Life was well. Then came the 2008 crash. Tom lost his job and was plunged into financial despair. His family broke up and his mental health deteriorated. He found himself living on the streets.
“This exacerbated my mental health difficulties,” Tom says. “With help from mental health services, I did manage to recover and I’m now a peer support advocate for others with mental health difficulties.”
There are impediments to recovery, he says, and one of these is housing. In Ireland and across the world, many people with severe mental health difficulties find themselves living in completely unsuitable homes. The rooms may not have enough light, the security may be inadequate and the water temperature controls may be too complex. All of this can stand in the way of a person’s recovery.
Housing guide
Earlier this month, the Housing Agency and the HSE launched an ambitious new document, “Design for Mental Health”, which is intended as a housing guide for architects, occupational therapists and anyone working with people who have mental health difficulties, to help them overcome the barriers to independent living.
Emer Whelan is an assistant director of nursing. She manages a mental health rehabilitation service based in Dublin and, along with architect Isolde Dillon and occupational therapist Áine O’Reilly, is one of the three main authors of the document.
“This is about modifying their environment to support, sidestep or bypass common difficulties that people experience in their own homes,” she says. “It is for a small but significant part of the population who have schizophrenia or other major psychoses which impact on their daily lives. We believe it is the first such document of its type in the world.”
Ireland has a grim history of locking people with mental illnesses away in institutional settings and, due to stigma and a misunderstanding of mental illness, local communities – especially more affluent communities – can still be reluctant to allow residential care units near them. People with mental health difficulties remain at a higher risk of social isolation and violence. But attitudes are changing and mental health services now aim to help people recover or at least live full lives in their communities. This document suggests that homes are now being treated as an integral part of the recovery process.
Empowering people
“We know now that colour schemes can be important in helping people recover,” says Tom, who served as a consultant to the HSE and the Housing Agency on the new guidelines. “It is about empowering people to be able to manage and to have a good standard of life. A lot of people who suffer with physical and mental health difficulties can get very stressed if an appliance is difficult to use or placed on a shelf that is hard to reach. These little changes can and do make a difference.”
In compiling the document, the authors were influenced by Donald Norman, a cognitive scientist, usability engineer and author of “The Design of Everyday Things”. Norman advocates for individual objects – including door handles, push-buttons and even kettles – to be designed so that they can be easily used by people with greater cognitive or physical problems.
However, the guidelines go further than the inside of a home; they also look at how its location could impact on a person’s reintegration into society. “When I was unwell, I found social isolation was a big problem, so it’s important to consider ways of ensuring that the person can be reintegrated into their community,” says Tom. “These are practical, affordable solutions and can be tailored to fit the circumstances of every individual. They will make a difference.”
For support with mental health difficulties, see mentalhelp.ie
Problems and solutions
Problem: People with difficulties in performing tasks might have problems getting dressed, keeping the home clean, finding items, using complex heating or water temperature controls. Solution: A bright bedroom is a cue to get up in the morning. Clearly delineated, customised storage could help, such as separate summer and winter wardrobes. A mirror in just the right place may help a person make sure they are properly dressed and groomed. Water supplied to hot taps should be linked to a thermostatic control.
Problem: People with mental health difficulties may not respond to fire alarms. Solution: Install monitored fire alarms or an alarm that verbally instructs them to leave the house.
Problem: There's a myth that people with mental health difficulties are more likely to be violent; in fact, they are up to 2.5 times more likely to be victims of violence and the target of antisocial behaviours. Some people with mental health difficulties may not be easily able to monitor their own personal safety, such as setting alarms or remembering to close the curtains while undressing. At the same time, they are more likely to have weaker social networks and suffer from loneliness and social isolation. Solution: Housing in a gated community may increase security but act as a barrier to outreach services, so this needs to be considered if a person has tendencies to be isolated. Houses opposite greens, on corner sites or backing onto alleys may increase the person's risk of being exposed to antisocial behaviour. Accommodation should fit in with the neighbours. Door chains increase security without adding to isolation, as can internal porches.
Problem: Gardens and greenery can be highly therapeutic, but a person with mental health difficulties can struggle to maintain them. Solution: Build a low maintenance garden unless the person is in a good position to maintain it.
