Adults

Support needs of ex-offenders and those at risk of offending

The Department for Communities and Local Government (DCLG) recognises fears that Supporting People (SP) may reduce services for the more politically unpopular groups, such as high risk offenders, sex offenders and rough sleepers and reduce the availability of services to people who need to move to other areas. The government makes it clear that these concerns must be addressed directly and that the needs of challenging and mobile people are crucial to the success of the programme.

Offenders are represented in all Medway's communities and across all social groups and their needs must be recognised and addressed if the public is to be protected and crime levels reduced. There are currently over 73,000 prisoners in 138 prisons. Prior to imprisonment, 75 per cent have misused drugs, 40 per cent of women have attempted suicide and 90 per cent have a history of mental health, drugs or alcohol abuse. Frequently prisoners have all three. Housing support can play a major part in reducing offending in the future. Research shows that over 40 per cent of prisoners without accommodation re-offend.

Kent Probation Area has set out a needs analysis for the next five years based on a survey of all Kent Probation and Accommodation Liaison Officers, who were asked to identify the type of accommodation most needed or requested in their localities between 1 April 2002 and 31 March 2003. Emergency short-term accommodation and supported housing 24 hour cover is always in demand and the survey identified a demand for more bed-spaces. A need was also identified for an increase in the number of local authority and housing association tenancies allocated to ex-offenders and demand for self-contained private accommodation was also high. Based on the survey results, there is likely to be a demand for the following types of accommodation:

• supported housing
  • shared;
  • self contained;
  • 24 hour support/supervision.
• emergency direct access accommodation with and without support;
• hostels;
• floating support.

An updated assessment of needs is currently being completed by the Kent Probation service. This data will be used to inform the strategy in due course.

Housing-related support needs

Housing-related support needs for offenders are identified by the Kent Probation Service Offender Assessment System (OASys). A comprehensive housing needs assessment tool has also been produced by the National Probation Supporting People Co-ordinator in London.

The chart below indicates the needs of a random sample of 734 Kent offenders. The information covers the period April 2002 to March 2003 and indicates that 67 offenders had no fixed abode and 47 were in short-term transient accommodation, 199 offenders have misused drugs and 115 had offended as a result of alcohol misuse. In 65 cases there was evidence of domestic violence; 117 were unemployed; 199 had problems with basic numeracy and literacy; and seven had psychiatric problems.

There are two women’s prisons in the area: Cookham Wood, with a capacity for 153 (167 prisoners were released 2002/2003) and East Sutton Park with a capacity of 100 (128 prisoners were released 2002/2003). There are six male prison establishments in Kent (capacity 2,820) and one young offenders institution (capacity 360). From April to 31 July 2002, 1,127 male prisoners were released. Approximately 60 per cent of male prisoners in Kent remain in the county and 40 per cent go to the London area. The Criminal Justice Intervention Programme provides Home Office funding for a through care and after care service for prisoners on release, including remand prisoners.

Mentally disordered offenders

The figures taken from pre-sentence reports written between April 2002 and March 2003 also indicate that 14 per cent of clients were women. Only just over 1 per cent of the prison population were suffering from psychiatric problems according to the survey but we know that Medway is supplying a high level of provision in the region for this client group. This figure is not consistent with research.  

One project in Medway for this client group skews the unit cost figure and unit costs are currently much higher than those for other similar schemes. This scheme is intended to support high risk mentally disordered offenders but in order to fill voids has provided support to individuals with lower level needs.

Offenders

Overall there is a high volume of cases and high levels of need which are likely to increase in the foreseeable future. There is also a high level of demand for available schemes. It is not clear however, that the level of need matches the level of support provided or that demand in Medway reflects local need.

The table below indicates the numbers of offenders imported and exported from Medway in comparison to neighbouring authorities. It is clear that although numbers decreased significantly in the December quarter Medway are net importers.

Referrals to Medway schemes are not restricted to Kent. Referral figures to Kent Women’s project indicate that of the 23 referrals made to the scheme only two women were originally from Medway and they were referred by Caring Hands day centre and Medway Cyrenians not Medway probation service. Of the remaining 21, eight originated from Kent and 13 came from other parts of the country. The cost of provision for other areas should be recognised in terms of SP funding. We must also ensure that other authorities are encouraged to increase provision given the high levels of demand in the area, this will be an area of focus for the Cross Authority Group (see appendix 9).

Probation services and police are aware that the unit costs of provision are higher than average in Kent and suggest that in some cases ex-offenders may have lower level needs and require lower levels of support. This could be achieved though independent tenancies with floating support and ongoing support from the probation service.

Young offenders

The Youth Offending Team (YOT) has had a considerable problem placing young people in the area. The problem is not necessarily a lack of accommodation but a difficulty in making placements with appropriate support. Schemes like the foyers(www.foyer.net/mpn/) will only accept young people with minor convictions and no YOT clients have been successfully placed in these schemes to date. We will work with foyers and providers who have specialist experience of this client to group, to try to extend the range of services available.

The YOT has recorded the needs and housing issues of clients in 2003. The results are set out in the chart below and indicate that over 50 per cent of these clients suffer from mental health and/or drug dependency issues. These figures compare with mental health problems of adolescents in the general population which have been estimated at 13 per cent for girls and 10 per cent for boys. Figures in Medway are consistent with the Mental Health Foundation's estimate that the incidence of mental health problems amongst those within the criminal justice system is at least three times as high as it is within the general population. As a recent report concludes,

“Young people who offend are much more likely to have mental health problems; these problems are likely to be similar to those of the general adolescent population but more severe (conduct disorder, emotional disturbance, hyperactivity and attention problems). Meeting these needs is a multi-agency responsibility requiring shifts of understanding and increased communication between players."*

Medway figures also indicate that many clients are placed in bed and breakfast accommodation without support or in hostels where their vulnerability may be exploited. This cannot be considered appropriate, given their needs and vulnerability. Without support, vandalism is a frequent problem and young people often find themselves excluded from more suitable accommodation as a result. Although the YOT provides support wherever possible, there are inadequate resources for the intensive levels of resettlement which are needed.

*The Mental Health of Young Offenders - Bright Futures: Working with Vulnerable Young People August 2002

33 clients were assisted by the YOT in 2003 and at least half of them lacked support from immediate family and were not living in permanent accommodation.

Independent living for people with physical health and sensory needs.

People with disabilities have the same problems as able-bodied people and there are growing numbers of young disabled people in Medway looking for independence with parents finding it increasingly difficult to cope. Most provision is funded through care but three users are funded through SP in accommodation based services. A further five people receive specialist floating support for the deaf at low cost. Our strategy is only to provide low level housing related support and Supporting People aims to support people from medium and low level support through to independent living over a relatively short period of time. In future we will not be funding high level support schemes.

Older people with support needs and frail elderly

Figures from the 2001 Census indicate that Medway has a significantly lower percentage of elderly people as compared with the rest of the south-east and the UK:

Between 2001 and 2021 the number of older people over the age of 80 is expected to increase by 21.6% nationally and 33.3% within the Medway area.***  People over 80 make the greatest use of social care services and it is unlikely that resources will grow relative to this increase. The numbers of elderly people generally and those requiring extra-care and residential care are likely to increase over the next few years as people are living longer and their support needs are ultimately higher. Population predictions set out in a recent review of elderly person's accommodation needs in Medway are as follows:

***Office of National Statistics 1996 (update available in Spring 2004)

Sheltered Housing

Medway has 357 units of sheltered accommodation and other providers in the area have 837. The total supply is 1,194 units. There are only around 40 vacancies each year but still many of the schemes are hard to let. Three schemes, Shalder House, Queens Court and Fitzthorold House, will not meet the decent homes standard and are too difficult to refurbish. 90 additional units of sheltered accommodation are required to replace those that cannot be brought up to decent home standards economically and to meet the increase in demand for accommodation of this type

In many cases the minimum age for admission to sheltered housing schemes has been reduced to 55 to ensure that schemes are fully let. Despite this there are currently (January 2005) 888 over 55’s on the Academy system with active applications, of these 545 have been there for over a year. Included in this figure are 98 applicants registered for transfer, 70 of whom have been on the transfer list for over a year.

Residential and Nursing Care

Over the next five years it is estimated that 128 beds could be lost as a consequence of home closures. 150 additional care beds are required by 2007 to address the demographic pressures, as well as the anticipated home closures

Maintaining Independent living

Medway Council is exploring a range of measures to allow elderly people to remain in their homes for longer, as consultation indicates that this is the preferred option for many people. These include:

• care and repair schemes which provide minor repairs and garden maintenance. These can reduce accidents and the need for hospitalisation and provide a psychological boost;
• telecare schemes, providing emergency call-out facilities. Medway Council is piloting the latest sensory technology, enabling problems to be detected before the emergency call is made;
• specialist floating support services are being increased to support elderly people across housing tenures.

Medway is exploring leasehold provision for the elderly, to provide support for former owner-occupiers.

The challenge for care agencies, statutory and independent, will be to create and market opportunities for volunteering and possibly work that is attractive to the retired person and that will add value to the services provided. A need has also been identified to expand day care but to re-focus it on delivering programmes that promote health and well-being.

It is not known how many people could remain in their homes given an appropriate level of support and the need for cross-sector floating support for the elderly is still to be researched and evaluated.

Medway Council spends considerably less than the regional and national averages on support services for this group, supplying around half the average number of units, compared with the national and regional averages, at very low cost. Although the number of elderly people is slightly lower in Medway, there is nothing to indicate that need is any lower in Medway than elsewhere in the region, so it is possible that Medway Council is under-investing in support provision for this client group.

Care leavers

Research estimates that 67% of children in care have a mental health issue, as compared with 10% of the general population. Nationally, this group is also disproportionately represented amongst the homeless and unemployed.

Care leavers needs in Medway

A “snap shot” of recorded needs was produced by the Medway 16+ Care-Leaving Team, covering a one week period in July 2004 of all care leavers. These records showed that during this period there were a total of 126 young people who were the responsibility of Medway Council and were eligible as “looked after” and care-leavers assisted by the 16+ Care-leaving Team. This snapshot represents a general reflection of the needs of care leavers in Medway. Such information by definition can only be used as an indication of the issues faced by the client group and not used as a sole basis on which to identify needs.

In total there were:

Twenty 16 year olds

Thirty one 17 year olds

Twenty four 18 year olds

Twenty 19 year olds and

Twenty five 20 year olds

Their accommodation needs were broken down as follows:

16 year olds

17 year olds

18 year olds

19 year olds

20 year olds

Snapshot of support needs

Regarding mental health issues on an individual basis, there were varying degrees of support needed for these young people, such as depression. Other support needs included addressing issues regarding the misuse of drugs and alcohol and offending behaviour. Such issues are often prevalent as a result of their life experiences, which led the young person into the care system in the first instance.

General Support Needs

There is wide recognition within Medway and the Care Leaver sector in general, that there is a high level of developmental support needed in order to prepare care-leavers for independent living and to enable them to develop the skills needed to ensure they can successfully maintain a tenancy. The current general provision such as Foyers, for young people plays a valuable role in this area and is well utilized.

There are however some young people with a high level of need where it has become apparent that placement in general supported accommodation for young people, often ends in eviction. This is as a result of the service not being designed to meet their level of need. It is also apparent that young people with a high level or complex needs can not be accommodated at such services for this reason. This highlights a gap in service provision to meet the needs of these young people and also places high and unrealistic expectations on existing services which in relation to the general level of service they provide are meeting the needs of the majority of individuals they support.

The 16+ Care-Leaving Team recognize, along with the Health Promotion Team, the need for development of life skills training for children leaving care, to prepare them for independence, but would also emphasize the need to develop a greater range of housing and support provision, which can work with the identified needs of care-leavers and especially those with high or complex needs.

People with mental health problems

The Health Promotion Service within Medway Council is carrying out a comprehensive needs assessment in relation to mental health. The needs assessment will cover the following areas:

• community mental health,
• primary care mental health,
• secondary care mental health.

The needs assessment is considering information from professionals, service users and carers and the results of this exercise are being used to inform service planning for the next three years. It is anticipated that this information will be available in December 2004.

Meaningful local targets will be developed after the needs assessment has been conducted. Service objectives are consistent with the National Service Framework (NSF) and include: early detection of severe mental illness, reduction of need for hospital admission, reduction of relapse following hospital admission, promotion of independent living and well-being and sustaining a collaborative approach.

No needs information is currently available for this client group and without this it is difficult to anticipate the volume and levels of support required currently and in the future. In addition, there is a need to consult service users about the range of support that they would like to have in place. Local research information is also limited and currently only covers research into the mental health needs of children in care see section 7.5.

In addition to SP-funded provision, the Primary Care Trust (PCT) currently funds provision for mentally disordered offenders through Medway Reachout in a shared house. There are eight small community support schemes also funded through the PCT and these are relatively expensive.

One Medway floating support provider employs a mental health specialist to meet the needs of individuals with mental health problems more effectively. This post assists early detection and home treatment and prevent crisis developing in the first instance

Homeless people

The Supporting People Programme aims to prevent homelessness by supporting the needs of homeless people.

In recent years there has been an increase in homeless applications from younger and older applicants who are likely to have support needs. In the case of younger applicants, this will be mainly due to changes in homelessness legislation but there has also been a disturbing increase in the number of applications from older people. This is illustrated in the table below.

The table below gives a breakdown of the support needs of homelessness applicants.

Services geared to these client groups often span the remit of staff in the Homelessness Team as well as Supporting People and it is therefore important that these two sections communicate to avoid duplication.

The vast majority of applicants accepted as homeless are accepted on the basis of dependent children and this masks other support needs that homeless families may have. In future, the council must build a more accurate picture of family needs to prevent repeat homelessness.

The health needs of homeless people

The physical health of homeless people is poor and recent research indicates that, in spite of their poor level of health, homeless people are 40 times more likely than the general population not to be registered with a GP.******

The floating support service in Medway is ideally placed to tackle the multiple needs of homeless people through assessment and referral processes. The service can support a range of needs and can be applied flexibly across different types of tenure. Unfortunately, many of its clients who need to be referred to specialist services via their GPs either do not have a GP or the service is unable to establish who the GP is.

To overcome these problems, the strategy must look at improvements in access to health care services and raise the profile of homelessness on the health care agenda. The Health Promotion Team has been focusing on methods of addressing the support needs of recently homeless people through a dedicated worker and a health focus group.

*****Critical Condition – Vulnerable single homeless people and access to GPs. Crisis 2002.

The needs of people in bed and breakfast

In November 2003, Medway Council commissioned Equinox to undertake a needs analysis of people in bed and breakfast accommodation. 42 people were assessed and the report concluded that there were very high levels of need.

• 17 of the people assessed had substance misuse issues;
• 15 people were diagnosed with mental health conditions;
• four people were care leavers;
• four were people with physical disabilities;
• three were pregnant females;
• nine were involved with criminality, either past or present;
• three were sex workers;
• four were HIV or hepatitis C positive;
• five were under 18 years old.

Help with drug and alcohol dependency is clearly a need for this client group and the issue is explored in more detail below.

People with drug and alcohol dependency

The table below shows the number of people entering drug and alcohol treatment services in Medway:

It is clear that more people in Medway are entering drug treatment programmes each year. Waiting times are currently in line with national targets - there is a two week wait for an appointment (the waiting time is three weeks nationally).

Although Medway has been successful in exceeding its targets by encouraging people into treatment programmes, it is also clear that the number of users is increasing, particularly among vulnerable young people. Young people with drug and alcohol problems are in danger of losing their tenancies, failing to pay their rent or being evicted for anti-social behaviour.

New services for crack cocaine and amphetamine addiction have recently been introduced in partnership with Ad-action. Equinox is part funded by the PCT and SP to provide adult drug and alcohol services.

Medway Council has developed a Drugs Use Screening Tool (DUST) which has been piloted in the Kent and Medway area and is now being rolled out nationally. The toolkit enables front-line staff and service providers to assess cases and make referrals. Training has not included floating support teams and tenancy sustainment teams find it difficult to broker drug treatment services on behalf of clients.

Unsupported teenage parents

The UK has the highest rate of teenage pregnancies in Western Europe. In 2001, in England and Wales there were 42.5 conceptions per 1,000 women aged 15 – 17 (this was however, the lowest figure since 1995). There has been a 10 per cent decrease since 1998 nationally. The figures in Medway are just below the national average.

The chart below shows the projected teenage pregnancy rates for under 18s up until 2010. The current teenage pregnancy prevention grant paid to all local authorities is due to end in March 2004. The chart illustrates that, without continued intervention, Medway is not expected to meet the target set by Government.

There are around 234 under-18 conceptions each year in Medway. The rate is about 45 per 1,000 households and figures are likely to stay roughly the same in 2003/2004. Of the 234, 50 per cent are likely to result in termination each year. It is not understood how many of these under 18 year-olds are likely to be supported each year and the histories of teenage parents are not currently well understood. Work is required to gain greater understanding of the problem and to gain knowledge of the support requirement for Medway.

The council knows that there is considerable overlap with clients who are children leaving care. It also knows that around 75 per cent of young people under 20 leaving prison are already parents.

Needs are likely to vary from low level floating support through to supported accommodation. It is important to ensure that transitional arrangements are in place when a young person leaves a supported housing environment, as experience shows that positive outcomes can fall away very quickly when support is removed. It is likely that better life-skills, budgeting and parenting advice will be required prior to becoming a parent.

Facilities are available in Medway but they need to be linked and people need to be aware of them. A 12-bed young mothers unit with support was opened in February 2003, funded through the council’s Supporting People Programme.

Information packs are currently being produced by the health teams but these will not give information about the full range of services available. It will be important to link information about health and support options in a single pack for users.

It is proposed that Medway Council’s web-based Supporting People information will include links to the Positive Parenting Network(www.medwayppn.org). It will be important to re-orientate this information away from the current emphasis on professional information needs towards service users, with a particular focus on Medway.

Medway Council has produced a comprehensive local teenage pregnancy strategy and action plan. The strategy is structured around four main areas:

• media and communications;
• sex and relationships education;
• contraception;
• advice and information services and support for teenage parents.

People with learning disabilities

The white paper, Valuing People, estimated a 1 per cent per annum increase in people with severe learning disabilities for the next 15 years. Advances in medical technology have resulted in a much lower death rate at birth and an extended life span for people with learning disabilities.

Although many people with learning disabilities are accommodated with and receive support from their parents, it is recognised that, where people with learning disabilities remain with parents, there is a need for respite adult placements. Over 255 people are currently accommodated in residential care, including 61 people in residential homes. The programme of long stay hospital closures comes to an end in April 2005 and services are currently being commissioned for community residential homes. Many people with learning disabilities could be living more independently.

Unit costs of provision for this client group are high but not as high as the regional average. There are no Medway-based schemes for clients who are ex-offenders with severe mental health and learning disabilities and as a result, nine clients are accommodated in schemes outside Medway at a cost of £180,000 per client per annum. This is currently funded from primary health care budgets. Pooling these budgets could enable the provision of more cost effective local specialist accommodation through Supporting People.

The strategy will involve the provision of a range of different schemes to support different levels of need.

It is recognised that supported housing providers are often small organisations lacking management skills, including risk assessment and business planning. Lunchtime learning sessions are held to facilitate the exchange of good practice and the learning of new skills, sometimes through external speakers. These sessions have been funded by drug companies.

The type of provision will depend on the results of needs assessments carried out in residential care homes and the identified preferences of clients. The council's aim will be to work with other commissioning partners to reduce numbers of people in residential homes through a phased process.

Some resistance is anticipated from parents who see residential care as the safest environment. There will be a need to build their confidence and win support for alternative options and increased independence.

There will also be a continuing requirement to place young people reaching the age of 19.

Women fleeing domestic violence

Medway has the highest number of recorded cases in Kent of violence against women, with particular concentrations in Central Chatham and Central Gillingham. Over the past few years the numbers of women accepted as statutory homeless due to domestic violence has increased.

There are cross boundary issues, as many victims of domestic violence need to be placed outside the borough so although Medway funds provision in the area Medway residents may have to rely on out of borough provision.

Medway spends around 25 per cent more than the regional average on this service. Medway is currently funding an interim (contract completion 1 April 2005) floating support service for the victims of domestic violence. Successful floating support schemes can avoid some of the additional pressures on victims e.g. disrupted schooling for children, disruption of GP and other health services and disruption to employment.

Sex workers

Sex workers have been identified as a group of people with special needs. A recent survey looked at prostitutes operating on the street and their housing circumstances.****** All had drug related problems, their partners did too and many were not living in stable accommodation. The survey concluded that re-housing these women away from their existing social networks with more appropriate social support appeared to be the key to their exit from prostitution.

The ISIS project aims to deliver outreach to sex workers in order to get them off the streets and back into the community. This benefits the sex workers by providing the opportunity for rehabilitation and the broader community benefits from the reduction in visible prostitution. The project is delivered jointly by the Community Safety Team and Health Promotion Team, with the broader Community Safety Partnership.

******Street Based Prostitution in Medway - 2002.

Travellers

There are two travellers’ sites in Medway. One is based in Cuxton and is managed and maintained by Medway Council. This accommodates approximately 50 people and has been allocated since the early 1980s for the use of travellers. There is also a site in Station Road, Strood which is owned by Fairground travellers, who stay there during the winter months. There is no data available regarding the support needs of this client group and no current supporting people service provision.

Refugees and asylum seekers

There are approximately 300 refugees and asylum seekers in Medway. Many are accommodated in bed and breakfast accommodation by the Home Office and as a result less temporary accommodation is available for other groups in the area and costs have been driven up.

A high proportion of refugees and asylum seekers in the area are vulnerable as they are young and support is already in place for this group. Social Services are required to give unaccompanied children seeking asylum under the age of 16 the same level of support as a British child – they are assigned a social worker and found a foster placement. Support, has, in most cases in the past, tapered until they are 18, after which it has been withdrawn and young people may be dispersed or detained. The high court ruled in August 2003 that asylum seekers should have the same after care and support package for 16 and 17 year olds as that afforded to British children in care. Medway must now make a decision about future provision based on this ruling.

The Kent Community Housing Trust (KCHT) has been providing support to unaccompanied minors through the Finding Your Feet project. This was commissioned and funded by Kent County Council. When these clients reach 18 they continue to be supported by the Moving Forward 18+ project.

The Moving Forward 18+ project is also funded by Supporting People. Over the last year the number of unaccompanied young people entering the country has decreased and therefore fewer young asylum seekers have needed the Finding Your Feet project. This in turn has affected the number of young people being supported by the 18+ project.

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