consent to the
exchange of information.
REFERRAL AGENTS
HAIL tenants with a mental health difficulty are usually already linked in to local
community mental health teams where the housing development or casual vacancy
occurs. Referrals are sought from the local team among other referral sources. This helps
to maintain continuity of service and builds on an already established relationship.
Moving from one catchment area to another may cause upheaval for the tenant and with
teams already stretched it may take some time to build a new relationship in a new
catchment area. It is essential that the tenant is comfortable with contact between the
support service and the mental health team and consents to the contact and information
share.
Professionals in the mental health services have observed and commented that:
“
People who
achieved a
tenancy with HAIL
had a high level
of satisfaction
with the provision
offered.
“
“
The HAIL model perfectly reflects the approach
described in A Vision for Change, Chapter 15,
(Government’s Mental Health Policy) which
encourages individuals to rejoin their natural
community in a supported context.
”
“
”
HAIL has been a
great resource for
the Mental Health
Service in efforts to
de-institutionalise
care and return
people with mental
illness to living in
the community.
HAIL has been invaluable to this service in
providing quality accommodation to people with
Mental Health issues particularly patients suffering
from Severe and Enduring Mental Illness. I think it
is safe to say that many of these patients would
have continued to reside in institutional settings or
risked homelessness without the support of HAIL.
”
”
“
“
As a social worker I have
placed over 10 clients in
HAIL Housing. Many for
the first time in their
lives, have the comfort of
secure accommodation
and most importantly
support and assistance
available if required. I am
happy to say that for
most their placement
with HAIL was the start
for them of being able to
manage their illness and
freed them to look at
other needs such as
vocational and leisure.
The type of support and
assistance is very
important and I have
found the HAIL staff well
trained caring and
enthusiastic. From time to
time crises will occur and
I have been impressed
with the calm and
appropriate way these
were managed.
Their range of residences offer
varying degrees of support which
allows our client group live
independent lives.
”
“
HAIL has provided extremely high quality
housing and support in equal measure, to
people with chronic and enduring mental
illness. The HAIL approach to this task is
extremely professional with interagency
consultation; proactive engagement with
potential residents by making presentations
to them and their families to inform them of
new developments; transparency in their
selection of residents and feedback on
resident’s progress. I would characterise HAIL
by their person centred flexible approach to
housing…
“
”
As Key Workers a lot of what we do involves
motivating and encouraging clients to go out and
take an active part in life, get involved in work,
study and social activities. I am pleased to say
that in this past year two residents from our
service are now housed by HAIL and both are
really moving on.
”
TENANT SATISFACTION
HAIL’s policy is to continually review the level of satisfaction with our housing and support
service. Recent feedback from both an independent consultant and our own evaluations
evidenced a high level of tenant satisfaction with the Housing Management and Support
Service. Comments by our tenants include the following;
“
The location is
great for me.
Close to the city,
family and
friends. Life is
getting better. I
have my own
front door, my
own space and
my daughter has
her own room,
when she visits.
The future is
looking good,
thanks to HAIL
and I am feeling
more positive.
“
”
“
I want to express my appreciation of HAIL, my Support
Worker in particular and also all the other staff members
I have had dealings with. I could not have made this
move without the help of my HAIL Support Worker. She
helped me with visits to the CWO and helped me set up
my home.
“
”
I really liked the shared house
I lived in and got on well
there. I saw this place being
built and that was very
exciting. I am really settled in
now, no complications really.
But if I have any worries at
all, I only have to pick up the
phone and talk with my HAIL
Support Worker.
”
What works for me best, is HAIL’s ‘hands off’
approach. The support is there if and when I need
it, but it is not intrusive and if I need support I can
just make a call and arrange a visit. It’s a really
satisfactory set-up and I can’t praise HAIL enough
for the help they have given me and the work
they do in general.
”
“
It has taken a long time
for me and mostly it’s
been about learning to
take responsibility and
have respect for
myself. This is my
place, my pad, and my
own little haven. I am
doing really well and
know I probably
wouldn’t have survived
without the support
that I get from HAIL. I
have my lovely home
and that extra backing,
knowing the support is
there if and when I
need it.
”
IN CONCLUSION
The primary aim for HAIL is to support tenants to sustain their tenancy, enabling them to
achieve independence, while managing their own recovery. Each supported tenant has a
needs assessment as the basis for a support plan which is reviewed and revised as needs
change and goals are achieved. If required, support can be increased relevant to the
tenant’s present needs. The vision is that tenants progress to a point where they require
the minimum support. HAIL provides ordinary housing in ordinary communities “pepperpotting” supported housing in among ordinary housing of a variety of tenure types.
The Government’s Mental Health strategy “A Vision for Change” anticipates and
recommends the use of mainstream housing for users of mental health services. The
emphasis in the strategy is on recovery and the use of everyday competencies with the
requisite levels of support as determined by need. It recommends that Mental Health
services develop strategies for providing housing in partnership with Local Authorities
and with the voluntary housing sector.
There are other issues, which must be addressed if real progress is to be made.
n Action on the Government’s mental health policy – needs to be speeded up.
n Joined-up planning and action between the Departments of Health and Children and
Environment, Heritage and Local Government to deliver on the recovery model as
regards units of non stigmatised housing with support in the community.
n More widespread use of fully resourced expert mental health support teams to
support tenants with severe and enduring mental health difficulties in their recovery.
If dependence on institutional care is to be reduced in favour of care in the community, it
is likely that housing will be required for people with higher support needs. A genuine
partnership between statutory services and voluntary services will require serious
attention to working practices and protocols. This will be achieved through training,
establishing working contact points between the various services in times of crisis, and
many other issues. It is also essential that a flow of units of accommodation is available
and that there is a dedicated funding stream for support in housing.
HAIL, HOUSING ASSOCIATION FOR INTEGRATED LIVING LTD.,
SHAMROCK CHAMBERS,
59-61 DAME STREET, DUBLIN 2.
Tel: 01 671 8444
Fax: 01 671 9591
Email: [email protected]
Website: www.hail.ie
A company limited by guarantee and not having a share capital.
Registered in Ireland No. 109465, CHY No. 6796, Registered Office: 59-61 Dame Street, Dublin 2.