Challenges and Issues

Challenges and Issues We Are Facing in Meeting Social Care Needs of Adults of Working Age with Mental Ill Health

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The more complex funding landscape for social care provision for adults of working age with mental ill health, (see the section 'Where We Are Now and What We Know - Budgets and Funding' ), can and has, impacted on the availability and timing of contract rate uplifts for mental health services. This, in turn, has impacted on mental health service providers ability to meet cost of living pressures, particularly wage inflation. West Sussex mental health service providers have reported ongoing significant challenges around the recruitment and retention of high quality staff, and that these funding challenges have exacerbated this.

Availability of and Access to Accommodation, Care, and Support

More people need accommodation, care and support and many of these people have high levels of and more complex needs. In July 2024 we had 34 individuals waiting for appropriate residential or supported living services and 82 individuals in accommodation based care outside of West Sussex.

It can be very difficult to source appropriate local care, there are a number of reasons for this including:

• Location of support – We don’t have the right accommodation based care and support services in the right places – individuals want to live where they have local connections, family and support. For example - We have many more services in the Coastal and Western regions of West Sussex than in the Northern region. (See the section 'Key Facts and Information Around the Current Supply of Social Care Services for Adults of Working Age with Mental Ill Health in West Sussex - Residential and Nursing Care/ Supported Living') . We also know there can be challenges for providers in setting up new supported living services in particular areas if District and Borough Council approaches to Housing Benefit rates restrict what is possible.
• Type of support – We don’t have availability of services that are suitable to meet the type, or complexity of needs and also potentially the age of the individual. For example: services for young people with complex autism and mental health needs. In addition, people who may have some eligible care and support needs but don’t require residential or supported living services can’t access appropriate housing.
• System and process issues – For example around assessment, reviews, transition and funding arrangements can also affect timely access to appropriate accommodation, care and support.

Retention of Care and Support Packages

Placements can breakdown when individuals have mental health crises and the individual and the service are unable to access the appropriate clinical care. In addition, providers may not have had or have access to the right learning and development for their staff to be able to effectively manage people with complex and challenging needs and also supporting people in crisis. These individuals may then go into hospital, lose their placement and go back onto a waiting list for a new service.

This has a devastating impact on individuals and providers feel unsupported in managing the risks and challenges.

Moving On from Care and Support

There isn’t an effective pathway for individuals to move through and out of accommodation-based higher level support into lower level services. Individuals who are ready to and want to move on get stuck in inappropriate services that could meet the needs of people who are waiting. Key issues around this are:

• Reviews and pathway – Regular reviews are vital to enable individuals who no longer need the care and support they are currently in to be supported to step down or move on.
• There isn’t always clarity around, support for, and incentives for providers to be proactive in undertaking this role themselves. Accommodation based care providers do not always discuss and plan for individuals moving on from the outset and regularly discuss and review these plans with individuals.
• Challenges accessing and lack of appropriate accommodation supply – When individuals are assessed by a provider or the Councils mental health teams as being ready to move on from accommodation based support it is very difficult to find or get access to appropriate general needs or supported housing for individuals. Stigma and discrimination against people with mental health needs within the general needs housing sector and also challenges around accessing and maintaining benefits to fund housing can also be factors which limit access for people with mental ill health. People can become stuck in accommodation based care they no longer need simply because they need somewhere to live.

Modernisation and Effectiveness of the Market and Provision

Early and timely discussions around service developments – Sometimes the Council is notified or involved in provider developments once they are already well progressed. It is most helpful and the Council is keen to engage and work with providers as early as possible within the development process.

Shifting models of care – Some services have vacancies, but they do not meet the needs profile for individuals who need accommodation based care. For example, a care home could have vacancies but the other residents are older and previously lived in long term hospital care, the individuals who are looking for services are younger and need and want to live in Supported Living where they will have more choice and control. There is a mismatch between what is available and what is needed.

Technology Enabled Care (TEC) – This can help to give individuals greater independence and reduce care costs, this is not well used and the potential of it is not being maximised.

Data and information - The Council and providers don’t always have readily available the data and information all parties need to be able effectively understand what is needed, review, plan and develop care and support services for people of working age with mental ill health. This includes information from children’s services around the young adults who will be needing adult social care services and needs for specific cohorts and services in specific locations. Because there are a wide range of cohorts of individuals with mental ill health needing support, each with differing need levels and support requirements (which can also change over time), and each cohort potentially low volume in specific locations, there are challenges around understanding and being able to confidently predict service requirements. Consequently, provision of cohort specific real time data on a regular basis is an important requirement to effectively work with the market to plan the development of services.

Outcomes –. There is little outcome information available including data and analysis around costs and spend and outcomes for customers as well as positive movement through pathways and placement breakdowns and reasons for this. There is also greater complexity around analysing and understanding factors impacting on outcomes for customers with mental ill health, because outcomes will be affected by both the health and social care interventions that individuals access and receive.

Impact of Challenges on Customers and Co-production

In co-producing this market position statement, with providers, customers and Council and NHS staff, all parties have expressed clearly the significantly negative impact that the challenges above have on individuals with mental ill health who need appropriate support. Many of these customers have already experienced significant trauma in their life and delays to and barriers around accessing appropriate accommodation, care and support, placement breakdown and also lack of opportunity to progress to more independent care can lead to institutionalisation, demoralisation and in some cases additional trauma.

All parties, therefore, agree that maintaining a focus on customer experience and impact, and co-producing initiatives with customers, carers, providers and other system partners is a vital part of how improvements and creative solutions to address system challenges will be achieved.