Tuesday 26 April 2011

The future of mental health care in austerity Britain

High-level supported-living housing is under threat as one London council calls a hostel 'surplus to requirements', writes Kate Belgrave in the Guardian

The soon-be-closed Tamworth high-level support hostel for people with mental health illnesses sits on the quiet Farm Lane in expensive central Fulham. "Location" is the word that leaps to mind here. Fulham Broadway station is just five minutes' walk from Tamworth hostel's front door and bustling Fulham Broadway is even nearer. Farm Lane itself is tranquil, though – it's tucked just far enough round the corner for refuge from the Broadway's crowds and noise. It's perfect.

Last month, Hammersmith and Fulham council's cabinet decided to close the 14-unit Tamworth hostel, make all staff redundant and sell the building. The council said alternative accommodation would be found for the hostel's eight residents. The council's rationale for closure was a Supporting People fund contribution towards a £300,000 austerity saving. Selling the building would be a nice little earner.

Things aren't looking as bright for those in the hostel, though. Inside, you find angry, soon-to-be-unemployed staff, concerned residents and a sort of muted, but palpable, sense of calamity. It's not just the job losses, or the uncertainty faced by residents. There's a feeling that with this sort of closure, we're getting a glimpse into austerity's darkest corners – corners where sufferers of severe mental illness rot in substandard B&Bs, or end up on the street. Time will tell.

High-level supported-living housing is a unique service. Experienced staff monitor residents' medication and keep and eye on drug and alcohol use. They arrange transfers, community activities and help residents organise appointments. The Tamworth hostel building is secure and always staffed. Many have worked here for years – a contribution that means little in our austerity age. Council reports dismiss their expertise and concerns: "Although there was some opposition to the proposal from the staff, the consultation did not present any strong arguments for keeping Tamworth open," stated authors of the council's March cabinet report on the closure. Spinning to reassure, the report's authors insisted that Tamworth residents would be catered for: "evidence demonstrates that there is sufficient provision for the client group in the borough's other mental health supported housing".

Visits to the hostel revealed a different narrative. It emerged that two of Tamworth's residents were to be moved to accommodation out of the borough. One of Tamworth's occupants – a woman called Agnes Usana, who I spoke to at length – still had nowhere to go. Usana, 47, has schizophrenia and is an alcoholic. She has been living at Tamworth for five years. Temporary accommodation had been discussed, but she felt she'd be vulnerable there. She's physically small, often confused and unwell. People prey on her. She knows this because she's lived in low-level support accommodation before. "People take my money from me, don't they? I would hand it to them. They would take my money for drugs."

Unions have tried to kick up a fuss about the council's plans, but the campaign hasn't caught fire. That is hardly surprising. Tamworth service users are adults with complicated, unpretty illnesses – schizophrenia, severe depression, alcoholism and drug dependency. Many are on benefits. Their behaviour can be frightening – Usana has apparently been banned from one store in Hammersmith, because her behaviour can be so extreme. Hostel staff are from demographic groups with little political clout: all are from black and ethnic minority groups and nearly all are women. Council reports describe their chances of redeployment as "highly unlikely".

That is partly because Tamworth is not the only supported-living hostel to shut down in Hammersmith and Fulham. The council recently closed a similar facility in Wood Lane and moved some residents and staff to Tamworth. Now, the council argues that Tamworth is surplus to requirements because occupancy rates have fallen. Union reps argue that occupancy rates have fallen because referrals to Tamworth were stopped to run the service down. They say that hostels like Tamworth are needed more than ever.

Certainly, there is reason to believe that the number of people seeking support for mental health problems is increasing all over. Interestingly, Hammersmith and Fulham's own draft Supporting People strategy says that mental health accommodation in the borough is oversubscribed. It is hard to buy into the notion that staff and buildings can easily be sacrificed. Ex-Tamworth hostel residents – people who move on to low-support or independent accommodation – regularly ring Tamworth, asking for help and advice. Sometimes, they ask if they can move back in.

Ken Clarke wants to divert people with mental illnesses from prison – so why aren't Tory boroughs retaining hostels like Tamworth to prepare? Is this how mental illness and care will unfold in the austerity era – building disposal, smoke and mirrors, with numbers and experienced staff railroaded out of jobs and debate? It seems so. Users of our least-visible services must take whatever they're given and be grateful.

Some are grateful, of course – I talked to Raphael Samuels, a Tamworth resident who was pleased to be moving to a new care project out of the borough. He was looking forward to the fresh start. That optimism hardly guarantees his future, though. Hammersmith and Fulham is not noted for its commitment to users and providers of public services. Few councils will be as austerity bites. There'll be no going back, either. Once the Tamworths are gone, they're gone.


Kate Belgrave, the Guardian