A community-led mental health support program could be a model for others

A UNSW Sydney assessment of a community-led mental health program funded by the NSW government finds the program is “extraordinary” and “life-changing” in its operation.

The NSW Ministry of Health commissioned the Social Policy Research Centre (SPRC) at UNSW’s Arts, Design & Architecture to evaluate the Community Living Supports (CLS) and Housing and Accommodation Support Initiative (HASI) from 2019-22. The CLS-HASI community-led mental health program is funded by the NSW government and has been running since 2002/2003.

CLS-HASI provides intensive support to people experiencing a mental illness that has affected their ability to function the way they want to within their life and community.

The evaluation by the UNSW researchers entailed interviews and focus groups with mental health consumers using CLS-HASI, as well as analysis of cost modelling plus program and state-wide outcomes data.

“The CLS-HASI program is quite extraordinary – I’ve never evaluated a social services program that is so committed to generating robust evidence to inform its development and influence other programs,” says Professor Karen Fisher, researcher from the SPRC and Chief Investigator on the CLS-HASI evaluation report.

Dr Peri O’Shea, a researcher at SPRC with lived experience as a mental health consumer and carer, says the program is having “life-changing outcomes” for its consumers.

“The highlight of this program is that everyone we interviewed had positive things to say – the main feedback was that stakeholders, carers and mental health consumers wanted more of this program,” says Dr O’Shea.

“Without this program, people experiencing mental illness would be coping alone and not participating in the community. CLS-HASI helps these people reconnect socially, assists with their housing needs and, overall, it helps them have a better quality of life.”

CLS-HASI meets people where they’re at

Dr O’Shea says CLS-HASI is changing people’s lives by helping them function and re-join their communities.

The program does this by meeting mental health consumers on their own terms and supporting them to set goals for how their recovery looks. These goals vary and are up to the person, from getting a new job, being confident to leave the house, making new friends or reconnecting with family. 

CLS-HASI owes its success to its approach of meeting people where they are at, rather than instilling a top-down approach, says Dr O’Shea.

“The program is geared towards setting mental health consumers up for independence. So, as well as listening to what people want, it also helps them to stretch in ways they’ve identified through discussion. Overall, CLS-HASI is giving people choices – making sure they’re empowered to make informed choices with support.”

The theory behind the program is that if you have somewhere to live and you’ve got somebody supporting you to live there, then you can make decisions and choices about your life that mean your life will be meaningful to you, says Prof. Fisher.

“When a person’s life is meaningful then there’s a reason for that person to recover and look after themselves and seek support for their mental health.

“And people exit the program when they’re ready, rather than being ‘kicked out’. Interviewees also highlighted this as a success. “

A worthwhile financial investment in mental health

“The transformation experienced by mental health consumers in this program, which we documented in our evaluation data, demonstrates to the NSW Ministry of Health that CLS-HASI is a worthwhile investment,” says Prof. Fisher.

“The reason this program is popular with mental health consumers, community providers and the government is because it’s a very small financial investment for convincing outcomes.”

Prof. Fisher says this program may seem expensive in the short term, but it’s worthwhile in the long term. The intensive mental health support provided in CLS-HASI generates cost offsets the longer consumers are engaged with it.

“Even measuring over a longer term of five years the program supported people away from reoffending, and they had decreased contact with police, hospitals and other public services,” says Prof. Fisher. 

“Because of the intensive support this program provides to people who were really struggling, overall it means that other parts of the systems work better.”

Other programs, like the NDIS, could benefit

Prof. Fisher and Dr O’Shea and their team found evidence of good practice throughout CLS-HASI – that is, effective processes and positive experiences and outcomes for mental health consumers.

“What we have here is a model that shows us how psychosocial support – the support a person needs to function in the community – can work in practice to have good outcomes for mental health consumers,” says Dr O’Shea.

“The strengths of this program will be important to replicate in other programs elsewhere – programs like the NDIS could draw on our findings from CSL-HASI.”

She emphasises that the key characteristics of the program are listening to what the consumers need now, stretching towards a positive vision of the future, and parts of service system working together – psychosocial support, health, housing and justice.