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Emerald Group Publishing Limited
Copyright © 2012, Emerald Group Publishing Limited
Article Type: Editorial From: Housing, Care and Support, Volume 15, Issue 1
Housing, in one form or another, touches almost every aspect of our lives; everything outside of hospital, prison, or, arguably, the armed services, is either some form of housing. Even for those in hospital, prison, or the Armed Services, having a home to go to may be critical to their leaving; and suitable housing, with support in some cases, may be the key. For some, a hostel may be the closest to a home that they have known. A hotel or a caravan may be home to some; and there are whole communities that live on water.
Similarly, health ranges from positive thriving – an almost infinitely variable state – to acute illness and through all intermediate degrees of disability and general malaise. But, if we include mental health – as we certainly must do – then substance abuse and personality disorders bring the whole range of human experience into the scope of appropriate housing. As we become more concerned to tackle issues of public health, the role of housing becomes critical; and housing agencies, we have argued, can become key partners in addressing the health of the nation, and not solely of the vulnerable.
This is a field therefore, that touches upon all age groups; many forms of technological innovation; and hence many forms of research and of evidence. This editon offers with a range of papers which between them illustrate well the breadth of this journal’s interests.
In recent issues of the journal, we have published accounts of innovative approaches to the needs of older people. This includes the efforts at “dementia proofing” of homes, the extra benefits of social capital in sheltered accommodation, and the value of informal engagement of tenants, through social activities and games, in consultations and feedback over the suitability and successes of the services housing agencies may offer.
The paper by Ruth Sims and her colleagues focuses in on a quite specific area of home life – how older people use their kitchens. If the kitchen is, for many, the heart of a home, it is a central example of how the built environment can form an important aspect of self-identity. This may be particularly so among older people – though it is true for many others too. Sims et al. explore the coping strategies of to maintain their independence in their home; and they note examples of design that have been found to be most useful to older people.
The philosopher Ludwig Wittgenstein argued that philosophers seek in vain to debate the essential meaning of words; the meaning of its word is in its use; and uses may change. The same might be said of many human artefacts; and perhaps none more so than a house, as a home. The meaning that a home has for us lies in the place it has in our lives, its use.
The Sims et al. paper is an elegant demonstration of the key fact for researchers – that the human meaning of the same physical architecture changes, as the needs of the users change. Simple associations between the objective characteristics of accommodation – high rise living, deck access, overcrowding, etc. – that do not take into account the social characteristics of the users will often miss the key issue of the social meaning and the “fit” of accommodation to cultural, health and social requirements.
At almost the opposite end of the age spectrum, Emilie Smeaton describes the lessons learnt for the commissioning of services for young runaways – children who flee the family home, for whatever reason. Such children will be especially vulnerable, both to mental health problems, to exploitation and danger, and to established but maladaptive lifestyles that will store further trouble for the future. Early engagement, as Smeaton suggests, where implemented with the good practice principles she describes, will result in savings in the longer run.
The commissioning of services that Smeaton refers to applies in the UK context – she outlines the English and Scottish legislation – but the same themes should be as relevant in any other country where governments, aid agencies or others are wishing to develop services to meet the same needs. Nevertheless, for those who might wish to consider the situation of young runaways from another, non-UK perspective, might be interested to also read Smeaton’s “Struggling to survive” (2012), on children living alone on the streets in Tanzania and Kenya.
The role of social housing, however, crosses all age groups – as we see amply evidenced in Jonathan Rosenberg’s article on WECH; a housing service can provide, besides just a roof, various specialist services, and events for older residents and for younger; and all ages between. WECH has made recognition of family ties an important part of their “offer” to tenants, after listening to the needs and wishes of their tenants – as WECH is uniquely well placed to do.
In this the second part of his extended paper, Rosenberg continues his account of WECH as a “mutual”, or tenant-owned housing association, the UK’s first resident purchase of former local authority housing, under earlier legislation now revived by the (no longer new) coalition government. His paper explores the difference that can be made by empowerment practice from a social housing service. The experience of WECH, though unique as an organisation, nevertheless has something to say about the broader potential in housing’s role in promoting health and wellbeing.
Rosenberg’s paper also raises interesting questions on the nature of the evidence we may think we need, to demonstrate a link between housing and wellbeing. He argues here that we can only truly see and understand the links in the causal chain between empowerment and wellbeing though the qualitative experience of tenants, as expressed in their own words … .
This is not the kind of knowledge or insight that can be derived from a randomised control trial, of the kind that is seen as the best quality evidence in healthcare research. But if we are to get serious about trying to understand the social determinants of health, as so many politicians and researchers now say we must do, we clearly cannot do so by demanding all research should meet the same criteria for evidence as trials of medicines or other laboratory-style experiments. The clue lies in the word “social”.
Meanwhile, if we are looking for practice that unites and integrates, the paper by Rex Haigh and his colleagues from the development group at the UK Royal College of Psychiatrists’ Centre for Quality Improvement – a group which included the co-editor of this journal – offers a bold step in that direction. This paper describing the roots of the “enabling environments” approach introduces an initiative whose aim is to find a common core of values and standards – a Rosetta stone, as the paper describes it – for healthier communities, and for the diversity of services that need to work together to improve the lot of participants, members, service users.
Homelessness services, social housing, and even private rental and home ownership had been envisaged from the outset as potentially part of this broad vision of an “enabling environment”. The authors conclude with an invitation to housing services and researchers to try out this approach, and their proposed ten core principles. This journal is especially devoted to issues that cut across between housing, care, and support issues; and we would welcome further articles exploring these themes, from the UK or from further afield.
Note that this paper also describes the origins of the term “psychologically informed environments” (PIEs) – a term currently exciting much interest in homelessness services in the UK. We will hear more of PIEs in the next issue of this journal.
Finally, new technology continues to open fresh opportunities for closer engagement and integration between housing, healthcare, and social support. We no longer seek to hide away the more vulnerable in specialist institutions – we have seen all too clearly the dangers and damage that that entails – and wherever possible we now aim to maintain vulnerable individuals in their own homes and communities. Yet support services for the more vulnerable still need to be connected, well integrated – but without need of the concentration on one site that was the hallmark of previous ages.
Telecare is the term now used for the development of healthcare – and, by extension, social care – delivered remotely, by electronic devices, in patients’ own homes. Frances Thompson’s paper on the three-year evaluation of the introduction and roll-out of telecare in the local authority area of Wakefield concludes that new technology allows additional support also for people with complex needs, learning disabilities, and also young carers.
Thompson cautions, nevertheless, that whilst “telecare can help people maintain independence, delay or even eliminate the need for residential care … (it) is not a replacement for human care: rather, it should be regarded as a supplement to help restore independence and dignity that may otherwise be lost, while providing a great deal of support and reassurance for family and carers.” The social context – including culture, geography, history and national and local policy frameworks – needs to be better recognised – another theme we will return to with this journal.
Note that the Wakefield findings, along with other related studies, have been disseminated and publicised in the UK, and the content of this paper is not exclusive to this journal. But we include it here, for its wider relevance, outside the UK context. Transnational and transcultural aspects may in future become a useful part of development and evaluation of these technologies.
Of course, there are also many countries where this process of de-institutionalisation has less resonance, as many never had the resources to build such institutions in the first place, and what care there was remained at home, in the family or the village. The development of telecare in the electronic age may be now bringing the, so called, developed and the developing world together into a single model of care and support for independent living. A fruitful area for future discussion?
Robin Johnson, Lynn Vickery
Smeaton, E. (2012), Struggling to Survive Children Living Alone on the Streets in Tanzania and Kenya, The Railway Children, available at: www.railwaychildren.org.uk/article.asp?id=1050