Fundamental to wellbeing is having appropriate accommodation and shelter (WHO 1986). A comprehensive range of accommodation options with varied levels of support needs to be available for people who have experienced mental illness, and options need to be suitable to people of difference ages, cultural backgrounds and personal circumstances.

The need for housing to be secure, safe and stable has been recognised in NSW through development of the NSW Framework for Housing and Accommodation Support for People with Mental Health Problems and Disorders (NSW Health 2002b). This report notes that although appropriate accommodation is critical, many people with mental illness are unable to afford stable housing or make their own housing choices, and frequently have problems accessing appropriate housing and difficulty maintaining tenancies because of disruptions caused by their illness.

Some people are discharged from hospital after an acute episode with little follow-up to ensure appropriate accommodation in the community, which leaves them open to neglect, abuse and homelessness (Groom, Hickie & Davenport 2003). People with complex needs, those who have co-occurring alcohol and other drug problems, and people who have been forensic patients have even greater difficulty obtaining and keeping appropriate housing.

Of major concern is the level of homelessness experienced by people with mental illness. An unintended consequence of the deinstitutionalisation that has taken place over the period of the National Mental Health Strategy has been an increase in the number of people with mental illness who are homeless or inadequately housed. Data collated by the AIHW on supported accommodation programs show that mental illness, directly and indirectly, is a major contributor to homelessness (AIHW 2003).

Homelessness and inappropriate housing expose people with mental illness to a wide range of risk factors for their mental and physical health and wellbeing. These include violence and abuse, harmful alcohol and other drug use, poor nutrition and sleep, severe social isolation, lack of amenities for self-care, disease, and even exposure to the elements. All of these are major stressors that are highly likely to compromise mental and physical wellbeing and pose additional challenges for providing continuing care (see Shern et al 2000).

In contrast, safe, secure and stable accommodation is protective of health, including mental health (Thomson, Pettigrew & Morrison 2001). Appropriate accommodation not only removes the risks associated with unsuitable accommodation or homelessness, but also provides a base from which a person can focus on their recovery. It enables people to develop links with organisations and services within their community, and allows them to channel their energy into other factors supportive of their ongoing wellbeing (such as education or employment).
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I've lived in some bad places, put up with all kinds of bad stuff. I couldn't go back to that now. Where I am now makes the difference. I can feel ok, I can do things, I'm doing ok now. —Consumer
Appropriate housing poses unique challenges for different demographic groups. For example, there are gender differences in housing needs—women are more likely to live independently, whereas men seek out housing arrangements that are more dependent (Cook 1998). Affordable housing in safe neighbourhoods is essential for single women and women with children (Blanch, Nicholson & Purcell 1998). Families need comprehensive accommodation services that "build resilience to help compensate for the stresses of poverty and disadvantage" (NSW Health 2002b p12). Teenagers and young adults need accommodation options that match their life-stage, and that do not increase their risk in other areas (such as sexual abuse and harmful alcohol and other drug use). For older people, age-related health problems, such as mobility and self-care problems, make housing needs especially complex.

Accommodation is also a major issue for families and carers. Living with someone with recurrent mental illness can be a significant stressor for families, and there are times when they may not be able to manage. Respite and a wider range of community care options are urgently needed to support families and carers (Groom et al 2003).

It's ridiculous. It's either here or hospital. There's no in-between. It's either all on or all off. —Carer
Another worry for carers is that they will become ill or too old to continue to care for their family member. This is a very real fear common for all people caring for someone with a disability.

I worry what will happen when I'm gone. It's up to me to keep her safe and protected. It's my reason for being here, but I'm not going to be here forever. What will happen then? —Carer