Home Group’s hospital discharge and mental health services

Rosie Lynch , 12 May 2022

Mental health is something that we can all relate to and according to the Department of Health one in four people will experience a mental health issue at some point in their lives. The past two years have been a challenge for everyone’s mental health due to the coronavirus pandemic, which has further highlighted the important role of the social housing a sector that provides homes for many vulnerable people in society.

It’s important social landlords including housing associations provide mental health services that enables people with mental health conditions to live in their community, make a home and achieve a good quality of life.

At Home Group we have put a mental health service model in place to help support our customers including:

One of our key support services has involved working in partnership with Durham County Council since 2016 to deliver a Hospital Discharge Service (HDS) offering housing advice and support for patients both in a ward-based setting then, following discharge, in the community.

The HDS has become an invaluable part of the ward-based team after initially being set up as part of our Homestay community service. The service has evolved to include a crisis support element and expanded it’s reach providing support for residents from Darlington and Tees Valley, in partnership with Durham and Darlington CCG and Tees Esk and Wear Valley NHS Trust (TEWV).

More recently, the service has been implemented across the rest of the North East in partnership with Cumbria, Northumberland, Tyne and Wear NHS Trust (CNTW).

Service overview

The hospital discharge and crisis support service involves our support staff working alongside the crisis team or on the mental health wards, providing housing support for those identified as needing it, from the point of contact through to discharge within the community.

The support offered may include:   

  • Help finding alternative accommodation. 
  • Help maintaining the safety and security of the home.
  • Help in managing finances and benefit claims.  
  • Support with long term tenancy management. 
  • Developing domestic or life skills. 
  • Support to access other appropriate services and support with filling in any required paperwork. 
  • Increasing social engagement and reducing isolation. 

The key aim of our HDS is to resolve any housing issues and deescalate any associated mental health distress. Subsequently, reducing pressures on crisis teams and preventing avoidable admissions, delayed discharges and readmissions.

The teams also reduce the pressure on existing crisis or ward-based staff to resolve housing issues, freeing up more clinical time. Simply put, we allow clinical teams to do what they do best, whilst we use our expertise as a social landlord to ensure patients have access to safe and secure accommodation. This helps remove any barriers to discharge or providing preventative support to those already living in the community.

One of the key elements in the success of our mental health services is the use of our knowledge as a housing association to find solutions for residents with more complex needs. This may include those with dual diagnosis, forensic history or financial arrears. We understand the systems in place and developed partnerships with other housing providers as well as offering our own general needs stock. All of which helps us get the best results for the residents we support.

Value for money

Our County Durham based community mental health service offers real value for money when compared to the costs of a mental health bed on a ward.

In a 12 month study of the Durham and Teesside hospital discharge services, the average reduction in duration of inpatient stay for individuals presenting with a housing need was over 100 days. This amounted to a cost saving for the trust of over £35,000 per person.

A separate study of the Durham crisis support service showed out of 404 customers supported only 2% were re-referred back into crisis and 3% were admitted to secondary care within 28 days of discharge. While 95% remained living independently, within the community.

In addition to the financial savings evidenced, teams collect feedback both from the customers we support and the clinical teams we work alongside. All of which are overwhelmingly positive. Examples of comments provided include:


"This is a fantastic service that allows clinical staff to use their time on clinical work, they take the pressure from staff and assist with social care needs. This is an excellent service that is making a big difference."

- Durham clinician


"The team have helped me through some tough times. They have helped me to move closer to my son and his family and access the benefits I’m entitled to. I could not be happier with the support."

- Teesside customer

Delivering mental health services

Home Group is currently working to further enhance our hospital discharge and crisis support offer by also looking at options for flexible support packages and furniture packs. This will be targeted at individuals who are unable to access housing or supported schemes but require more help to live independently within the community.  

This service is just one great example of how Home Group is working closely with health to understand some of the current challenges facing the NHS and working collaboratively to develop solutions.

As a sector, we must understand having suitable accommodation that enables residents to live as independently as possible is a major factor in anyone’s recovery from mental health issues.

It’s important housing associations deliver a range of mental health services as part of our social purpose to help support people with mental health conditions to live in the community, make a home and achieve a good quality of life.

For further information about the HDS service or to discuss how the service could impact delayed discharges or demand on crisis teams in your region, please contact Rosie Lynch, Sales Partner, Home Group.