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Data from the Specialist Homelessness Services (SHS) Collection describes clients who receive services from specialist homelessness agencies, and the assistance they receive, including clients with a current mental health issue.
This section presents information provided by SHS agencies on clients identified as having a current mental health issue aged 10 years or over who received services during 2020–21 as well as those without a current mental health issue.
Mental health issues are common in Australia with an estimated 1 in 5 Australians aged 16–85 experiencing a mental health disorder in any given year. However, the rate of mental health issues is substantially higher among people with a history of homelessness (54%) compared to the general population (19%) (AIHW 2021a).
People experiencing homelessness and mental health issues concurrently require the support of various services. Navigating these services can be challenging, and adequate support from homelessness and mental health services is crucial for these people to find and retain housing (MHCA 2009, Jones et al. 2014, Woods et al. 2016, ABS 2014).
There were 234,033 people aged 10 years and older assisted by specialist homelessness agencies nationally in 2020–21 (AIHW 2021a). Of these, almost 2 in 5 (88,210 or 37.7%) were clients with a current mental health issue.
In 2020–21, there were 391.7 SHS clients per 100,000 population nationally with a current mental health issue (Figure SHS.1). Tasmania had the highest rate (700.4), followed by Victoria (570.5) and the Northern Territory (497.5).
Figure SHS.1, Vertical bar graph showing SHS clients with a current mental health issue per 100,000 population for each state/territory and nationally in 2019–20. Rates: NSW 356.5; Vic 603.4; Qld 261.0; WA 267.3; SA 383.3; Tas 688.5; ACT 470.3; NT 512.4; National total 395.6. Refer to Table SHS.1.
Figure SHS.1.1, Line graph showing SHS clients with a current mental health issue per 100,000 population from 2015–16 to 2019–20 for each state/territory and nationally. The rates show an overall increase over time, with the exception of the ACT. Rates: NSW: 2015–16, 332.6; 2016–17, 356.4; 2017–18, 348.2; 2018–19, 359.9; 2019–20, 356.5. Vic: 2015–16, 509.0; 2016–17, 539.2; 2017–18, 573.8; 2018–19, 603.0; 2019–20, 603.4. Qld: 2015–16, 238.8; 2016–17, 235.9; 2017–18, 251.0; 2018–19, 261.8; 2019–20, 261.0. WA: 2015–16, 228.1; 2016–17, 244.0; 2017–18, 247.7; 2018–19, 266.5; 2019–20, 267.3. SA: 2015–16, 309.2; 2016–17, 335.1; 2017–18, 347.1; 2018–19, 373.6; 2019–20, 383.3. Tas: 2015–16, 608.9; 2016–17, 629.5; 2017–18, 630.0; 2018–19, 671.8; 2019–20, 688.5. ACT: 2015–16, 516.3; 2016–17, 467.8; 2017–18, 440.5; 2018–19, 415.2; 2019–20, 470.3. NT: 2015–16, 496.5; 2016–17, 520.1; 2017–18, 538.4; 2018–19, 499.4; 2019–20, 512.4. National total: 2015–16, 345.5, 2016–17, 364.0; 2017–18, 375.0; 2018–19, 393.3; 2019–20, 395.6. Refer to Table SHS.1.
The national rate of SHS clients with a current mental health issue has been increasing since the beginning of the collection in 2011–12 (up from 20.0 clients per 10,000 population to 34.3 clients in 2020–21). There was a slight decline in the rate of clients from 2019–20 to 2020–21 (from 34.8 to 34.3), with this decrease larger for males (from 27.4 to 26.6) than females (from 42.2 to 41.9). Clients with a current mental health issue represent one of the fastest growing sub-groups supported by SHS agencies. This could indicate an increase in the number of SHS clients that have a current mental health issue, or an increase in the reporting of mental illness among SHS clients due to potential factors such as increased identification, community awareness and reduced stigma. Some of the increase may also be due to changes in service delivery models by some states and territories. Nationally, the population rate of clients with a current mental health issue increased between 2016–17 and 2020–21 (Figure SHS.2) at an annual average rate of 1.9%. The national population rate of all SHS clients was relatively unchanged over the same period at an annual average change of 0.2% (AIHW 2021a). The average annual change in the rate of clients with a current mental health issue has varied between jurisdictions since 2016–17, ranging from –1.1% in the Northern Territory to 3.4% in South Australia. A longer time series is available in the SHS data tables as well as the Specialist homelessness services annual report 2020-21 historical tables.
The COVID–19 pandemic created significant health, lifestyle and economic challenges in Australia. Emerging evidence indicates there has been a negative impact on the mental health of the population since the start of the pandemic in 2020 (Dawel et al. 2020, Newby et al. 2020, NMHC 2020). Research suggests that various risk factors of poor mental health, including uncertainty, fear of potential exposure, job loss, financial strain and social isolation, have become more pervasive among the population (Biddle et al. 2020, Ricc-Cabello et al. 2020, Newby et al. 2020). A recent study found that the pandemic-related changes to social and working conditions were strongly associated with poorer mental health (Dawes et al. 2020). In 2020–21, Medicare-subsidised mental health-specific services increased substantially compared to previous years (AIHW 2021a). In terms of support provided by SHS agencies, there has been a general upward trend in the number of SHS clients with a current mental health issue since the start of the pandemic, especially among females (up 4.7% females, less than 1% increase for males) (AIHW 2021b).
In 2020–21, the number of SHS clients with a current mental health issue was highest for people aged 35–44 years, compared with 25–34 years among clients without a current mental health issue. The age group with the lowest number of SHS clients either with or without a current mental health issue was 65 years and over (Figure SHS.2).
Horizontal bar chart showing number of SHS clients with and without a current mental health issue in 2019–20. Number of clients with a current mental health issue: 10–14, 3,781; 15–17, 6,534; 18–24, 17,232; 25–34, 19,513; 35–44, 19,900; 45–54, 14,129; 55–64, 5,454; 65+, 1,795. Number of clients without a current mental health issue: 10–14, 15,650; 15–17, 10,582; 18–24, 23,896; 25–34, 34,056; 35–44, 31,139; 45–54, 21,133; 55–64, 10,372; 65+, 6,800. Refer to Table SHS.2.
Source data: Specialist homelessness services tables 2020–21
In 2020–21, the proportion of SHS clients with a current mental health issue was slightly higher for males (38%) than for females (37%).
In 2020–21, the proportion of Indigenous SHS clients with a current mental health issue was lower (31%) than for non-Indigenous clients (42%).
In 2020–21, half (49.6%) of SHS clients with a current mental health issue reported an episode of homelessness in the 12 months before presenting to an agency, compared with about a third (34.5%) of clients without a current mental health issue. It should be noted that many SHS clients are at risk of homelessness rather than currently experiencing homelessness when they start receiving support from an SHS agency. Half (50%) of all SHS clients with a current mental health issue were at risk of homelessness at the start of SHS support in 2020–21 (AIHW 2021a).
For clients with a current mental health issue, the most frequently recorded source of referral to an SHS agency was a Specialist homelessness agency/outreach worker (28.4%), followed by Other agency (government or non-government) (16.6%).
In 2020–21, 1 in 5 (20.3%) SHS clients with a current mental health issue reported Domestic and family violence as the main reason for seeking assistance, followed by Housing crises (19.8%), Inadequate or inappropriate dwelling conditions (13.7%) and Financial difficulties (7.8%) (Figure SHS.3). Clients without a current mental health issue reported the same top 4 reasons, with Domestic and family violence as the main reason (29.8%), followed by Housing crises (16.5%), Financial difficulties (11.5%) and Inadequate or inappropriate dwelling conditions (11.2%). About 1 in 24 (4.3%) SHS clients with a current mental health issue had mental health issues recorded as their main reason for seeking assistance.
Horizontal bar chart showing per cent of SHS clients with and without a current mental health issue by main reason for seeking assistance 2019–20. Clients with a current mental health issue: Family and domestic violence, 20.0; Housing crises, 19.8; Inadequate or inappropriate dwelling conditions, 13.1; Financial difficulties, 9.4; Housing affordability stress, 6.6; Relationship/family breakdown, 6.5; Previous accommodation ended, 4.9; Mental health issues, 4.1; Transition from custodial arrangements, 3.2. Clients without a current mental health issue: Family and domestic violence, 28.9; Housing crises, 16.7; Inadequate or inappropriate dwelling conditions, 10.4; Financial difficulties, 13.7; Housing affordability stress, 6.7; Relationship/family breakdown, 3.6; Previous accommodation ended, 3.9; Mental health issues, n.a.; Transition from custodial arrangements, 2.2. Refer to Table SHS.5.
Note: 1. Top 9 reasons shown are based on SHS clients with a mental health issue.
Source data: Specialist homelessness services tables 2020–21
Clients can nominate other reasons for seeking assistance alongside their main reason. When all presenting reasons for seeking assistance are considered, Mental health issues (55.7%), Financial difficulties (52.3%) and Housing crises (46.3%) were the most frequent reasons clients with a current mental health issue sought support. For clients without a current mental health issue, Domestic and family violence (37.6%), Financial difficulties (36.0%) and Housing crises (30.0%) were the most frequently reported reasons.
On presentation to an SHS agency, clients may need a variety of services. They may receive Accommodation services, Other support services (excluding accommodation services), or a combination of both. They may be referred to another agency for support or not receive or be provided some of their needed services.
Nationally, nearly 43,800 (69% of those who needed accommodation) clients with a current mental health issue received at least one accommodation support service in 2020–21.
It is important to note that not all clients who needed accommodation services received those services. In 2020–21, around 63,200 SHS clients with a current mental health issue identified a need for accommodation. Of those clients, around 32,900 (52%) were provided with some form of accommodation, 10,900 clients (17%) received a referral only and 19,500 clients (31%) received neither accommodation nor a referral (AIHW 2021a).
Regardless of whether clients needed accommodation services or not, of all clients who received accommodation services in each state and territory, New South Wales, Victoria, Tasmania and the Australian Capital Territory had a larger number with a current mental health issue than without, while Queensland, Western Australia, South Australia and the Northern Territory had a larger number without a current mental health issue than with a current mental health issue (Figure SHS.4).
Vertical bar chart showing number of SHS clients with and without a current mental health issue by state/territory who received accommodation services in 2019–20. Number of clients with a current mental health issue: NSW 11,130; Vic 16,348; Qld 6,338; WA 3,853; SA 2,891; Tas 2,440; ACT 961; NT 8,788. Number of clients without a current mental health issue: NSW 8,788; Vic 13,907; Qld 8,866; WA 7,626; SA 4,262; Tas 1,706; ACT 684; NT 2,812. Refer to Table SHS.7.
Episodes of assistance provided by SHS agencies are referred to as support periods and clients may have one or more during a reporting period, either at the same agency at different times or with different agencies. Different service provision models between states and territories can result in differing support period profiles. For example, some states and territories have central intake models which leads to their support period profile differing from other jurisdictions.
In 2020–21, nationally there were 957.7 support periods per 100,000 population for SHS clients with a current mental health issue. Victoria had the highest rate of support periods (1,975.2), followed by Tasmania (1,627.1).
Nationally, the rate of support periods (per 100,000 population) increased between 2016–17 and 2020–21 at an annual average rate of 2.6%. The amount of change varied between jurisdictions, ranging from an annual average decrease of 0.9% in New South Wales and the Australian Capital Territory to an increase of 4.6% in Victoria.
Of the around 88,200 SHS clients with a current mental health issue in 2020–21, almost all received a service or referral (98.1%). The most common service or assistance provided was Advice/information (89.4%), followed by Other basic assistance (76.9%).
In 2020–21, clients with a current mental health issue received longer periods of support (that is, continuous support or multiple support periods throughout the financial year) on average than clients without a current mental health issue overall two–thirds (66.3%) received support for longer than 45 days, including more than a quarter (28.3%) who received support for longer than 180 days (6 months) (Figure SHS.5). By contrast, almost 3 in 5 (56.9%) clients without a current mental health issue received support for 45 days or shorter, and about 1 in 8 (12.8%) received support for longer than 180 days. These figures represent the total length of support provided to a client during 2020–21.
Horizontal bar chart showing the per cent of SHS clients with and without a current mental health issue by the length of support provided in 2019–20. Clients with a current mental health issue: up to 5 days, 12.4; 6–45 days, 25.4; 46–90 days, 17.3; 91–180 days, 19.6; over 180 days, 25.3. Clients without a current mental health issue: up to 5 days, 28.1; 6–45 days, 31.5; 46–90 days, 15.6; 91–180 days, 13.2; over 180 days, 11.6. Refer to Table SHS.10.
In 2020–21, of those SHS clients with a current mental health issue more than two-thirds (69%) were returning clients, that is, they had previously received assistance from a SHS agency at some point since the collection began in July 2011. The remainder (31%) were new clients, having not previously received services (AIHW 2021a).
In 2020–21, over half (55%) of the 88,200 SHS clients who had a current mental health issue were experiencing additional selected vulnerabilities. About 2 in 5 (41%) clients also experienced Domestic and family violence, almost a quarter (23%) reported problematic Drug and/or alcohol use and 1 in 10 (10%) experienced both of those vulnerabilities, in addition to a current mental health issue (AIHW 2021a).
In 2020–21, half of those clients (50% or 27,600) with a current mental health issue were experiencing homelessness at the start of SHS support. This proportion decreased to 37% (19,700 clients) at the end of support. Fewer clients were ‘rough sleeping’ (13% to 7%) and ‘couch surfing’ (18% to 12%) at the end of support. The majority (4 in 5) of clients who were at risk of homelessness at the start of support were assisted to maintain housing. The number of clients living in public or community housing (renter or rent free) increased from 1 in 9 (11%) to almost 1 in 5 (19%) from the start to the end of SHS support (AIHW 2021a).
You may also be interested in: Specialist homelessness services annual report, Clients with a current mental health issue.
All agencies that receive funding to provide specialist homelessness services under the National Housing and Homelessness Agreement (NHHA), formerly known as the National Affordable Housing Agreement (NAHA) or the National Partnership Agreement on Homelessness (NPAH), are in scope for the Specialist Homelessness Services Collection (SHS collection). Agencies whose details have been provided to the AIHW by the relevant state or territory government department are included. Not all agencies were expected to participate in the collection.
Nationally, there were 1,698 agencies that delivered specialist homelessness services in 2020‒21.
Of the agencies expected to participate in the collection in at least one month during the 2020–21 reporting period, 100% of agencies provided data for each month that they were expected to participate.
A person is described as at risk of homelessness if they are at risk of losing their accommodation or they are experiencing one or more of a range of factors or triggers that can contribute to homelessness.
Risk factors include:
A specialist homelessness agency client is a person who receives a specialist homelessness service. A client can be of any age. Children are also clients if they receive a service from a specialist homelessness agency.
To be a client the person must directly receive a service and not just be a beneficiary of a service.
Children who present with an adult and receive a service are considered to be a client; children of a client or other household members who present but do not directly receive a service are not considered to be clients.
SHS clients with a current mental health issue are identified as such if they have provided any of the following information:
The client’s homeless status at the beginning and end of their support.
Clients are considered to be homeless if they are living in any of the following circumstances:
A support period is the period of time a client receives assistance from an agency. A support period starts on the day the client first receives a service from an agency and ends when:
AIHW (Australian Institute of Health and Welfare) 2021a. Specialist homelessness services annual report 2019–20. Cat. no. HOU 327. Canberra: AIHW, Australian Government, accessed 3 May 2022.
AIHW (2021b) Specialist Homelessness Services: monthly data. Cat. no. HOU 321, AIHW, Australian Government.
Biddle N, Edwards B, Gray M and Sollis K (2020) Hardship, distress, and resilience: The initial impacts of COVID-19 in Australia, COVID-19 Briefing Paper, ANU Centre for Social Research and Methods, Australian National University, Canberra.
Dawel A, Shou Y, Smithson M, Cherbuin N, Banfield M, Calear AL, Farrer LM, Gray D, Gulliver A, Housen T, McCallum SM, Morse AR, Murray K, Newman E, Rodney Harris RM and Batterham PJ (2020) The Effect of COVID-19 on Mental Health and Wellbeing in a Representative Sample of Australian Adults, Frontiers in Psychiatry, 11:579985. doi:10.3389/fpsyt.2020.579985
Newby JM, O.Moore K, Tang S, Christensen H, Faasse K (2020) Acute mental health responses during the COVID-19 pandemic in Australia;, PLOS ONE, 15(7): e0236562. doi:10.1371/journal.pone.0236562
NMHC (National Mental Health Commission) (2020) National Mental Health and Wellbeing Pandemic Response Plan, NMHC, accessed 28 September 2021.
Ricci-Cabello I, Meneses-Echavez JF, Serrano-Ripoll MJ, Fraile-Navarro D, Fiol de Roque MA, Pastor-Moreno GP, Castro A, Ruiz-Perez I, Campos RZ, and Goncalves-Bradley DC (2020) Impact of viral epidemic outbreaks on mental health of healthcare workers: a rapid systemic review, Journal of Affective Disorders, 277(1):347-357.doi:10.1016/j.jad.2020.08.034
Data coverage includes the time period 2011–12 to 2020–21. Data in this section was last updated in July 2022.
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