-Julie Layton, Advance UK
As a housing and support organisation for people with learning disabilities or mental health conditions, Advance is committed to providing high quality support that will enable our customers to live the lives they choose. However, in today’s financial climate, it is proving increasingly difficult to provide services that are customer-centred, deliver positive outcomes and which are also financially viable. In some areas of the country we have seen a reduction or total removal of support for people who really need it. The negative impact this has had on our customers with mental health conditions, has been highlighted by our own research.
Why is support under strain?
We continue to see an increasing demand for support services. This is largely due to an ageing population, and a continual growth in the number of disabled people in England (expected to grow by 0.7 million in the next 8 years). Given this, there are an increasing number of people who need support for mental health, physical disabilities and learning and social needs. In particular, the need for mental health services has significantly increased due to a growing awareness and diagnoses of mental health conditions (around 1 in four of us will experience a mental health problem every year).
Despite the growing demand for support, and an increase in the unit cost of care provision, funding in adult social care has not increased sufficiently to keep pace. According to an independent report, the average hourly rate paid by local authorities to provider organisations is not enough to cover their costs. This makes commissioning services highly competitive, with an inevitable drive towards low-cost solutions.
What is the impact?
The strain on support providers unsurprisingly has consequences on the quality of social care being provided, as well as the number of providers still in business- Between 2014 and 2017, 19% of adult social care services inspected by the Care Quality Commission were rated as “requiring improvement”. Additionally, support needs are not being met; the number of people not receiving the help they need has increased by 48% since 2010.
We researched the short and longer-term impact the cut or reduction in services has had on our customers with mental health conditions. The biggest impacts were as follows:
–The ability to do everyday tasks; This issue was more prevalent in customers living in self-contained accommodation, that were not able to access shared support when their individual support packages were totally cut. For them, coping with living more independently and carrying out everyday tasks-such as cooking, sorting bills and getting out and about- became a bigger struggle. While independence increased over time, the difficulty in this transition period led to long-term issues in other areas (see below).
–Mental health and wellbeing; Compounded by other issues caused by a lack of support, mental health was negatively affected due to lack of emotional support, increased social isolation and the stresses of independent living. Unsurprisingly, customers with mental health conditions reported being more affected by this, but customers with learning disabilities also experienced lower levels of wellbeing because of the practical barriers they faced in getting out.
–Social isolation; For customers with mental health conditions, their conditions which went unsupported acted as further barriers to going out, reducing independence and increasing isolation. This led to a negative cycle, causing mental health to deteriorate further.
–Effect on household; For those living in self-contained supported accommodation or a shared house, a reduction in support for one person often had a negative impact for the entire household or block. Issues included a lack of communication with house members and neighbours, resulting in an increase in anti-social behaviour.
Where does this leave us?
This research has highlighted to us the importance of providing consistent support for people with mental health conditions. Our long-term aim is to work with customers and commissioners of services to increase independence for our customers and thereby reduce their reliance on support in the long-term. We have a strong track record of doing this – but it takes time. Short-term cuts and reductions in support services, driven by wider funding challenges, are clearly negatively impacting our customers and in many cases creating situations which lead to an increased need for support.
Whilst the cuts have in some cases lead to more innovation in support services, as we search for creative solutions where funding is lacking, this can only go so far as quality is ultimately driven down by price. The role that the charity sector has played in filling the gaps where support provision is lacking- through befriending schemes, support groups etc- is important, but acts as a responsive, rather than preventative method to mental health needs and is not sustainable in the long term.
Our ask of local authorities, who commission our support services, is to work with us and give us as much notice as possible of any funding challenges so that we can best prepare customers for any reduction in support and put mitigations in place to reduce the negative impact. We also vitally need to look at funding for adult social care services and the ongoing increase in demand, which will only continue to grow.
 VODG, ‘True costs; why we cannot ignore the failure in social care funding’ (2017).
 CQC, ‘The State of Health Care and Adult Social Care in England’(2017).