Enhanced supported living for people with severe and persistent mental health problems: A qualitative investigation.

The summary below is intended as such and does therefore not represent the full depth and detail of the paper as published in Health and Social Care in the Community.

A distinctive feature of the novel enhanced supported living model developed and used by Northern Healthcare is the transparency with which it has been, and continues to be, informed by and subjected to rigorous evaluation. The description that follows is of an in-depth study of the personal experience of tenants of the enhanced supported living model used in Northern Healthcare residences. This is the first report of a number of studies of outcome. In the near future, we will make the results of other research on the value of supported living, conducted by university partners available on this website and in more formal academic journals.

Research on the value of supported living

Traditional supported living models have been shown to improve functioning and social inclusion in people with severe and persistent mental health problems^{1, 2}. Such an approach may be effective in reducing hospitalisations³, and in providing secure accommodation for a population where housing needs are often unmet^{4, 5}. Conversely, living in some supported accommodation has been described by tenants as being a depersonalising experience⁵, one of marginalisation^{6, 7}, and as an ordeal to survive⁵.  In addition, evaluations regarding housing and support also often lack a thorough consideration of the experiences of the individuals under their remit. While such findings are not without value, they have not however offered substantial insight into whether supported accommodations are effective in supporting the ongoing recovery process of their residents, nor have they given a voice to the very individuals whose recoveries are so intertwined with these services⁸. Indeed, a recent editorial in the British Journal of Psychiatry called for qualitative research (with an emphasis on reporting personal experience)  to fill this notable void in our knowledge⁹.

Research Summary

The research team at Northern Healthcare conducted semi-structured interviews with nine residents of the service between July 2020 and February 2021. Transcripts were analysed using thematic analysis and indicated three superordinate themes of experiences considered valuable to residents:

(1) support from care staff which was readily available;

(2) a sense of community and daily activity offered by the residence and on-site activities; and

(3) the experience of supported living as a stepping-stone in an ongoing recovery process.

Firstly, one theme which emerged continuously throughout the interview process was the feeling of being comprehensively supported in their recovery process. Participants alluded to several provisions which they believed manifested this feeling. These ranged from the delivery of both formal therapeutic services to informal support from residence staff with basic everyday tasks to the security offered by the stability of their tenancy and support in recovery, which promoted a state of feeling ‘at home’. Residents frequently cited the availability and consistency of support as being important to their recovery and ongoing stability in terms of not only their diagnosis, but also wider associated health problems.

Secondly, residents also frequently commented on the feeling of community offered by their tenancy. Every resident partaking in the interviews noted that they felt that they had, to some extent, made connections within the residence, either with staff members or fellow residents, with many citing that these connections had developed into, or felt like, friendships.

Finally, supported living was often discussed as a means of developing functional independence. Again, residents associated the support offered by their residency and care staff in supporting their rehabilitation and fostering their autonomy. The value of wider rehabilitation in the support provided by supported living was echoed in residents’ conceptualisations of their time at Northern Healthcare as being a ‘stepping-stone’ in their ongoing recovery.

Overall, our findings highlighted the power of comprehensive care in the enhanced supported living model. Residents frequently cited the value of supportive staff, peer relations, autonomy, and fostering hope in empowering them in their ongoing recovery. Additionally, and notably, these findings also indicate the importance and value of giving the opportunity to residents for their voices and experiences to be heard.

These findings have recently been accepted for publication in the international peer-reviewed journal Health and Social Care in the Community and can be viewed in full here. 

What this publication adds to the field:

• A comprehensive program of individual care delivered by supportive care staff may make a meaningful contribution toward empowering individuals in their ongoing recovery.
• Policymakers and practitioners should consider the value of peer relationships, autonomy and functional independence in fostering social inclusion and reducing marginalisation.
• A better understanding of the lived experience of individuals in supported living is helpful in understanding what makes the care-environment ‘supportive’ to those who depend upon it.

References:

1. Slade, M., Bird, V., Clarke, E., Le Boutillier, C., McCrone, P., MacPherson, R., Pesola, F., Wallace, G., Williams, J., & Leamy, M. (2015). Supporting recovery in patients with psychosis through care by community-based adult mental health teams (REFOCUS): A multisite, cluster, randomised, controlled trial. Lancet Psychiatry, 2, 503-514. doi: 10.1016/S2215-0366(15)00086-3.
2. Killaspy, H., Priebe, S., Bremner, S., McCrone, P., Dowling, S., Harrison, I., Krotofil, J., McPherson, P., Sandhu, S., Arbuthnott, M., Curtis, S., Leavey, G., Shepherd, G., Eldridge, S., & King, M. (2016). Quality of life, autonomy, satisfaction, and costs associated with mental health supported accommodation services in England: A national survey. The Lancet Psychiatry, 3(12), 1129-1137. doi: 10.1016/S2215-0366(16)30327-3
3. Kyle, T., & Dunn Barts, J. R. (2007). Effects of housing circumstances on health, quality of life and healthcare use for people with severe mental illness: a review. Health and Social Care in the Community, 16(1), 1-15. doi: 10.1111/j.1365-2524.2007.00723.x
4. Watson, J., Fossey, E., & Harvey, C. (2018). A home but how to connect with others? A qualitative meta-synthesis of experiences of people with mental illness living in supported housing. Health and Social Care in the Community, 27(3), 546-564. doi: 10.1111/hsc.12615
5. Humberstone, V. (2002). The experiences of people with schizophrenia living in supported accommodation: A qualitative study using grounded theory methodology. Australian and New Zealand Journal of Psychiatry, 36, 367-372.
6. Jarosinski, J. (2006). A life disrupted: Still lived. (Unpublished doctoral dissertation). Virginia Commonwealth University, Richmond, VA.
7. Yennari, A. (2011). Living with schizophrenia: A phenomenological investigation. (Doctoral dissertation). Retrieved from ProQuest Database (3465900).
8. Khatri N., Romney D. M., & Pelletier, G. (2001). Validity of self-reports about quality of life among patients with schizophrenia. Psychiatric Services, 52, 534–535.
9. Killaspy, H., & Priebe, S. (2021). Research into mental health supported accommodation – Desperately needed but challenging to deliver. British Journal of Psychiatry, 218, 179-181. doi: 10. 1192/bjp.2020.74

Author: Steven Barnes BSc(Hons)