Written evidence submitted by St Mungo’s (MHB0018)

St Mungo’s is a leading homelessness charity with national influence. We work in partnership with local authorities, health colleagues and communities, to end homelessness and rebuild lives.
 

Last year, we supported more than 24,900 people who were homeless, or at risk of homelessness through 180 services. We support more than 2,800 people every night. Our ambition is to end rough sleeping in this country, and we believe that policies and interventions can be put in place to end all forms of homelessness for good.

• Are there any additions you would like to see to the draft Bill?

Overall the draft Bill addresses many of our concerns with the previous Mental Health Act 1983. It looks to giving far more weight and focus to patient choice and it tightens the criteria for detention more. We were particularly pleased to see accommodation needs included in care and treatment plans, but are disappointed that a lack of appropriate housing is not given more focus.

Accommodation

In our response to the white paper on Reforming the Mental Health Act, we emphasised that housing needs are infrequently properly considered as part of recovery, and suggested that they be included in Care and Treatment Plans. The new Act stresses that care and treatment plans “can include both the patient’s care and treatment and also wider issues such as those relating to the patient’s life in the community, like their employment and accommodation”, but this is the sole mention of accommodation in the Act. We therefore do not think that enough focus is given to accommodation, and would like to see this considered more widely in future iterations of the bill.

People’s housing has a substantial effect on their mental health and wellbeing. Having appropriate accommodation is paramount to the care and treatment of mental illness. Research has shown that sleeping on the streets is toxic for mental wellbeing[1]. During interviews with health and homelessness stakeholders as part of St Mungo’s 2020 report ‘Housing and health: Working together to respond to rough sleeping during Covid 19’, we consistently heard that being in safe and reliable accommodation was an essential requirement for mental wellbeing. For many people who sleep rough, the primary focus is survival. One client told us that: “Becoming homeless was a period of really high stress. My brain just couldn’t function in a normal state. Being in a state of constant fight or flight doesn’t give your brain room to do anything else.”

Having safe and secure accommodation where basic needs are met helps address the huge toll which sleeping rough can take on mental health. It also gives people the time and ‘headspace’ to address their mental ill health.

Transition out of hospital can often be a time when people become homeless or end up sleeping rough, if the right accommodation and support have not been put in place for them before they are discharged. St Mungo’s carried out a national survey of outreach workers across the UK in 2016, and 78% of the homelessness professionals who responded said that in the last 12 months they had met at least one person sleeping rough who had recently been discharged from a mental health hospital. In the same survey, 44% of respondents said that the number of people who sleep rough soon after being discharged from a mental health inpatient service is increasing; only 7% said it was decreasing[2].

People sleeping rough with severe and enduring mental health problems and those with additional support needs, for example around substance use, often find it difficult to sustain an independent tenancy. They may also be evicted from hostels or supported accommodation projects that cannot meet these needs if they exhibit behaviour that is considered threatening or difficult for other residents.

They may require specialist supported accommodation, where staff are trained to work with people who are seen to exhibit difficult and disruptive behaviour and can provide intensive support. Supported accommodation is crucial for many people to help them to escape rough sleeping, address their health challenges, and tackle the causes of their homelessness. However, research from WPI Economics in 2020 showed that £1 billion less was being spent on housing related support services per year (which help many people with complex needs gain and retain accommodation) compared to a decade before[3]. This was primarily funding for homelessness services rather than mental health or specialist provision, but these cuts have a compounding impact on other services, which are put under even greater pressure to support a more complex group of people whose range of needs are no longer being met.

Detention criteria

We agreed with the White Paper that the detention criteria should be amended so that an individual “is only detained if there is a substantial likelihood of significant harm to the health, safety or welfare of the person, or the safety of any other person”. We did, however, flag in our response to the white paper that in each individual’s context there should be different barometers for harm. For people who are rough sleeping, their living circumstances are a harm to their health and welfare. It is important that their underlying context, and the level of change experienced by that individual, is taken into account – otherwise people who are homeless are more likely to be detained than other cohorts of the population. This was not reflected in the draft bill, and so we would like to see further consideration of this reflected in any future versions of the bill.

14 September 2022