| A high-support residential service offers people with severe or complex mental health needs suitable housing where they can get support from trained staff to gain the skills and confidence they need in order to live as independently as possible in the community in the future.
Each service is based in an ordinary house on an ordinary street, and, above all, it is home to the people who live there.
Who is the service for?
High-support services such as Together's are for people who have been diagnosed with long-term and/or severe mental health problems, often alongside other difficulties such as:
- drug or alcohol misuse
- a learning disability
- challenging behaviour
- previous criminal convictions
- self-harm
- a personality disorder.
Some of these people may move to a high-support service straight from a psychiatric hospital or secure unit, others may have had problems settling in other types of housing.
A high-support residential service can offer a chance to live in the community to people who might otherwise remain in hospital because there is nowhere else suitable for them to live.
Together’s high-support residential services are open to men and women aged 18 to 65 (younger and older people can be considered if the service meets their needs). Residents tend to be men under 35.
|Top| What happens at a high-support residential serivce?
A high-support residential service is first and foremost home to the people who live there. So activities are the same as in anyone else’s home – people sleep, eat, cook, do their washing, watch television, talk to their friends etc.
Everyone at the service takes part in the cooking, does their own washing and their share of the housework.
Living with others gives residents the chance to socialise and improve their communication skills. In some high-support residential services, the people who live there enjoy doing some activities together such as playing sport, going out to the cinema, restaurants and so on.
Our main focus is on supporting and encouraging people to take part in the wider community, perhaps by doing a college course, playing sport, joining social clubs or finding work. We want to help people regain their rightful place in society and have a role as active citizens. We emphasise getting on with daily life, and getting as much out of it as possible.
Staff are available 24 hours a day, and everyone is given the kind of support that they need and want. This could be the chance to talk about feelings, support with managing medication and budgeting, or help with daily-living skills like cooking and shopping. There is a strong commitment to an open and trusting atmosphere. Staff encourage residents to discuss their difficulties and hopes, and share their problems.
When someone first moves in, they work with staff to draw up a personal plan of action that sets out what they want to achieve while they live at the service, and what particular challenges they need to manage. This involves agreed targets for everyday activities and addresses individual skills and interests. It can include input from friends, family and professionals such as social workers. The plan will form a key element of the resident’s overall Care Programme Approach (CPA). Plans are reviewed regularly and updated as people’s needs and interests change.
Our aim is to help each individual to grow and change, to gain confidence and find positive and satisfying ways of relating to other people, as well as to take responsibility for themselves and their own actions, so that when they are ready they can move on to live more independently.
|Top| What kind of support do people receive?
Our high-support residential services offer a mixture of emotional and practical support, tailored to the individual needs of the people who live there. Staff meet with residents individually, and sometimes in small groups, to identify goals (for example, attending literacy classes, coping with stress or improving daily-living skills such as shopping, budgeting and socialising) and to plan how these can be achieved.
Some residents need support in developing ways to control their behaviour in the home and the community. So staff may help them with, for example, anxiety, anger and risk management. We work with each individual's needs and capabilities, helping them to set realistic, achievable goals.
Each resident usually has a keyworker, with whom they can build a close working relationship, and who supports their action plan. Day to day, this might involve accompanying the resident to the shops, or supporting them to write letters about benefits, make a housing or job application, or manage their medication.
Where appropriate, activities like role-play, counselling, peer mentoring and support (talking to other people with similar problems) can be arranged in or out of the home.
|Top| Who are the staff?
The staff team at a high-support residential home have a range of training and experience. Their backgrounds might be in nursing, social work, occupational therapy, psychology or housing.
Staffing levels are higher than in standard care-homes for people with mental health needs. All Together staff have an understanding of mental distress and the stigma and fears associated with it, and receive training in equal opportunities and problems such as substance misuse and personality disorder.
If any resident needs additional help, is ill or having particular difficulties, support from psychiatrists, social workers and the community mental health team is available.
|Top| What is the accommodation like?
Most high-support services can accommodate between six and 15 residents. They are furnished like comfortable family homes and many are in large Victorian houses.
The accommodation meets the standards for care-homes set out in the Care Standards Act 2000, which means, for example, that everyone has their own, good-sized, properly decorated room, and has their own key to it. Many rooms have an en-suite bathroom. Everyone shares the communal rooms such as the kitchen and lounges, which are divided into separate smoking and no-smoking areas. Some services also offer extra facilities such as a garden, multi-gym or games room.
Some high-support services also offer self-contained bedsits or flats alongside, so people can live more independently but still have the security of support from the main house. These offer a stepping-stone for people who are feeling better and who want to move on, helping them to build their confidence before moving into a place of their own.
|Top| How long do people stay?
Initially, people stay for a few weeks to see whether they feel comfortable in the home. After that, people usually live in the accommodation for between six months and two years, depending on how long they need the support for. Most residents eventually go on to live in their own flats, where they may receive support from a community-support service.
|Top| What happens when I am ready to move on?
In a Together service, staff will help residents find somewhere more independent to live and support them as they prepare to move. Often they will visit the person once they have moved into new accommodation and offer support for a limited period. We encourage former residents to keep in touch, so that the transition from one place to another does not leave them feeling isolated.
|Top| Who pays for the service?
The fees for most people who live in a high-support house are paid by their local authority or primary care trust.
|Top| How can I get involved in the day-to-day running of the service?
Together supports people to make informed choices about their life. We believe that residents should be fully informed and consulted about the services they use and the medical treatment they receive.
In high-support residential services all the residents get together regularly – perhaps once a week or fortnight – to talk and make decisions about what happens in the house. Staff come to the meetings too and it is a chance for everyone to comment on what is happening in the home, voice concerns and make complaints, and plan social or other activities.
Residents also have a say in recruiting new members of staff, and are regularly asked for their opinions on the service as part of Together’s quality-assurance system.
|Top| How can I get a place in a high-support service?
Before you can move into a high-support service, you must be assessed as needing the level of support that it will provide by whoever will pay your fees at the service. You also need to be assessed to make sure that you will fit in at the service and are ready to live in the community.
People are usually referred to high-support services by their care manager. After this, an opportunity will be provided to meet the staff so everyone can decide if it will be a suitable arrangement. Residents usually come for an overnight visit first, to see whether they feel comfortable before moving in properly.
If you think that a high-support service might be right for you, talk to your care manager, social worker, keyworker or consultant. | 
