Justice Action proposes the formation of a consumer-run Housing Cooperative drawing upon the overseas and local experience of successful community-controlled housing.
Justice Action supports Callan Park's development as a privileged living area to accommodate mental health consumers, demonstrating a positive model of recovery with social support. It wants consumers to utilise the area for independent living now, and as a centre created for the benefit of generations to come. Justice Action supports the application by Breakfree Services and partners, to utilise a number of buildings on the site to establish a housing cooperative for mental health consumers.
Callan Park is an area that was brought by the government in 1887 and was dedicated to supporting people with mental health related disabilities. The Master Plan proposes creating supported accommodation for 83 mental health consumers.
Some NGO organisations oppose any mental health consumers living in Callan Park on the basis that it would form a stigmatised ghetto. Instead, they want to build a conference centre.
To exclude mental health consumers from living in Callan park would be a radical move after its dedication to them in 1887. As organisations and individuals, we need to consider carefully our reasons to do so whilst using the remaining area for drug and alcohol rehabilitation accommodation and mental health administration for the NGO sector.
Mental health consumers are vulnerable, yet central to the whole justification for mental health resources. It is hard for them to defend the Master Plan recommendation for homes for 83 consumers in Callan Park in this lobbying process – the point made in the OUR PICK Report.
Consumers have real problems with accommodation. We constantly have people who are refused public housing who go to hospital after being homeless and offered space in our own homes. The increasing homelessness is expressed on the City of Sydney website so the opportunity for a housing cooperative for consumers if very significant.
Our people are crying out for housing. The Report of the 2007 Forum with over forty consumers at the Rozelle Conference Centre, lists accommodation: "lack of choice, safety and support" as of vital importance. It is consistently highlighted.
Consumers need housing
Adequate, affordable and secure accommodation has been identified in both the HREOC "Burdekin Report" 1992 and the "Not For Service Report" 2005 as being a critical factor in determining the recovery of people with a mental illness in the community.
The Canadian Senate Report "In from the Margin: A Call to Action on Poverty, Housing and Homelessness" 2009 highlighted that "the cost of land can be prohibitive to any organisation seeking to build affordable housing, for purchase or rent".
Burdekin stated that: procedures dealing with the discharge and coordination of the community treatment and care for people with a mental illness are generally inadequate. Mental health consumers are being discriminatorily excluded from government housing programs.
As a consequence, homeless shelters, refuges and boarding houses now function as primary sources of 'accommodation' for people with mental illnesses, with these shelters generally lacking the support needed for effective rehabilitation. The current housing problem for mental health consumers requires a sustainable, affordable solution in which consumers are given access to intensively supported accommodation in the community.
The same point was raised in the Consumer Forum facilitated by the Mental Health Services Conference 2000 (TheMHS) in Issue Four in the Twenty Three Big Issues. This means that people are often discharged from hospital and forced to find accommodation outside their established security network, leading to further isolation and alienation.
Why a housing cooperative?
"Co-operative Housing is rental housing for people on low to moderate incomes where members select tenants, manage and maintain the housing. It is long term, secure and affordable. The government provides funds to build or buy dwellings and the co-op self-manages, making it a cost effective alternative to other forms of social housing. Rents are used to cover running costs, upgrades, administration and training." – Association to Resource Co-Operative Housing. http://www.arch.asn.au/coop.
Supported community living is a key feature of housing cooperatives. Community housing, such as cooperatives, are differentiated from public housing in that they follow a more 'community development' approach, focusing on empowering participants, strengthening communities and reintegrating people back into the mainstream. Additionally, cooperative housing, as defined by the Association to Resource Co-operative Housing, provides people with the ability to rent housing at a reduced price , and thus offers an affordable and secure living situation for disadvantaged members of society.
Models of successful housing cooperatives
Cooperative housing models tend to provide geographically separate and independent housing options for members of a particular community or group. Residents are required to pay rent, and are typically given the option of participating in cooperative activities. Additionally, many cooperatives that are aimed at people with a disadvantage or disability provide ongoing support to residents both in terms of a support network and in terms of access to information, medical care or relevant services.
The following are just some of many examples.
L'Abri en Ville in Quebec. L'Abri en Ville provides safe, affordable housing for people with a mental illness by placing three compatibility-matched residents together in an apartment. The structure of the living arrangements itself promote social cohesion and integration, and the fact that each resident is responsible for an allocation of household chores as well as rent additionally promotes individual capacity building and rehabilitation. L'Abri en Ville also eases the reintegration of mental health consumers through providing a strong support network in the form of volunteers assigned to assist each apartment, as well as having a staff coordinator meet weekly with the residents of each apartment.
Metro Non-Profit Housing in Canada supports 18 bachelor apartments, each with a separate kitchen and bathroom that it makes available to the homeless or those especially vulnerable to homelessness. The Association however also provides an ongoing support network to residents through their Housing Centre, which provides a number of services including information on housing and benefits issues, supportive conselling from two support centre workers, and access to medical and psychiatric care from visiting trained medical staff. The success of this organisation has been demonstrated in the description of the development of a 'family culture' amongst residents, providing a valuable support network for the disadvantaged and consequently building individual capacity and social cohesion.
Australian housing cooperatives include the Northern Suburbs Housing Cooperative, which provides long-term, secure, rental accommodation to eligible people over 55 years of age. In addition to providing affordable housing for the vulnerable, this cooperative also focuses on providing a supportive community network that provides opportunities for tenants to be involved in Co-ops management functions as well as assisting tenants to gain access to other community resources and services.
Cooperatives may also be aimed at ethnic groups, such as the Tongan Housing Cooperative called 'Hope, Faith and Love' based in Sydney. Given the difficulty of finding affordable housing in Sydney, as well as the desire of many migrants to remain close to members of their community, many Tongans chose the cooperative housing model as it was an affordable option that provided long-term security and allowed people to live within a supportive environment.
Trieste Model of Mental Health Services
The Trieste-style community-based mental health model is the foundation upon which the future Callan Park Master Plan is based, and its obvious success should not be overlooked. It is a social response to mental illness, with integrated housing, employment, treatment and social services. This has led to a dramatic decrease in the occurrence of both forensic involuntary and homeless consumers.
The philosophy underlying the Trieste mental health system is that people must have the opportunity to be both patients, as well as individuals with complex lives and needs. The social capital of relational resources of individuals, measured by trust, reciprocity, the use of the power of negotiation, political awareness and civic participation, are positively correlated with health conditions. The community must openly take responsibility for its own community mental health. Rather than being merely a goal, work functions as an instrument for recovery, emancipation and defeating stigmatisation, consequently providing a very important path out of the psychiatric 'circuit'.
Prior to the mental health reforms during the 1970's, Italy ran a substandard psychiatric system where patients were routinely subjected to concentration camp conditions and neglect was common. The real problem faced by mental health patients was not their mental illness, but rather, the way society treated and viewed them. In particular, the essential substitution of the illness or the patient and the subsequent incarceration of the mental health patient. Dr Franco Basaglia led reform and de-institutionalisation in the early 1970s with the mental health hospital unlocking its doors in 1974, allowing patients to come and go freely. Currently, 94% of mental health budget is spent on community-based services. Health and social services are well integrated, employment rates are high, as are the functioning levels of those affected by mental illness. Few individuals with mental illnesses are trapped within the criminal justice system.
Mental Health Services
In Trieste, accommodation is provided in the form of therapeutic /rehabilitation residences for people with a chronic mental illness, and/or people with mental illness who lack a strong support network of family and friends. These are 10 houses or apartments, which provide places for a total of 70 guests, with 6 of them (43 guests) located within the grounds of the old San Giovanni psychiatric hospital. Even after an individual has entered the housing area, they maintain contact with their family, friends and home community in order to receive all necessary support. With the well-respected international World Health Organisation (WHO) regarding Trieste as a celebrated example of successful mental health care, the Trieste model appears to have huge adaptive potential. Mental health services in Trieste are mainly delivered through four community-based Mental Health Centres (MHC) serving a catchment area of approximately 60,000 each. Predominantly provide short-term 'guest' accommodation for approximately 8 people. MHCs are drop in centres staffed by psychiatrists, psychologists, social workers and psychiatric nurses that operate 24/7 and provide both formal and informal engagement between staff, mental health patients, their families and importantly, the outside world. They are in spacious, well-designed buildings with ample multi-purpose indoor and outdoor spaces. A mental health worker assesses an unwell person very soon after they present at the centre. No one is turned away, yet it is unusual for all beds to be occupied.
There is also a four-bed university based clinic, 12 group homes with a total of 72 beds staffed at a range of levels according to need, and 8 emergency beds in the psychiatric unit. Importantly, there are no physical, structural or service restraints, even for individuals who are under compulsory orders. The eight beds in the psychiatric ward are used principally by those with a mental illness that also require treatment for a physical illness, and are rarely fully utilised.
Psychiatric nurses and doctors based in MHCs conduct regular home visits to mental health patients. Additionally, patients with serious and enduring mental health problems are accommodated in group homes where psychiatric nurses live in on a rotational basis. Other services include individual and group therapy, psycho social rehabilitation, a GP 'health tutor' and facilitation of membership of associations and social enterprise activities.
Social Cooperatives and Employment Initiatives
In order to better integrate mental health patients into the community, proper employment for mental health patients is promoted via the workplace. Negotiations with unions and local employers have resulted in patients gaining the right to proper union pay rates. The psychiatric services have set up a series of workers' cooperatives which provide regular paid employment through training and ongoing support for mental health patients.
400 people with mental illness are employed on award wages in social cooperatives operating businesses ranging from restaurants, horticulture, gardening, the arts, museums, hotels, etc and 30% of these people are affected by psychosis. A further 200 people are employed in private firms.
There are two types of social cooperatives, Types A and B. Type A cooperatives provide community services such as home care, educational centres, social support, group homes, nursery schools, etc. serving for example, the elderly and those with physical or mental disability, children and adolescents, disadvantaged youth, drug addicts and people affected by AIDS. Type A cooperatives are similar in some respects to Australian NGOs and compete for service delivery contracts.
Type B cooperatives operate as businesses and employ people who encounter systemic limitations or difficulties in achieving acceptable standards in working and social life. These include those with disabilities, psychiatric service users, drug addicts, convicted people, the long-term unemployed, youth at risk and immigrants. Type B cooperatives receive individual tax exemptions for employing disadvantaged people and business tax cuts of 25%. Member-employees are paid normal wages and profits from the business must be re-invested
The indicators of rehabilitation through work include improved socialisation, self-care, family relationships, lower admission rates and less medication. The theory is that work settings should be capable of promoting and widening other fields of interest, develop worker/employer partnerships, job attachment and a sense of identity and belonging. The challenge is to overcome the passive status of being 'assisted' and to involve people as 'subjects' with their own abilities.
Trieste Model New South Wales
Treatment per 100,000 An average of 7 per 100,000 residents are subject to involuntary treatment in Trieste. In the rest of Italy this is 30 per 100,000. The number of people taken to a Mental Health Facility in NSW involuntarily in 2007 is 16,206 out of a population of 7.11 million. This amounts to 228 per 100,000 residents subject to involuntary treatment.
Prevalence of ECT ECT has been Abolished in Trieste. In NSW 5174 people were subject to ECT in 2008.
Suicide rate The suicide rate was reduced by 30% in the 8 years leading up to 2005 in Trieste. The suicide rate was only reduced by 18% in 11 years leading up to 2008 in New South Wales
Number of Homeless people with Mental Health There are no mental health patients who are homeless in the region. The number of people who sleep rough in Sydney is 880, 85% of whom are mentally ill.
Number of mentally ill people in a forensic hospital In Trieste, there is only 1 mentally ill person in a forensic hospital. The Justice Health Forensic Hospital at Malabar is a high security mental health facility providing 135 beds and consisting of five units. The new Forensic Hospital deals primarily with individuals within the criminal justice system who are struggling with mental health issues.
Proposed Social Structure of Cooperative
The focus of the 'Our Backyard' Callan Park project is to empower mental health consumers by providing resources essential to independent and self-sufficient living. However, the Park would be founded on the notion of 'community', with consumers helping each other recover in a safe, accommodating environment. As may be seen in this report and the Trieste model of mental health services , housing cooperatives simultaneously provide residents with support and autonomy, offering a network of social, medical and informational resources.
Housing and housing support was identified by 70.1% of respondents to the Mental Illness Fellowship of Australia (MIFA) "Australians Talk Mental Illness" survey as a key issue. It was estimated that in 2007, 57% of homeless people had a mental disorder within the past 12 months ; however, the prevalence rate may be as high as 75%. With this in mind, the need for a stable housing cooperative has been identified by several organisations. As is seen in the case of L'Abri en Ville where 30 mental health consumers live independently with the support of 60 volunteers, the Callan Park proposal suggests that consumers reside in homes autonomously with only minimal assistance. Such aid would take the form of volunteers who would help with issues of daily management (such as budgeting, shopping, etc) and mental health nurses who would make house calls, enquiring into their general state of well-being. Any further treatment would be determined by consumers and health professionals in a cooperative setting, with consumers having the final say (as is seen in Trieste).
The Callan Park community would hold weekly meetings to discuss and resolve any issues regarding misconduct, renovations and improvements to the community, upcoming events, etc. Such meetings would facilitate community involvement and social interactions, thus preventing the isolation of consumers – an issue they may encounter when living within the general community. Consumers could also freely dictate the terms of their living arrangements in order to promote self-sufficiency and self-efficacy.
As in Trieste, there would be no use of seclusion, restraint or involuntary treatment within the community. However, treatment options would be made available to all residents if they desire additional support, only being administered with the consumer's full consent.
In order to help residents integrate fully into the community, support would be provided by individual specialists in the forms of education services, vocational training and employment opportunities. As with the Mental Illness Fellowship based in Victoria , such staff-assisted programs are tailored to suit both low and high support needs. As is additionally done in Victoria, recreational activities would be organised to encourage the further development of consumer independence. Worker co-operatives may be established where consumers and non-consumers are employed to work jointly across a range of varied business enterprises (eg cafes, restaurants, carpentry).
With stable accommodation and ease of access to mental health services being an instrumental factor in managing psychiatric problems and subsequent coping strategies, the housing cooperative proposed for Callan Park would provide the optimal environment for mental health consumers to live independently while making strides towards recovery.
Justice Action recommends that the meeting supports the inclusion of this proposal in the final Master Plan and the continuation of Callan Park as an independent living space for consumers as part of a Callan Park Housing Cooperative.