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Housing to End the Prison of Hospital

Author: Sam Sly

A version of this article was first published in Learning Disability Today.

Housing is in the forefront of our minds at Beyond Limits at the moment as social housing just isn’t working for the people we support who have been institutionalised for years in Specialist Hospitals. 

As part of planning for people leaving Hospital we do an in-depth assessment of a person’s housing needs from their ‘must haves’ to their hopes and dreams, as any of us would when house hunting. The problem we have come across time and time again is that as with the other needs of people in Hospitals who have labels of challenging behaviour we are not always getting an accurate picture of how needs may change once they are back in society. Noise and issues around when the person is anxious are often dealt with in Hospital in ways that are not transferable in the community (nor would we want to support people in those ways), and they are discharged without so called ‘treatment’ having changed anything much. People have tended to be restrained and secluded to prevent anxiety turning into anti-social behaviours in Hospitals, or the noise levels accepted have been far greater than those accepted by neighbours. Couple this with a social housing process, that although great because people have priority for housing on offer, leaves the family and person having to bid and accept properties at short notice to coincide with discharge dates meaning that the chosen property is often not perfect.

It really is a recipe for disaster, or at best a lottery. We have also found that housing location and house design for a lot of social housing again is not right for the people we support. With paper thin walls, most properties are terraced and set in neighbourhoods where difference is not appreciated, even with lots of community work to settle people in, and if the person shows any signs of distress cracks start to appear in neighbourhood acceptance.

So we have had to turn to other sources of housing which are more bespoke but sometimes come at a cost or are not accessible to all. We are now helping people gain housing through shared ownership with ‘My Safe Home’ and Advance Housing. This works for people who have, or can access the deposit and fees required to get into the scheme. Ironically for people who have been in Hospital for many years, they have often accrued money because they haven’t had a life to spend it on. Once purchased people are then proud home owners, meaning they have stronger rights when it comes to disputes with neighbours.

The other source of housing that we are starting to work with is the Cameron Trust set up by Duncan Cameron, a man with a vision for providing good quality housing for people at core rent. This new and developing project means that people should be able to have bespoke housing that is affordable. However, I worry about the future for everyone leaving Specialist Hospitals, as we are working with only a handful of the thousand plus identified who are still in Institutions, and we are struggling to get it right first time for them.

I believe there needs to be some really detailed planning and a national strategy to ensure that housing does not become another stalling point for discharge for people. 

Some startling facts have emerged from the data we are collecting about the 13 people we have worked with so far, either through planning with service designs and working policies or through going on to support, that emphasises the depth of the issues around delays to discharge. 

We looked at the length of stay that people had experienced in either a Specialist semi-secure, low secure or other type of Institutional Hospital since admission. These stays were either under a section of the Mental Health Act (usually section 3 or section 37/41) or as informal patients.

Most people have moved Hospital to Hospital since admission, remaining on a section of the Mental Health Act, except for 4 people who have moved into homes of their own with Beyond Limits. 

Of the 13 people:

  • 2 people have been or were informal patients for 5 years and 15 years.
  • The longest admission was 15 years (and they are still in Hospital)
  • The shortest admission was 5 years (and they are still in Hospital)
  • The average admission is 9.5 years and rising

To put this into context, looking on www.gov.uk, the average prison sentence given to criminals excluding life and indeterminate sentences is 24.7 months. The maximum sentence able to be given for Actual Bodily Harm is 7 years, for Riot it is 10 years and Burglary with intent to cause Grievous Bodily Harm is 10 years; with most of those criminals being released long before that time and often in half that time.

The total number of years spent languishing in Hospital for the 13 people we have planned with, or now support, is a shocking 124 years. 

I fail to see that ‘treatment’ is working for these people and I fail to see, from what we have experienced when people return, that any rehabilitation has taken place; since we have to start that when the person moves into the real world and has to re-adapt to being a citizen again, with all its highs and lows.


The publisher is The Centre for Welfare Reform.

Housing to End the Prison of Hospital © Sam Sly 2013.

All Rights Reserved. No part of this paper may be reproduced in any form without permission from the publisher except for the quotation of brief passages in reviews.