The
quality of life largely depends on where someone lives, this is even more
important when individual is vulnerable with mental health disorder. This paper
investigates impact of supported living on mental wellbeing of service users
i.e. individuals with mental health conditions such dementia, schizophrenia,
psychosis, self-harm, and suicidal feelings. The current demand for social
health care for both vulnerable children and adult have increase significantly
across many local authorities in the United Kingdom, according to Age-UK (Health and care of older people in
England, 2017), changes in demographic i.e. the number of people aged 85+
in England has increase almost by a third over the last decade, they further
explained that, “all part of social care faces about £160 million cuts in total
spending in real terms on older people’s social care in the five years to
2015/16”.
The
same level of pressure and demand for children and young adult with mental
health disorders was presented by MENCAP- Report into housing situation of
individuals with learning disabilities. Mencap
– Report (housing for people with a learning disability) indicated that
there is “an increase of 89% in local authority reports in the number of adult
with learning disability seeking housing support in the last three years”. (Market Opportunity Report, 2014) conducted
by Barnet Local Authority stated that, “there is about 300 services users were
under accommodation with support and 40 schemes in the borough with annual cost
of around £8.75 million providing support of young adult with learning
disabilities on the other mental health problems including misuse of
substances.
The
following highlights the importance of different types of supported
accommodation i.e. supported living accommodation and Extra Care Housing in
providing adequate accommodation for a growing demand by individuals with
mental health disorders. This brings the research topics that seek to
investigate how these types of accommodation helps to bring about mental
health wellbeing for service users given the current regulations and
institutional requirements setup by The Care Quality Commission, Legislation,
and The Local Authority.
Regulations
and responsibilities of services to service users in support facility
Supported
living, Extra Care, Shared Lives and Domiciliary care are most identified
housing facilities for people in care. Supported living is a “scheme that provides
personal care to people as part of the support that they need to live in their
own homes, accommodation is largely shared”, Individual personal care is
provided based on contractual arrangements, according the CQC guidance. In
contrast Extra care housing are a purpose-built, a single household
accommodation that is owned or occupied under an occupancy agreement, according
to CQC guidance, this type of housing made up of building or campus of the same
households specifically designed to facilitate the delivery of care to
individuals.
Shared
Lives accommodation is whereby individual lives in under an occupancy
agreement, the premises are generally owned or tenanted by another person who
has been approved as a support carer by a ‘shared Lives’ scheme that is
register to provide care, in contrary, where individual lives in a single
household accommodation that is owned or occupied by the person receiving care
is known as Domiciliary care, according to CQC guidance.
The
role and responsibility of service providers is to seek to support service
users based on The Care Quality commission fundamental standards (CQC) i.e.
individual receiving support and care under all these facilities must be
treated the Human Right Act 1998 where respect for their privacy and dignity
are observed. Care must deliver in a person-centred approached to enable
service users to determine the type of care they may preferred. Service and
facilities (premises and equipment) must meet safety standard as defined by the
health and Safety at Work Act 1974. According the CQC guidance, service users
consent must be obtained at all times, all decision making by care and support
providers must governed by the Mental Capacity Act 2005, ‘a legislation design
to protect and empower individuals who may lack the mental capacity to make
their own decisions’.
Providers
of accommodation must be registered as set under the Health and Social Care Act
2008, participant of this paper setup is categories under supported living or
extra care housing service where individuals’ independency is paramount,
accommodation is subject to occupancy agreement i.e. a legal agreement for the
provision of supported care and accommodation.
Methods
The
methodology for this paper is based on analysis of qualitative. Qualitative
research is defined by its objectives and relates to presenting understanding
of some aspect of social life such as the topic for this paper: “impact of
supported living on mental health being of service users”, this method collects
words or participant account of events, which are transformed to numbers for
data analysis. The sample size represents
as (
) as number of participants for this paper is limited to (10 =
, 10 participants) have been be selected form project.
The
number of participants (sample size = 10) presents weakens to this methodology,
according (Albert, 2007) small sample size failed to capture broader
representation for the general population; consequently, qualitative research
could lack rigour. However, analysing small simple size is subjective to the
purpose of the research where further finding are needed to understand trends
or outcome of selection sample form a population.
Questionnaire
is main at source participants satisfaction to their resident in supported
living environment, consequently questionnaire form issued to participant
captured feedbacks in scale of ‘strongly disagree to strongly agree’ as
answers to respective question. Example of question and data souring is in
table: 1. Analysis is complete in percentages and the use of Microsoft excels
to arrive at participant responds to respective questions, output is presented
in the appendix.
Table 1
Participant 1 (code:101)
Strongly
Disagree (code:1)
Disagree (code: 2)
Neutral (code:3)
Agree (code:4)
Strongly Agree (code: 5)
Items: Questions
I am happy
with the support I receive from staff
Additional Comments
I would recommend
the project to another homeless person who need support
Additional Comments
Participants
are coded with numerical: 101 to 110 (n= 10), codes (1 to 5) are assigned to
their responds each question for example strong disagree represent code: 1 and
agree present code: 4. Participant are all males (n=10) with average age of 21
years old (range: 19 to 24 years), all participant have mental disorders
including schizophrenia and psychosis. Participants were informed of the
objective and procedure of the paper and how all information would be used and
destroy on completion given the ethic that must be observed.
Different
researches have drawn various research methods to examining the impact of
various factors on their wellbeing based on individuals’ satisfaction to
service they receive, (chadsey-Rusch and Heal, 1985) employed quotation. This
brings about the importance of ‘Research Ethics’, (Tom and Jim, 1983) outlined
importance of respecting the rights of participants, justice for equal
representation and safeguarding of individuals.
Review of Range
of methodology and different researches
(Hsiu-Fang
and Sarah E, 2005) presented three approaches to qualitative content analysis
which were, ‘Direct Content Analysis, Conventional Content Analysis and Summative
Content Analysis’. Content analysis is
widely use by researchers to analysis qualitative data in Health care
literatures according to (Hsiu-Fang and Sarah E, 2005), the flexibility of
content analysis allows different theoretical and selected interest of
researchers to be conducted however, lack of definition and standardized
research procedure could limit the use of content analysis according to (Tesch,
1990). According to (Hsiu-Fang and Sarah E, 2005), researchers use Conventional
Content Analysis is identify a described phenomenon whereby a generalized
research question is hypothesised without categorising, i.e. an open-ended
question to selected participants. This present weakness in conventional
content analysis thereby perceived to lack reliability or trustworthiness
according to (Lincoln and Guba, 1985).
Another
qualitative approached is Directed Content Analysis, in contrast to
Conventional approach a researcher categorise research questions based on
variables of interest i.e. (Investigated
topics) correlation or relationship with other variables. (Hsiu-Fang and Sarah
E, 2005) identified that this methodology allows directing coding to develop however
it could result to omitted variables as a results strong bias data analysis.
According to (Hsiu-Fang and Sarah E, 2005), Summative Content Analysis allows
qualitative researchers to identify and quantify certain words, (Babbie, 1992)
stated that this process explore the meaning of words or content.
The
under-lining principal to all these methodologies involves wording coding to
generate data that could be analysis i.e. (Thematic analysis of data). In
summary, as noted by (Albert, 2002), qualitative research data could be obtained
or generated from participants in interviews, Asking Questions, Topic Guided,
observational approached, reanalysis of previous literatures band reports of
topic of interest and Oral approaches.
Research
Ethics:
Following
(Tom and Jim, 1983) guidance for research ethics, the characteristics of
participants is based on them having mentally capability. This paper applies
ethical factors which include the capacity to consent from
participants to contribute, and participants contributions are treated with strict
confidentiality. Participants names are omitted during questionnaire,
all information destroy as defined by the Data Protection Law. Procedures to
research in health sector demands the treatment of participants with respect
and dignity, safeguarding measure must be observing to protect all participants.
It must be mentioned that this paper has been referred to any ethical review
board (ERB) for endorsement resulting from it being a project work.
One
of the most recent research on well-being of young people in UK is present by
“Quality of Life- UK”, their findings were based on most of the indicators to
measuring well-being as presented by various literatures discussed, and the
methodology used was transformation of qualitative data (individual interview)
to quantitative i.e. measurement via rating individuals satisfaction from high
or very high (rate allocated: 9 to 10 out of 10) to low or very low anxiety
(rate allocated: 0 to 1 out of 10). The primary background to this method
employs means analysis to present their findings.
In
contrary, (Sigelman & Schoenrck et al, 1981) employed ‘Yes or No’, picture
choice; either-or, verbal multiple choice and open-ended formats to investigate
individuals’ well-being through series of questions, according to (David and
Perry, 1995). A cross sectional survey
was employed by (Alison, Kirten et al., 2012) to investigate aspects of mental
health services on service users’ well-being in preventing suicide in NHS
facilities.
Literature
review
The
quality of life is multidimensional, according to (David and Perry, 1995),
these dimensions could be categorised as, “physical
wellbeing, material wellbeing, social wellbeing, emotional wellbeing,
development and activity wellbeing”, researching into wellbeing of a
population or a group of people have had broad historical research, as a
result, different assessment or indicators of wellbeing such psychological and
social development as indicator on individuals welfare was well examined by (Bigelow, Olson and Mcfarland, 1991).
According
to (David and Perry, 1995), different definitions of quality of life indicate
diversity and subjective to individuals and society perspective on what
accepted at quality of life. These echoed in the outcome of this paper,
participant have different demands and challenges, this means health and social
care service must integrate working practice and policies that seek to meet
these variation in service users demand.
What constitute
quality of life?
There
is wide research to capture indicators that constitutes quality of life.
(Conroy and Bradley, 1985), explored possible impact of relocation i.e.
movement from different community support institution on growth of residents
(mentally retarded persons), their findings related users, satisfaction to
service received as indicator of individual wellbeing according (David and
Perry, 1995). This is conformity to the role and responsibility of professional
and health and social care facilities (Peter w, 1990) research into mental
wellbeing translate the importance environment on affecting individuals’
wellbeing, according ((Peter W, 1990) other research have produce literatures
which covers, “derivation of satisfaction, happiness, positive effect, negative
effective, anxiety, self-esteem and depression” as emphasised by (Cook,
Hepworth, Wall & Warr, 1981).
Service
users are by large expected to receive support as a safeguarding measure and a
duty of care by service providers to meets demand of users i.e. users must be broadened
encompass family members, clients, advocates and all professionals who may come
in contact. (Lowe & de Paiva, 1991) elaborate how environment quality,
availability of staffing and their performance, existence of professional
services, availability of development progress activities, community
activities, friendship and family contact translate into consumers
satisfaction.
Service
users’ satisfaction of service clearly plays vital role in determining how they
classify their mental wellbeing, (Emerson, 1985) accounted personal
satisfaction and psychological wellbeing as primary model to evaluate how
provided service meets a client demand and expectation. (David and Perry, 1995)
analysis of conceptual model of quality of life examined (Borthwick-Duffy,
1992) perspective model of quality of life. According to (Borthwick-Duffy,
1992), the quality of life represents
the quality of individuals’ life conditions and this must be composite of
individuals’ satisfaction of underlined life condition, furthermore, life
condition and satisfaction must have combined to defined individuals’ quality
of life. Figure: 2 illustrate (Borthwick-Duffy, 1992) model of definition
of quality of life.
The
quality of life of individual with mental health conditions have largely been
priorities by government and local authorities alike, this is shown in
Islington – local authority strategy policy whereby there is partnership with
service providers and NHS in promoting Mental Health and Wellbeing. Emphasis
have been placed on how service users could be supported to access care,
safeguarding and promotion of independence in determining the level of care,
decision making that may affect their outcome. According to (Emerson, 1985),
the quality of life definition captures utilization of available services to
balance the fulfilment of individuals values, goals and needs through
actualisation of service users’ abilities.
Critical analysis of what constitute quality
of life as indicator of individuals’ wellbeing could present argument among
researches as to what constitute accepted definition of wellbeing in different
literature according (David and Perry, 1995).
Figure 1
Source: David Felce & Jonathan Perry: (Quality of Life, Its
Definition and Measurement- 1995)
(David
and Perry, 1995) stated that, because individuals can only decide their
satisfaction and ideal life conditions to determining their quality of life, it
is inevitable that society i.e. existing regulations, institutions, family
members, program professional and advocates contribute or supervise to bring
about quality of life judgement base on their own definition, in other words,
interested parties play role to defining satisfaction and acceptable life
conditions.
The
general principal accepted to defined satisfaction and life condition as put by
(M. Powell, 1983) in the literature Environmental and Other Determinants of
Well-Being in older People as “the good life” encompasses, “behavioural
competence, perceived quality of life, psychological well-being and objective
environment. Participant of this paper returned answers to questionnaires would base on these indicators as well
explained by various academic literatures. (David and Perry, 1995) expanded on
(M. Powell, 1983) and (Blunden, 1988) well-being indicators as including
individuals and institutional accepted conceptual axioms of quality of life
base on: material wellbeing, financial constraints, privacy, possessions,
social wellbeing i.e. relationship with family and health care professionals
where individual religion and values are respected and treated with dignity ,
community involvement and acceptance or support, independence and having choice
and control of personal life. According (M. Powell, 1983), the outcome of
individual wellbeing contributes to their Emotional wellbeing; emotional wellbeing
affects individuals’ mood and satisfaction.
