Background
In September 1996, UCWPA was contracted by the SA Department of Human Services Health Department to provide a community based recovery and psychosocial support service for people with a mental illness who had their clinical management provided by the South Australian Mental Health Service. UCWPA’s initial program, Metro Access, began when the South Australian Mental Health Services handed over 23 houses with a capacity to accommodate 52 consumers. Initially, however, there were only 34 consumers participating in the program, this was to change dramatically as UCWPA moved from a Transitional Housing Model to a Supported Housing Model.
Since 1996 there has been considerable growth in the number and diversity of Community Mental Health Programs provided by UCWPA. As of June 2006 UCWPA has 14 programs providing support to over 400 consumers. Among the variety of programs are
Program Principles and Values
The purpose of UCWPA Community Mental Health Programs is to assist consumers to develop and/or maintain the skills, resources and confidence needed to live in the community.
UCWPA Community Mental Health Programs have always worked from a strengths perspective and embraced the developing principles of the recovery model. In practice consumers can expect to be instilled with a sense of hope as they are encouraged and supported to make decisions, be responsible for managing their mental health, consider holistic health issues, develop meaningful daily routines and connect with their community.
UCWPA Community Mental Health Programs believes in
Programs
Avalon: A group of units in the southern suburbs providing housing and support to 10 consumers and 8 tertiary students on low incomes, operated in partnership with Housing Spectrum.
Consumer Consultant: Two consumers who represent the views and ideas of consumers to the managers and workers of UCWPA Community Mental Health Programs.
GP Access South: Accessing housing and providing supports to 40 consumers living in the southern suburbs who see a GP for their clinical management.
GP Access West: Accessing housing and providing supports to 40 consumers living in the western suburbs who see a GP for their clinical management.
Individual Psychosocial Rehabilitation Support Services: Providing individual psychosocial rehablitation supports to consumers living in their own homes or need of housing,delivering 900 support hours per month in the Central Northern Adelaide Health Services region.
Metro Adelaide Community Living: Accessing housing and providing support to 20 consumers in metropolitan Adelaide who are affected by the closure of a Supported Residential Facility or a Boarding House.
Metro Community Living North: Accessing housing and providing support to 15 consumers with high levels of need living in the northern suburbs, consumers receive between 8 – 21 hours of support per week.
Metro Community Living South: Accessing housing and providing support to 15 consumers with high levels of need living in the northern suburbs, consumers receive between 5 – 30 hours of support per week.
Metro Options: Supporting 25 consumers who have a mental illness and an acquired brain injury living in metropolitan Adelaide, consumers receive on average 8 hours of support per week.
Neighbourhood Access: Supporting consumers living in the northern suburbs to participate in community activities such as community radio, day actvity centre in Gawler, mental health week activities and self improvement course.
Personal Helpers and Mentors Program: Supporting up to 50 consumers in the Marion community to access a range services and activities, consumers are able to self refer.
Refugee Program: Accessing housing and providing support for asylum seekers in South Australia who have exited the Special Stay Unit at Glenside Hospital, consumers receive on average 4 hours of support per week.
Rehab and Recovery Packages Port Augusta and Whyalla: Accessing housing and providing support to consumers with low to high levels of need in the Northern and Far Western regions of South Australia. Aboriginal people are a priority.
South East Community Living: Assists consumers to access housing and provides support to consumers with high levels of need living in the South East Region of South Australia. Consumers receive between 6 – 21 hours of support per week with a total allocation of 112 hours per week.
Whyalla Community Living: Accessing housing and providing support to consumers with low to moderate levels of need living in Whyalla, consumers receive up to 10 hours of support per week with a total allocation of 65 hours per week. Youth 15 years and over are a priority.
Community Mental Health Program Model
UCWPA’s initial program, Metro Access, began when the South Australian Mental Health Services handed over 23 houses with a capacity to accommodate 52 consumers. Of the 23 houses, 15 were group homes/share properties and the remaining 8 were single dwellings. All the houses were South Australian Housing Trust (SAHT) properties sublet to Mental Health Services. The program was based on a Transitional Housing Model which required consumers to move house as they required reduced levels of support, the end point being the consumer’s own home with outreach support or no support (see the diagram below).
Transitional Housing Model
Whilst there are some merits with the Transitional Housing Model UCWPA adopted a program model that enables consumers to have flexible support arrangements and ideally choose their location and type of housing. In order to achieve this and best meet the needs of the consumers in the program and utilise resources for consumers on the waiting list UCWPA implemented the Supported Housing Model.
The Supported Housing Model (see diagram below) replaced the Transitional Housing Model thus enabling consumers to live in a house as tenants in their own right, in the area of their choice, while receiving varying levels of flexible community support. In doing so, the program has been able to support considerably more consumers and offer real choices of housing and support. This is a widely recognised and referred to model as described by Dr Carling of Vermont USA in 1993… In the field of mental health, this approach has been termed supported housing and is organised around three central principles:
Supported Housing Model
The implementation of the Supported Housing Model has resulted in
Role of the Community Support Worker
Crucial to the success of the UCWPA’s Community Mental Health Programs has been the coaching role of Community Support Workers (CSW) in getting alongside consumers, developing support plans and delivering support in the community. In doing so, UCWPA Community Mental Health Programs have assisted consumers to better understand and monitor their mental illness and maintain treatment plans, improve their general health status and minimise or eliminate re-admissions to psychiatric institutions.
Community Support Workers work directly with consumers in the community to provide psychosocial support with an emphasis on recovery; CSWs work along side consumers to develop or maintain the skills, resources and confidence to live independently in the community by supporting the development and maintenance of a lifestyle and community/social network that will aid and maintain recovery.
CSWs work with consumers in their homes and in an unlimited variety of locations in the community, such as shopping centres, community houses, community health centres, clubs and a variety of other venues.
Support tasks may appear straightforward, but UCWPA acknowledges the complexity of providing this service in an ethical, purposeful and respectful way. The work requires a clear problem solving approach and a strong focus on developing Individual Goal Plans.
Each consumer referred to the service participates in initial and periodic assessments (The Camberwell Assessment of Need) to identify specific needs and goals to be achieved. The actual resulting tasks that CSWs undertake with individual consumers are varied, but can generally be grouped under a series of headings.
Accommodation - Support to find and establish suitable accommodation
Social Needs - Support to maintain or develop social networks and assistance with family and personal relationships
Independent Living - Support that assists clients to take responsibility for such activities as shopping, cooking, cleaning, self-care, using public transport etc.
Community Links - Support to participate in meaningful daytime activities such as community groups, education, training, work, sport etc.
Health Issues - Support that enables clients to gather information about and take responsibility for their physical and mental health (i.e. attend appointments)
Finances - Support with budgeting, bill paying, ensuring clients receive their full entitlements / payments.
Three Way Support Agreement
A cornerstone of UCWPA’s Community Mental Health programs is the Three Way Support Agreement between the consumer, the Community Support Worker and the clinician (Key Worker from Mental Health Services or GP). This agreement outlines the agreed goals and clarifies the role of all three parties, particularly clinical and non-clinical responsibilities. The agreement is reviewed regularly according to an agreed schedule and modified as the consumer’s goals and challenges change.
An Individual Goal Plan is put in place to highlight strategies and timeframes for goal completion. This ensures clarity of purpose but also provides a focus for each of the three parties to review their role, responsibilities and task achievement. Consumers report that the Three Way Support Agreement moves support from being general to providing a focus on specific on individual needs, and this helps them to know what to expect and where they stand with their support workers and clinicians.
Promoting real and effective consumer participation ensures that each consumer is genuinely listened to and involved. The Support Agreement provides a practical means for genuine consumer participation and clarifies the relationship between the Community Support Worker and the Consumer on a day-to-day level.
Achievements and Outcomes
Outcomes of UCWPA’s Community Mental Health Programs are the accomplishment of goals identified in each consumer’s Individual Goal Plan.
For many consumers, a significant outcome is a reduction in the frequency of hospital admissions and/or the severity of illness experienced during admissions.
CSWs assist consumers to monitor their physical and mental health and access timely assistance from their GP or Specialist Mental Health Services. Such early and pro-active intervention also helps to avoid crisis situations that may otherwise result in hospitalisation.
The ultimate outcome is that consumers are linked with their community, thus forming informal and interdependent support networks that do not require formal support arrangements.
In summary, tangible outcomes for many consumers who have been supported by UCWPA Community Mental Health Programs include achievements such as:
Other qualitative and valuable outcomes include:
