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Residential care 

Residential care
Residential care
Oxford Textbook of Community Mental Health

Geoff Shepherd

and Rob Macpherson


We all need somewhere to live where we feel safe and comfortable. Given this simple fact, it is unfortunate that for far too long, housing has been seen as at the periphery of the concerns of most mental health professionals, service providers, and researchers. While the importance of adequate housing may be recognized in principle, little research has been done to identify staffing and management practices associated with high quality care, or to improve outcomes. Meanwhile, people with severe mental health problems continue to live in substandard accommodation and struggle to gain access to decent and affordable housing (Kirby and Keon, 2006). This chapter explores these issues. We will describe the historical and policy background, review current issues, and bring together the available research to make practical, evidence-based suggestions for improving the quality of residential care. The context is the ‘mixed economy’ of care that now characterizes housing provision for people with mental health problems in the United Kingdom and in most of northern Europe, Australasia, and North America. This has grown up as we have moved away from long-term care in hospital. The ‘total institution’ has thus disappeared, but we now have many smaller ‘institutions’, with different management authorities, cultures, and values. How have we arrived at this point?

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