Week 7 – Homelessness and Mental Illness

Homelessness and Mental Illness in Western Australia

Homelessness is one of the deepest expressions of social exclusion and extreme poverty in Australian society. At its core, homelessness is a housing issue as it represents the lack of permanent secure housing. However, if we look only through a housing lens we miss the multi-dimensional nature of homelessness. Homelessness intersects with many other deep social, health and economic issues. Without addressing these issues alongside a housing response we will not be able to fully address the problem of homelessness (Page 1).

Family and domestic violence plays a crucial role in contributing to homelessness, as does family dissolution, social isolation, and the absence of close, fulfilling and strong relationships. Those experiencing homelessness exhibit elevated rates of chronic health conditions as well as mental health conditions, alcohol and other drug dependence and high risk use. Psychological distress is very high in the homeless population; wellbeing and quality of life outcomes are well below Australian population levels. A significant number of those experiencing homelessness report that they are managing co-occurring health issues across mental health, substance use and/or physical health domains and there are high levels of trauma in the population. Justice and legal issues also affect a great number of people who are homeless; many people experiencing homelessness in Western Australia have been previously incarcerated. People also report high rates of assault while homeless. The justice and legal dimensions of the experience of homelessness are significant, especially in that they represent a major barrier to a successful transition out of homelessness (Page 1).

Economic drivers are also fundamental to homelessness and without systems change it is very difficult to address homelessness successfully. Housing supply and housing affordability affect people’s ability to access and maintain a secure house. While health and justice issues are critical to the homelessness problem we face, there are those for whom the cost of housing relative to low income represents the cause of homelessness. Those transitioning from homelessness to housing will, in many cases, require tenancy and social support to maintain that housing. Very low rates of employment, even after transitioning from homelessness to housing, mean that those experiencing homelessness and transitioning from homelessness are trapped in a state of poverty placing further pressure on health and social drivers of homelessness (Page 1).

The vast majority of people experiencing homelessness in both WA and Australia are dependent on government income support payments; over 80% of WA Specialist Homelessness Services clients reported a government income support payment as their main source of income and 90.8% of WA Registry Week respondents reported receiving regular income primarily from government income support payments. However, only 41% of WA Registry Week respondents reported that their income was enough to cover their expenses and debts (Page xiii).

On average, 67 requests for assistance went unmet each day. Across all states and territories the figure is 261. While the population of WA is only 10.8% of the total Australian population, unmet requests for assistance in WA represents over 25% of all unmet requests for assistance nationally. This suggests the service system in WA is failing to meet needs at a disproportionate level, compared to the national average (Page 24).

Inadequate income inhibits one’s ability to address existing legal and health problems. Without sufficient resources it is incredibly difficult to take the necessary proactive, preventative steps with regard to issues facing those experiencing homelessness, let alone to gain secure employment or filling skill gaps. Thus it becomes clear that homelessness and its corollary, very low income and wealth, create and compound existing problems including chronic physical and mental health conditions (Page xiii).

This problem is often exacerbated by a lack of education due to the same drivers causing homelessness in the first place. Educational attainment was low amongst the Registry Week respondents. Only 6.6% reported their highest level of education as an apprenticeship or tertiary studies. These rates were higher in WA overall (7.7%), particularly high in Fremantle (13.3%) and 7.4% in the rest of Perth. However, the proportions of respondents reporting their highest level of education as Year 9 or below were also high across WA: 28% overall, 36.7% in Fremantle, and 27.4% in the rest of Perth (Page 27).

The natural consequence of this in terms of healthcare utilisation is higher utilisation of emergency healthcare which incurs a much higher unit cost and is much less effective at addressing root causes of ill health. In the case of WA Registry Week homeless respondents, if we exclude those who do not access any acute healthcare services from the analysis, the mean cost of accidents and emergency, inpatient admissions and trips to hospital via ambulance was $28,249 per person/six months, compared with $24,987 in Australia overall (Page xiii).

In addition, lack of stable housing leads to increased interactions with the police and the justice system, either through assaults of those who are homeless on the streets, the issuing of fines linked to the homeless experience and through engagement in petty and nuisance crimes that for some homeless people may constitute ‘survival behaviours’. Homeless individuals are more likely to be jailed for these crimes than non-homeless individuals and 31% of Australia’s prisoners anticipate a spell of homelessness upon exit from prison. Hence, a revolving door between prison and the street emerges.

Indigenous Australians experience very high rates of homelessness and particularly high rates of rough sleeping both in major cities as well as regional and remote areas. In the Western Australian context, this also means that homelessness is high in areas such as the Pilbara and the Kimberley, well away from metropolitan Perth. Any response to homelessness in Western Australia has to be strongly centred on addressing Aboriginal homelessness in the regions as well as in Perth (Page 1).

Aboriginal and Torres Strait Islanders made up 3% of the Australian population in 2016, and yet represented 20% of the national homeless population. This figure is also likely to be an underestimate. Aboriginal people are overrepresented to an even greater extent in WA where they made up 3.7% of the total population in 2016 and yet 29.1% of the homeless population identified as Indigenous (Page 14 – 15).

To compare, Western Australia had the lowest rate (per 10,000 of the population) of non-Indigenous homelessness. This means that if you are not Indigenous, you are less likely to be homeless in WA compared with other states and territories (Page 15).

The highest counts of homelessness were found in the north of WA (the Kimberley and the Pilbara) and the Southeast corridor of Perth. Other areas of Perth and the South of Western Australia have about equal numbers of those experiencing homelessness on Census night (Page 17).

The number of homeless persons aged 55 years and above has steadily increased over the past three Censuses, from 12,461 in 2006, to 14,581 in 2011 and 18,625 in 2016 (a 28% increase between 2011 and 2016). The rate of older persons experiencing homelessness has also increased, from 26 persons per 10,000 of the population in 2011 up to 29 in 2016.

A standard typology of homelessness utilises a chronic-episodic-transitional characterisation in which homelessness can be experienced as a long-term phenomenon, one involving recurrent or episodic bouts of homelessness, or as a one-off response to a housing, financial, health or social crisis. The duration of homelessness will affect the actual experience of homelessness and its impacts. Also, importantly, the extent to which one becomes acculturated into the ‘life of homelessness’ also impacts on the duration of the experience. Broadly speaking, the longer a person is homeless the more likely they are to be exposed to factors that keep them entrenched in homelessness, and the more difficult a successful transition out of homelessness becomes. Homelessness exhibits strong hysteresis characteristics (Page 1).

Homelessness also needs to be understood across the lifecycle. Many of those who are homeless as adults began their homelessness ‘journey’ as children and teenagers, some after running away from home or being thrown out of home—principally due to family and domestic violence in the home. Others leave home with their mothers as a result of family and domestic violence, others experience homelessness with their parent(s) due often to poverty or a housing crisis, and others find themselves homeless after leaving school or exiting out-of-home care. Preventing homelessness in the early years and intervening through a range of responses when the risk of homelessness is high is crucial in and of itself, but also because intervening early helps to prevent individuals experiencing a lifetime of chronic and episodic homelessness (Page 2).

Those currently sleeping rough reported being homeless for an average of 5.4 years. This is significantly longer than the ABS data indicates—but this is the effect of different sampling frames, and also the scale used (i.e., the ABS scale only extends to six months or more) (Page 22).

Specialist Homelessness Services Data for Western Australians denotes that which population groups (based around their demographic characteristics or presenting needs/circumstances) are more likely to be seeking services and therefore vulnerable to homelessness (Page 23).

Groups experiencing increasing need

Service rates (per 10,000) in WA were slightly higher in 2016-17 than the previous year for the following groups:

• Older people (55 and over) (7, to 7.6)

• Clients with a current mental health issue (19.5 to 21.2)

• People with drug and alcohol use problems (10.1 to 10.9) (Page 23)

Reasons for contact with services

The top three reasons for WA clients seeking assistance were:

• Domestic and family violence (higher in WA – 42%, compared with 37% nationally)

• Financial difficulties (same in WA and nationally – both 38%)

• Housing crisis (lower in WA – 25%, compared with 44%). (Page 23)

Groups with the highest client rates

The most significant priority groups in WA in 2016-17 identified in the SHS Collection based on the highest client rates per 10,000 are:

1. Indigenous people (922.8 per 10,000)

2. Clients who have experienced domestic and family violence (42.5 per 10,000)

3. Clients with a current mental health issue (21.2 per 10,000)

4. Young people presenting alone (15-24) (11.1 per 10,000)

5. People with drug and alcohol use problems (10.9 per 10,000)

When comparing WA to the Australia-wide figures, the rates for these groups are fairly comparable, or lower, except for the Indigenous client rates which are significantly higher in WA (Page 23).

However, preventing homelessness in the early years will not, in itself, resolve homelessness, as early onset homelessness affects around half of the adult homeless population. The other half of all adult people who are homeless have not experienced homelessness prior to turning 18. The challenge for policy makers is that all the different homelessness pathways, journeys and risk factors across various demographic groups and across the life cycle need to be recognised in responses to homelessness (Page 2).

When abuse and/or neglect is found to occur in families, young people are taken into out-of-home care. A considerable body of research from small-scale qualitative studies and international research indicate that young people who exit care experience significant social and economic marginalisation and homelessness and/or housing instability. While this issue is recognised by the Federal and State Governments and there have been recent commitments to support young people leaving care, evidence suggests there are still shortfalls in efforts to prevent youth homelessness after leaving out-of-home care.

The experience of violence and out-of-home care were both found to be major factors in the life experience of the homeless young people in the Cost of Youth Homelessness Study, which expands on the Intergenerational Homelessness Survey by delving into children with out-of-home care histories. In the survey sample, nearly two out of three (63%) of the homeless young people reported that they had been placed in at least one form of out-of-home care (sometimes more than one) by the time they turned 18 years of age, including:

                Residential care (63%);

                Kinship care (45%); or

                Foster care (33%).

The high rates of housing instability in this cohort are thought to be a result of family background issues—as they are more likely to come from disadvantaged backgrounds characterised by “poverty, relationship breakdown, substance abuse, violence, disability and mental illness” — combined with the lack of family, societal and structural supports available to young people as they exit the out-ofhome care system. According to Mendes et al. (2011), contributing factors for a high risk of homelessness include:

• A lack of affordable housing;

• The decrease in public housing/insufficient public housing;

• Abrupt and poorly planned departures from OOHC/poor transition planning;

• A lack of employment; and,

• Failed attempts at reunification with family.

Many young people, including those from privileged or stable backgrounds, experience some housing instability, as often the appropriateness, location or meaning of their home

Reference: Kaleveld, L., Seivwright, A., Box, E., Callis, Z., and P., Flatau. (2018). Homelessness in Western Australia: A review of the research and statistical evidence. Report prepared for the Department of Communities, Government of Western Australia, by The Centre for Social Impact, The University of Western Australia. Pages xiii – 27.