The foremost conceptual model of accommodation support in NSW can best be described as a linear continuum or transitional model whereby each setting provides a different level of service and consumers move to less intensively staffed environments as their level of functioning improves. Efforts are being made by services to integrate knowledge about consumer preferences but many consumers are still not offered a choice of housing options and most of the accommodation available is in group homes or hostels.
The types of support provided by services are very similar and include living skills training, medication management, and social and leisure services. Consumers from non-English speaking backgrounds. Aboriginal and Torres Strait Islanders and those with a dual diagnosis of drug or alcohol abuse were evenly distributed across services. However, there was a greater percentage of consumers with a dual diagnosis of intellectual disability in services with 24-hour staffing.
Most services had staff based on-site and 79% employed at least one nurse. Rural services were significantly less likely than their urban counterparts to have psychologists and social workers on staff.
Consumers completing need assessments reported having 7.6 needs of which 2.1 were unmet. The most common areas of unmet need were:
- Company
- Daytime activities
- Intimate relationships
- Sexual expression
- Information on condition and treatment
- Physical health
- Psychological distress
- Transport
Three-quarters of consumers were having their needs met for 'accommodation' and 'psychotic symptoms' and over 90% reported having no problems in the areas of 'alcohol'/ 'safety to others', 'drugs' and 'child core'.
Consumers reported that they more often received help from friends and relatives than from local services in the areas of 'intimate relationships' and 'child care'. Friends and relatives also assisted consumers with 'company', 'psychological distress', 'psychotic symptoms', and 'safety to self'.
For 18 of the 22 CAN items, the levels of help that consumers reported receiving, and the levels they felt they needed, were highly correlated. There was also an association between having ones needs met, and being satisfied with the amount of help being received, but the direction of causality between these two concepts could not be established. Likewise, more than 25% of consumers were not satisfied with the amount of help received in four of the eight areas of unmet need listed above.
The LSP-16 scores obtained by consumers ranged from 0 to 44 (the maximum score is 48) and were commensurate with a score which might be obtained from someone without a psychiatric disability, to one expected from someone in a psychiatric in-patient setting. There was no relationship between consumers' level of functioning and the number of needs they expressed.
Open-ended questions revealed that the majority of consumers wanted to move out and live independently with nearly a third specifying that they'd like to live alone and 16% wanting to share with a friend or romantic partner.
The percentages of met and unmet need were very similar across service settings. Consumers residing in facilities with 24-hour staff support did not have a significantly greater number of needs than consumers in less intensively staffed settings. However, the number of consumers satisfied with the help they receive did vary according to the type of service they resided in. Overall, there was a greater degree of dissatisfaction with the help received amongst consumers in 24-hour settings, than amongst those in accommodation without 24- hour staff support.
There were significant differences in consumers' level of functioning between different service settings.
To summarise, consumers at NGO's, rural services and services without 24-hour staff support had a lower level of functioning than consumers at Area Health services/ services in urban areas and 24-hour services.
Focus group participants indicated that practical help with daytime activities, emotional support, and help with developing and maintaining relationships is valued, but there needs to be more opportunity to choose accommodation and the type and level of support received.
Consultations with high support accommodation services in Victoria indicated that with the appropriate inter-agency partnerships, some people with high needs can be supported using a home based outreach / 'supported housing' model of care (recommendations for implementing and managing such a model can be viewed in 6.1). Service providers offering intensive home-based outreach emphasised the importance of flexible funding which allowed for support levels to be increased in the event of an individual being at risk of hospitalisation.
The advantages of a supported housing model from the perspective of key agency representatives were greater opportunities for consumers to live alone/ a more normalising environment and greater housing stability. It was considered important to ensure the availability of appropriate housing and well-trained staff, and to acknowledge that this model may not be appropriate for some groups (e.g. young people; people with drug and/or alcohol difficulties).