Clients with a current mental health issue using specialist homelessness services Print this page

There is an association between mental illness and homelessness. Broadly, people with a history of homelessness experience higher rates of mental health issues compared with the general population (Fazel et al. 2008, Gutwinski et al. 2021). For example, the most recent National Study of Mental Health and Wellbeing showed that among people with a history of homelessness, 39% reported experiencing a mental illness in the last 12 months compared with 20% among people with no history of homelessness (ABS 2023).

Those experiencing concurrent mental illness and homelessness have different onset, severity, and duration of mental illness, experience different barriers and homelessness trajectories and may require specialist support (Scutella et al. 2014). However, the relationship between mental illness and homelessness is complex. While it has been observed in a 2005–06 Melbourne study that about 30% of those experiencing homelessness had a mental illness, it was estimated that 53% of those with mental illness developed the illness after becoming homeless (Chamberlain et al. 2007; Johnson and Chamberlain 2011). This distinction provides differential profiles and affects outcomes such as length and trajectory of homelessness. For instance, people with mental illness before becoming homeless tend to become homeless at a younger age than both those without any mental illness as well as people who develop mental illness after becoming homeless (Scutella et al., 2014). Yet, those with mental illness prior to homelessness also tend to become homeless for shorter discrete periods than these other groups. However, people with a mental illness – whether this developed before or after becoming homeless – are more likely to cycle in and out of homelessness and experience a larger number of homeless periods compared to those without a mental illness (Scutella et al. 2014).

People experiencing mental illness are more likely to experience homelessness (25% compared with 11%) during their lifetime (ABS 2016) with trauma and associated mental illness a significant factor in long-term homelessness (O’Donnell et al. 2014). However, mental illness and homelessness share risk factors which makes determining causality difficult (Chamberlain and Johnson, 2013). The homelessness-mental illness relationship is further complicated by variability in observed prevalence based on the type, duration and severity of mental illness. For instance, compared with more common and less severe conditions, people with more severe and persistent psychotic disorders (such as schizophrenia) are more likely to be homeless relative to the general population (Scutella et al., 2014). These disorders are associated with worse health outcomes and these clients may require specific housing service needs (Harvey et al. 2012; Morgan et al. 2012).

The COVID-19 pandemic created significant health, lifestyle and economic challenges in Australia. Housing and homelessness and SHS clients were impacted across the acute pandemic phases in 2019–20, 2020–21 and 2021–22. In response to the pandemic, states and territories implemented various provisions designed to support jurisdictional SHS and address impacts on housing (refer to Specialist Homelessness Services: monthly data, COVID-19 responses). Many of the service changes over this time may have influenced the number of clients supported by SHS agencies. As of 2022–23, the pandemic response has shifted to living with the virus, with widespread vaccination and the restoration of unrestricted travel.

The proportion of SHS clients with a current mental health issue increased during the pandemic, with client numbers peaking in 2020–21. However, both client number and rate (per 10,000 ERP) peaked in 2019–20. Interestingly these relative increases occurred alongside a decrease in total SHS clients, which also peaked in 2019–20. This pattern may have been influenced by a range of measures introduced during the pandemic (refer to AIHW 2021).

During the emergency phase of the pandemic, initiatives focused on providing emergency and temporary accommodation for those experiencing homelessness (AIHW, 2024b). This may explain the increase in Short-term/emergency accommodation and services provided to Sustain tenancies and prevent eviction during 2020–21. From 2022–23, Short-term/emergency accommodation provision decreased further, but Long-term housing provision reached its highest level since 2017–18. The Main reasons for seeking assistance remained consistent: Housing crisis, Family and domestic violence, and Inadequate/inappropriate dwelling conditions. Notably, Family and domestic violence briefly surpassed Housing crisis as the top Main reason for seeking assistance during 2019–20 and 2020–21 (refer to AIHW 2024a).

From 2019–20 to 2022–23, outcomes for SHS clients with mental health issues have remained consistent. Although the proportion of clients beginning support Without or improvised/inadequate shelter was trending down since 2019–20, 2021–22 saw the lowest proportion of clients in this category, which then increased back to pre-pandemic levels in 2022–23. There have been some changes in the outcomes for clients from the pre-pandemic period to the emergency-phase and the most current reporting period. For more information and data specific to each year, please refer to Specialist Homelessness Services annual report, report editions.

ABS (Australian Bureau of Statistics) (2023), National Study of Mental Health and Wellbeing: Table 4 - 12-month mental disorders by population characteristics [data set], ABS website accessed 12 June 2024.

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AIHW (Australian Institute of Health and Welfare) (2021) Australia’s welfare 2021: data insights, Australia’s Welfare Series 15, catalogue number AUS 236, AIHW, Australian Government, accessed 12 June 2024.

AIHW (2022a) Specialist homelessness services annual report 2021–22, AIHW, Australian Government, accessed 12 June 2024.

AIHW (2022b) Specialist homelessness services client pathways: Clients with mental health issues in 2015–16, AIHW, Australian Government, accessed 12 June 2024.

AIHW (2022c) Specialist homelessness services client pathways: Indigenous clients in 2015–16, AIHW, Australian Government, accessed 12 June 2024.

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AIHW (2024b) Specialist homelessness services annual report 2022–23, AIHW, Australian Government, accessed 12 June 2024.

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Chamberlain C, Johnson G and Theobald J (2007) Homelessness in Melbourne: Confronting the Challenge, RMIT University.

Fazel S, Khosla V, Doll H and Geddes J. (2008) The prevalence of mental disorders among the homeless in western countries: systematic review and meta-regression analysis, PLoS Med, 5(12):e225, doi: 10.1371/journal.pmed.0050225.

Gutwinski S, Schreiter S, Deutscher K and Fazel S (2021) The prevalence of mental disorders among homeless people in high-income countries: An updated systematic review and meta-regression analysis, PLoS medicine, 18(8), doi: 10.1371/journal.pmed.1003750.

Harvey C, Killackey E, Groves A and Herrman H (2012) ‘A place to live: Housing needs for people with psychotic disorders identified in the second Australian national survey of psychosis’, Australian & New Zealand Journal of Psychiatry, 46(9):840-850, doi: 10.1177/0004867412449301.

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Morgan V A, Waterreus A, Jablensky A, Mackinnon A, McGrath J J, Carr V., ... and Saw S (2012) People living with psychotic illness in 2010: the second Australian national survey of psychosis, Australian & New Zealand Journal of Psychiatry, 46(8):735-752, doi: 10.1177/0004867412449877.

O’Donnell M, Varker T, Cash R, Armstrong R, Di Censo L, Zanatta P, Murnane A, Brophy L and Phelps A (2014) The Trauma and Homelessness Initiative: Research Findings, Report prepared by the Australian Centre for Posttraumatic Mental Health in collaboration with Sacred Heart Mission, Mind Australia, Inner South Community Health and VincentCare Victoria, accessed 12 June 2024.

Scutella R, Chigavazira A, Killackey E, Herault N, Johnson G, Moschion J and Wooden M (2014) Journeys Home Research Report No. 4, Melbourne Institute of Applied Economic and Social Research, Melbourne, accessed 12 June 2024.