Although the relationship between housing conditions and health has been recognised since Chadwick in 1842; policy development is still very much related to the physical health outcomes associated with housing problems. The Marmot Review ‘Fair Society, Healthy Lives’, 2010 considered health inequalities but with an emphasis on the physical health outcomes as outlined in the initial Framework Indicators. The indicators were to be supported by evidenced based programmes and, as has been discussed earlier, the evidence base for housing interventions, designed to improve mental health and wellbeing, is not as robust as for physical health outcomes.
The introduction in 2011 of a cross-government Mental Health Strategy for England ‘No Health Without Mental Health’ for people of all ages set objectives to improve people’s mental health. In line with Marmot, the aim was to improve the mental health and wellbeing of the population and keep people well, through the provision of high quality services which are accessible to all equally. The Public Health Outcomes Framework ‘Healthy Lives, Healthy People: Improving outcomes and supporting transparency’ provides indicators for local authorities on areas that affect health inequalities and are relevant to improving housing and improving mental health outcomes supporting the outcomes of ‘No Health without Mental Health’. Many of the indicators relate to those issues which have been evidenced to be contributory factors to anxiety, depression, social isolation and child wellbeing, such as noise, fuel poverty and excess winter deaths; suitable support and social contact for care user and carers, including adults in contact with secondary mental health services and living in stable, appropriate accommodation.
With the phasing out of the Warm Front Scheme and the Green Deal taking no new applicants, there is little Government funding to improve energy efficiency and manage fuel poverty, although the means tested Warm Home Discount Scheme and Winter Fuel and Cold Weather payments are still available. The Department of Energy and Climate Change(DECC) has made available a ‘catalogue of health-related fuel poverty Schemes’, locally targeted at individuals with health problems, focusing on energy efficiency measures and other fuel poverty interventions.
Standards and mental health costs
The Housing Health and Safety Rating System (HHSRS), described in physical health, applies to all rented property including single and multiple occupancy premises. These criteria, when applied can reduce the risk of health impacts; however, it is not always the condition of the premises that is problematic but the circumstances of those that occupy the premises, including those in owner occupied premises. Mental health issues are diverse and can be compounded by an individual’s living conditions.
The BRE’s Cost Calculator, used by local authorities to support their input to both the JSNA and wider housing initiatives, is limited in scope at present. The costs of mental health outcomes have not been considered as part of the BRE calculator and this may be due to the limited data available on the full cost of mental health impacts associated with housing. It must also be borne in mind that the process of factoring in mental health impact costs for use in the calculator could be quite complex. Further research in this key area is therefore necessary.
There needs to be cross-sector partnerships with housing providers, local authorities, CCGs, the voluntary sector and the NHS. The Memorandum of Understanding (MoU) ‘to support joint action on improving health through the home’, sets out a shared commitment to joint action, including the reduction in health inequalities, through a shared action plan.
Mental health and wellbeing is the focus of charitable and voluntary organisations such as MIND, Age Concern, the Mental Health Foundation and Young Minds etc. One way of understanding, accessing and working with the local community is to use the expertise of the local VCSE sector, which may have close links with local people and communities and socially excluded groups.