1. Well at Home Project

2. Well at Home Partnership project NHS Funded Aim to improve health & well-being Targeted interventions Vulnerable residents Across tenures Several phases – currently work with GPs.

3. Assessing Housing Conditions Health & Safety Rating System (HHSRS). Looks at health impact of property deficiencies. Range of 29 hazards – 4 groups: Physiological Psychological Protection against infection Protection against accidents

8. Psychological Most of the hazards can have a psychological component e.g. Excess Cold 4 specific hazards where effects on mental health are recognised: Crowding and space Entry by intruders Lighting Noise

9. Crowding “ Lack of space and overcrowded conditions have been linked to a number of health outcomes, including psychological distress and mental disorders, especially those associated with a lack of privacy and childhood development. Crowding can result in an increased heart rate, increased perspiration, reduction of tolerance, and a reduction of the ability to concentrate.”

10. Entry by Intruders Potential effects are the fear of a possible burglary occurrence or recurrence; the stress and anguish caused by a burglary; and injuries caused to occupants by an intruder. The most common harm suffered as a result of burglary, or fear of burglary, is emotional stress, with 28% of victims being affected “very much”, 31% “quite a lot”, and 24% “just a little”.

11. Lighting The health conditions which can be caused by inadequate light include: a) Depression and psychological effects caused by a lack of natural light or the lack of a window with a view. b) Disturbance by intrusive artificial external lighting at night. c) Eye strain from glare and a lack of adequate light (natural or artificial). d) Flicker caused by certain types of artificial light causes discomfort and may cause photo convulsive reactions to those susceptible.

12. Noise “The best understood effects of noise are psychological disturbances and physiological changes resulting from annoyance and sleep disturbance. Typical health effects are stress responses, sleep disorders and lack of concentration. Headaches, anxiety and irritability are also associated with noise induced stress, and the effects of sleep disturbance may affect mood the following day. Extreme psychological outcomes include suicide, and assault due to aggravation over noise.”

13. Cumulative Hazards More than a single hazard, can cause compounded psychological effects on occupiers. Examples: Excess Cold and damp & mould growth. Dampness in a basement associated with poor lighting. Crowding and mould growth (condensation)

14. Holistic Health Often; the psychological effects on health are not fully recognised, or admitted. This is likely to lead to no treatment or mistreatment. Psychological stress can lead to related physical symptoms. GPs don’t routinely think about the home as a health determinant when treating patients.

15. Well at Home Project Aims to take a holistic view of health: Physical health Home environment (deficiencies) Key is visiting patients in their homes Undertaking an HHSRS assessment. Assessing their wider circumstances and health stressors. Then offer appropriate solutions with advocacy.

16. Well at Home 2012/13 Currently working with GP practice in Lisson Grove/New Elgin Practice. Raising awareness of health & housing link. Educating health professionals on scope of HHSRS hazards. Encouraging referrals of vulnerable patients where home environment is implicated in poor health.

17. Questions? Contact details: Martin Turner Chartered Environmental Health Practitioner Residential Environmental Health Team Westminster City Council 020 7641 3049 mturner@westminster.gov.uk