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Cluster 3

By Ray Alexander,2014-07-11 17:12
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Cluster 3 ...

    Ealing Supporting People Strategy Refresh

    Needs analysis - Cluster 3

Appendix 4 - Cluster 3: People with mental health problems,

    people with drug and alcohol problems, offenders and

    offenders with mental health problems.

Current Supply

    People with People People Mentally Offenders Client group

    mental with drug with disordered and people

    health problems alcohol offenders with

    problems problem offending

    behaviour Annual 2,185,356 221,000 103,883 ?48,176 577,866 Expenditure

    Accommodation 261 18 18 39 based units

    Floating support 128 12 106 units

    Total 389 18 18 12 145 Inner London 372 24 59 4 33 Average

    Outer London 179 12 12 0 53 Average

For all these client groups Ealing has a comparatively good supply of services

    when compared with the London averages. The borough has above average

    supply when compared with other outer London boroughs and, with the

    exception of substance misuse services, above the inner London average as

    well. There are many overlaps between these groups of people as many

    people with a substance misuse problem commit offences to support their

    habit and there are significant proportions of offenders with a mental health

    problem.

Our move-on survey shows that there are some difficulties in moving on from

    services, for example one 6 unit service reported 50% of service users were

    ready to move-on at the time of the survey, another reported 30%. However

    the probation service and the DIP team report a good though put where

    people have access to the rent deposit. There is more of a problem for those

    who are not statutorily homeless as their banding for Choice Based Lettings is

    lower and access to social housing more difficult. Most people in this cluster

    will not be accepted as statutorily homeless. We are planning to increase

    move-on opportunities in the private sector and improving access to rent

    deposits and expect that this will generate better move on.

Information on needs varies for this cluster; there is good information on

    people who access statutory services such as the DIP, probation services or

    who are in contact with statutory mental health services. The CAT team

    provides good information on the street population including street drinkers

    and drug users. There is less information available on people who have

    support needs but who are not in touch with any of these agencies, such as

    people with alcohol problems who are not street drinkers. The Gateway

    service will help us improve our data gathering for these groups of people.

    Ealing Supporting People Strategy Refresh

    Needs analysis - Cluster 3

The summary of support needs for this cluster identified a number of

    themes:

Multiple needs

    ? Lack of specialist services for people with mental health problems who

    have a dual diagnosis with substance misuse/learning disabilities, drug or

    alcohol problems

    ? Lack of schemes for mentally disordered offenders with 'dual' diagnosis,

    sex offenders and those with a history of violence ? Lack of schemes for people with drug and alcohol problems that have

    specific health issues and multiple or special needs groups Women needs

    ? Lack of refuges/ safe hostels for women with drug and alcohol problems

    who have multiple needs such as mental health problems, substance

    misuse, suffering domestic violence

    ? Lack of women only services for women with mental health problems

    especially for multiple needs e.g. drug or alcohol problems, learning

    disabilities

    ? Lack of information on the housing-related support needs of women

    offenders and substance mis-users

    BME needs

    ? Lack of information on the needs of people with mental health problems

    from BME communities

    ? Lack of information on the housing support needs of refugees with mental

    health problems

    ? Lack of information on the resettlement needs of offenders from minority

    ethnic backgrounds and what housing support would be appropriate ? Lack of information on whether there is a need for culturally sensitive

    services for people with drug and alcohol problems

    Other needs identified

    ? Lack of a range of support models and services ranging from high to low

    levels of floating support

    ? Insufficient accommodation for single men who are a low priority on 'local

    authority housing lists'

    ? Lack of specific accommodation & support for people with early onset

    dementia/Korsakoffs

    ? Lack of schemes for high level care and support provision following

    inpatient detox

Progress

? We have completed a strategic review of mental health services which

    concluded there was a need to focus funding on a smaller number of

    accommodation units capable of working with people with more complex,

    and multiple, needs;

    Ealing Supporting People Strategy Refresh

    Needs analysis - Cluster 3

    ? We have commissioned rent deposit scheme for this client group ? We have commissioned HAWK workers to work with people coming out of

    prison;

    ? We have commissioned a floating support service for clients of the Drug

    Intervention Programme;

    ? We have re-tendered a number of poorly performing services for people

    with substance misuse problems and people with mental health problems

Ealing LAA targets

    There are a number of Ealing’s draft priority LAA indicators that relate to this cluster:

    NI 142: Number of vulnerable people who are supported to maintain independent living

    NI 38: Drug-related (class A) offending rate

    NI 15: Serious violent crime rate

    NI 16: Serious acquisitive crime rate

    NI 17: Perceptions of ASB

Other relevant National Indicators (out with the LAA) are:

N1 115: Substance misuse by young people

    NI 18: Adult re-offending rates for those under probation supervision NI 30: Re-offending rate for prolific and priority offenders

    NI 31: Re-offending rate of registered sex offenders

    NI 39: Alcohol-harm related hospital admission rates

    NI 40: Drug users in effective treatment

    Access to housing with appropriate support is an important factor in reducing re-offending, improving stability and reducing drug use in people who have a substance misuse problem and maximising independent living for people with mental health problems. Reducing drug use also helps cut drug related offending. We also fund an outreach team to work with rough sleepers and the wider street population. Reducing rough sleeping, street drinking and drug usage helps reduce perceptions of anti-social behaviour.

Current Needs

People with mental health problems

    The Mental Health accommodation strategy identified the following gaps in services which could be SP funded:

    ? Accommodation and services for people with a dual diagnosis (particularly

    where the mental health issue is combined with substance misuse and/or

    learning disability);

    ? Female hostel accommodation;

    Ealing Supporting People Strategy Refresh

    Needs analysis - Cluster 3

    ? Accommodation and support services which are ethnicity specific

    (particularly for the Somali and Afghan communities who have made up

    80% of asylum seekers in recent years, many of whom have been given

    leave to stay and who do not have a robust support network)

    We have recently carried out a strategic review of our services for people with mental health problems. The review included an appraisal of all SP funded schemes, an analysis of referrals and a survey of the views of service users. The review identified that it is difficult to place people with high support/complex needs and there are too many shared housing schemes as many, but not all, service users would prefer more independent living. The review proposes funding a small number of high support units through a remodelling of services that will require a reduction in low support units and a rationalisation of the current array of floating support services.

People with drug and alcohol problems

    Many people with a substance misuse problem will not be found in either drug or alcohol specialist services. In 2006/7 the Client Record form data shows that 21% of the 122 people whose primary need was identified as mental health had alcohol problems listed as a secondary need; 24% had drug problems. Where homelessness is primary need drug problems is a

    secondary need for 11% and alcohol for 6%.

    National Treatment Agency (NTA) data show the number of people in structured drug treatment for 05/06 in Ealing as 1,547 compared with an estimated number of problem drug users as 2,725 (Integrated Commissioning Strategy). The relevant population in Ealing is relatively young with the majority in their 20s and 30s.

    The Drug Intervention Programme (DIP) works with drug misusing offenders to offer a route out of crime and into treatment. The support on offer includes access to housing, and where appropriate, clients are helped into supported housing or provided with floating support in independent housing. The DIP currently (March 2008) has 60 clients of whom 12 are in supported housing and 15 in shared housing with floating support; 14 are currently in prison. The remaining 19 are in a range of housing situations, some of whom also receive floating support.

    The DIP team reports that clients housing needs are generally met but some clients in shared flats or independent housing would benefit from more support than is currently available, as the floating support services only operates 9-5 and on weekdays.

    The Contact and Assessment Team (CAT) provides an assertive outreach service targeting and engaging street drinkers and drug users in key town centre areas of Acton, Southall, West Ealing and Hanwell. The CAT targets and engages street drinkers and drug users using assertive outreach to assess their needs and link them into relevant services. These include

    Ealing Supporting People Strategy Refresh

    Needs analysis - Cluster 3

booking people into accommodation or accessing tenancy sustainment, as

    well as a range of treatment services. Over 70% of the people contacted in

    the year up to April 07 were in unsettled accommodation. During this time 45

    people were booked into accommodation and 35 were referred to the tenancy

    sustainment team.

The Ethnicity breakdown for CAT team contacts for the year ending

    December 2007 is set out below.

    475045403335302125172014141571041111150

    Asian

    Asian Indian

    Asian Other Asian

    Black African

    Black Caribbean

     Mixed Other

    The new wave of migration from A8 countries (the last group of countries to Mixed White & Black Caribbeanjoin the EU) into Ealing over the last year has been challenging for the CAT

    service. The vast majority of individuals from this migration have managed to Mixed White & Asian

    successfully integrate into the U.K, however like any large wave of migration Other Ethnic Groupthere has been a small minority of individuals who have found this harder to

    Unknowndo and groups have started street drinking in LBE.

    White BritishMigrants from A8 countries are unique as, they are not entitled to benefits (e.g.

    HB) that would allow support services to access/provide housing for them. White IrishThis lack of entitlement bars them from the usual avenue of support such as

    White Other (EE)housing and some treatment.

The DAAT team has identified a shortage of services for people with more

    complex needs and a lack of access to services for people with alcohol

    dependency needs. However more work is required to assess the extent of

    the need which will be done through the Gateway service.

Offenders and people with offending behaviour, including mentally disordered

    offenders.

Accessing to housing for offenders is generally considered to work well in

    Ealing, with good partnership working. Through put is good with a rent

    deposit scheme generating move-on into the private sector. Most offenders

    do not need specialist housing and can be accommodated in independent

    Ealing Supporting People Strategy Refresh

    Needs analysis - Cluster 3

housing with support or in supported housing for single homeless people.

    The area of under provision is high support for offenders with substance

    misuse problems. The DIP team have highlighted the need for an extended

    hours floating support service to provide crises support during evenings and

    weekends.

Analysis of the needs of offenders in Ealing highlights the link between

    offending and substance misuse and the prevalence of mental health

    problems. According to probation service data for offenders assessed

    between January and December 2007, 51% of offenders had a substance

    misuse problem, rising to 63% for those with a housing problem; 58% had a

    mental health issue, 69% of those with an accommodation problem.

Accommodation

    Problem Frequency Percent

    No 389 61%

    Yes 249 39%

    Total 638 100%

     Total Offender Population Accommodation Needs Substance Frequency Percent Frequency Percent Drugs Problem 183 29% 104 42% Alcohol Problems 204 32% 89 36% Drugs & Alcohol Problems 62 10% 36 14% Neither Drugs or Alcohol

    Problems 313 49% 92 37% Total 638 100% 249 100%

     Total Offender Population Accommodation Needs Mental Health Issue Frequency Percent Frequency Percent No 271 42% 76 31% Yes 367 58% 173 69% Total 638 100% 249 100%

Ethnicity monitoring of this group shows that:

    ? 35% were white British

    ? 18% were black Caribbean heritage

    ? 135 of Indian heritage

This data includes 15 MAPPA cases, of whom 12 had accommodation needs.

    Between April and December 2007 only 8 ex-offenders left supported housing,

    of whom only 3 moved on successfully

Summary of needs

The key themes remain those highlighted in the original strategy, but the

    increase in floating support and the rent deposit schemes have improved

    access to accommodation for both probation and DIP clients.

    Ealing Supporting People Strategy Refresh

    Needs analysis - Cluster 3

There continues to be:

    ? a lack of services providing high support for people with complex needs

    especially combinations of mental health problems, substance misuse

    issues and/or histories of violent behaviour;

    ? patchy information on needs for people who are not in contact with

    statutory services;

    ? a lack of access to services for people with alcohol dependency;

    ? insufficient move on from some services

Priorities for the Supporting People programme are to:

    ? improve-move on to the private sector by providing wider access to rent

    deposits and providing floating support to ensure that tenancies are

    sustained if users continue to need some support;

    ? use the Gateway service to provide better needs information for those

    people who are not covered by statutory services and to monitor unmet

    needs for all as move-on improves;

    ? use this needs information to remodel services to better meet the full

    range of needs by:

    o targeting accommodation based services at people with

    high/complex needs, and

    o using floating support for people with lower support needs.

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