People with mental health problems

This page looks at Westminster City Council's Joint Assessment Service, which brings together the housing and social services departments to assess the housing needs of people with mental health problems.

By Elaine Hurll, Joint Assessment Team, Westminster City Council

The need for a Joint Assessment Service

Nearly nine per cent of all priority need decisions are made because the applicant is vulnerable due to mental health problems. [1] This is the third largest category after pregnant women and households with dependent children. People with mental health problems often require support from both housing and social services. Yet if these departments fail to work together it can leave vulnerable people at a continued risk of homelessness.

Failure to co-operate can be the result of departments being unsure of:

• the roles and responsibilities of other departments that work with people with mental health problems, or
• how people with mental health problems can be assessed so that necessary services can be provided.

Westminster City Council has responded to this problem through the work of its Joint Assessment Service (JAS) for homeless people with mental health problems.

Remit

The JAS is jointly funded by social and community services and the housing department. It is staffed by social workers or nurses and is linked to the Council's joint homelessness team in Westminster.

The JAS is used by the Council's housing department for:

• assessment of a homeless applicant's vulnerability
• assessment of support needs whilst the applicant is in temporary accommodation
• comments on intentional homelessness
• assessment to determine appropriate permanent housing
• reviews of negative decisions on vulnerability when further information becomes available.

Referrals

The housing department refer homeless applicants to the JAS when they have reason to believe that an applicant may be vulnerable (and hence in priority need) because they:

• have mental health problems, or
• were in the armed forces or prison.

Those referred are placed in interim accommodation pending the assessment by JAS.

If support needs, due to mental health problems, become apparent whilst an applicant is in interim accommodation, s/he may be referred to the JAS at a later date.

Hospital discharge

People discharged from hospital after being detained under section 3 of the Mental Health Act 1983, are assessed by the Community Mental Health Team, not the JAS.

The JAS does assess people discharged from hospital where:

• no after care or follow-up has been arranged, and
• there has been no referral to another mental health service.

Community care

If the initial screening indicates that the person might have ongoing mental health needs, a broader assessment of needs is completed by the JAS (as required by section 47 National Health Service and Community Care Act 1990).

Targets

The JAS has a target for making an initial recommendation within 24 days of the applicant's first interview. It aims to achieve this target for 80 per cent of cases. In the other 20 per cent of cases, more time is needed to carry out necessary enquiries. The JAS works with about 500 applicants each year.

Model of assessment

Many of the JAS's clients have chaotic histories, and often they are of no fixed abode. The JAS will dedicate the necessary time to finding evidence of client vulnerability.

In making an assessment, the JAS build a composite picture of the clients' mental health from factors such as:

• housing history
• medical history
• family and social history
• employment history
• forensic history (eg criminal offences).

As a consequence we are able to make an assessment of:

• the severity and the enduring nature of the applicant's illness
• how it impacts upon the her or his day to day life
• her or his ability to cope with homelessness.

Assessment of risk

Case law has determined that, in assessments of vulnerability, it is the 'risk of injury or detriment' to the applicant that is critical. Risk is therefore always a decisive factor in the JAS's recommendations.

Risk to others can also be a significant factor in the JAS's assessment. It should be noted, however, that risk to others on its own would not usually warrant a recommendation of vulnerability. This risk would usually be in conjunction with other factors, such as a diagnosis of severe personality disorder and institutionalisation.

Properly considering all the risk implications is consistent with the guiding principles of the Homelessness Act 2002 in relation to joint working and homelessness prevention. With high risk clients the JAS will work with other departments and agencies in order to reduce risk and prevent future homelessness. These may include:

• probation
• social and community services
• mental health services
• the housing department.

Outcomes

Recommendations to Housing

The JAS only make recommendations to inform the housing department's decisions. However, it is rare for the recommendations on vulnerability to be overturned.

Those people we recommend as not vulnerable are usually:

• advised about alternative accommodation, or
• provided with information about other housing advice agencies.

There is also a 'non-priority officer' in the housing department who has referral rights to various hostels and other accommodation.

Support needs

The JAS's assessments also address:

• recommendations as to the type of accommodation needed (whether permanent or temporary)
• access to support services
• referrals to supported accommodation
• referrals to resettlement support
• recommendation of medical points for housing register
• referral of applicants to mainstream services such as:
  • drug and alcohol projects
  • community mental health teams
  • bed & breakfast support team
  • tenancy support services.

Ongoing support

Occasionally the JAS will carry out ongoing work with clients, especially where the applicant cannot easily be linked in to mainstream services (for example, someone who has been an entrenched rough sleeper). This ensures that people who have lost contact with support services are, over time, able to re-establish links with those services.

The JAS manager is also involved in regular meetings with support agencies to ensure that appropriate support continues to be provided to those JAS has assessed.

Further information

If you require any further information about the work of the JAS, please email ehurll@westminster.gov.uk.

Use the discussion forums on this website to exchange views, share good practice and ideas about working with homeless people with mental health problems.

[1] Shelter, Report on the analysis of ODPM statistics: financial year 2001/2, 2003