Supporting social inclusion for people with serious mental illness living in supported housing (SUSHI study)

Brynmor Lloyd-Evans In progress  

Introduction

Social exclusion occurs when an individual does not participate in the key activities of their society as they would like, relating to connectedness, participation and citizenship. People with mental health problems are often socially excluded, with greatly increased risks of unemployment, loneliness, poverty and debt, and criminal victimization.

Around 60,000 people with the most severe mental health problems and complex needs live in supported accommodation, including residential care, 24-hour and daytime-staffed supported housing, and “floating outreach” from housing support workers to people living independently.

Supported accommodation services have better outcomes when they implement greater recovery-based practice (including collaborative care planning) and promote human rights. Supporting residents to achieve better social inclusion in the areas of life where they would like to participate more, is highly relevant to recovery-based practice. But evidence shows that no structured recovery or social inclusion training programmes or resources in use for staff in supported accommodation settings.

Previous NIHR SSCR-funded research which developed and validated the SInQUE tool. In its current version, SInQUE is a 46-item tool to measure social inclusion and guide care planning in mental health contexts, which asks about actual and desired participation across five life domains.

Objectives

This study aims to develop and test an online tool (SInQUE) to assess the social inclusion needs of residents living in mental health supported accommodation and guide care planning and provision; and to understand the perceived benefits of using the tool and how they are achieved.

Specific objectives are to:

  1. Develop of an online assessment tool for social inclusion, tailored for use in mental health supported accommodation settings, and determine its acceptability to staff and residents
  2. Investigate rates of take up and usage of the online tool by supported accommodation staff: in two areas with minimal implementation support; and within one London borough, with a locally developed and supported strategy to promote its use
  3. Explore staff, residents’ and their families’ views on the perceived utility of the online tool for routine practice in supported accommodation; barriers and facilitators to its use; and other resources and support required to promote supported accommodation residents’ social inclusion
  4. Iteratively develop a programme theory and logic model for the online tool, informed by study findings, which specifies the anticipated outcomes of using the tool, the mechanisms by which they will be achieved, and contextual factors which may affect this process, relating to the intervention and how it is used, the staff and residents using the tool, and the organisational and community context.

Methods

This mixed methods study has three phases:

  1. Develop and refine the online tool (SInQUE) for assessing needs with social inclusion in mental health supported accommodation, through lab and field testing with staff and qualitative interviews with staff and service users
  2. Develop a plan to encourage use of the online tool within routine care in supported accommodation services in one London borough and investigate rates of take up within services over a 5-month period
  3. Focus groups will be held with supported accommodation staff, service users and family carers to explore experience of using the online SInQUE and contextual factors and barriers and facilitators which affect its use. The research team will examine what role the tool plays in targeting care and support in key areas to improve social inclusion, and what other knowledge, resources and support may be needed to improve residents’ social inclusion. They will refine their programme theory for the SInQUE tool, with attention to contextual factors and enablers which influence its impact, and hold a final stakeholder event to discuss study findings and their implications.