Homelessness services

Persistent, chronic, recurrent or long-term homelessness refers to the experience of prolonged and/or repeated episodes of homelessness over weeks, months or years of a person’s life.

Most people who experience homelessness do so for a brief period or only once before finding stable housing (O’Donnell 2020). However, the life circumstances that lead to persistent homelessness and its resulting health effects are profound.

Characteristics of persistent homelessness

The risk factors for experiencing persistent homelessness are often rooted in early life experiences of housing instability or trauma (Parpouchi et al. 2021; Scutella et al. 2012; Woodhall-Melnik et al. 2018). Adverse childhood experiences (ACEs) – such as abuse, neglect or household dysfunction, can contribute to the development of homelessness (Liu et al. 2021; Scutella and Johnson 2012; Widom et al. 2024; Woodhall-Melnik et al. 2018). People experiencing persistent homelessness have a high prevalence and broad range of ACEs, which impact the development of social networks and limit education and employment opportunities (Boesveldt et al. 2024; Liu et al. 2021). 

Children or young adults may enter homelessness directly by leaving an unsafe home, or transition into homelessness after time spent in institutions like juvenile detention (Noble-Carr and Trew 2018). Others may overcome a difficult childhood to achieve independent living, only for a major life event such as job loss or relationship breakdown to trigger an episode of homelessness or housing instability (Pope et al. 2024). Without a strong social or financial safety net, the homelessness is more likely to become persistent (Duchesne and Rothwell 2016; Woodhall-Melnik et al. 2018).

People experiencing persistent homelessness are more likely than those experiencing shorter-term homelessness to report having little to no contact with family and friends (Boesveldt et al. 2024). This could be due to a wide range of reasons, including (Ayed and Clarke 2024; Boesveldt et al. 2024; Bower et al. 2018): 

• choosing to leave unsafe relationships
• judgement from others
• diminished ability to ‘give back’ to friends and family
• difficulty forming new connections due to stigma. 

For many people who experience extended periods of homelessness, relationships with other people experiencing homelessness are rare or of low quality (Bower et al. 2018). However, establishment of social networks within homeless communities can complicate the transition to stable housing (Johnson et al. 2014). For example, some people may choose to leave housing programs to reconnect with friends or family who are also experiencing homelessness (Cole 2023; Johnson et al. 2014). Others may face eviction for allowing friends or family experiencing homelessness to stay with them (Glennie and Robinson 2024). 

Chronic mental or physical health conditions, rough sleeping, substance use and the need for frequent health service use are common among people experiencing persistent homelessness (AIHW 2023; Miscenko et al. 2017). Stigma, shame, and a fear of being perceived as a burden, can prevent people from seeking help (Reilly et al. 2022). Men often feel a strong sense of personal responsibility for their situation (Pope et al. 2024), while women may be unlikely to trust services due to negative past experiences (Bullen 2017, 2019). People seeking a pathway out of persistent homelessness also face systemic barriers, such as fragmented services and unaffordable housing (Thielking et al. 2020).

Pathways to reducing persistent homelessness

Prevention and early intervention

Early intervention is critical to prevent short-term periods of homelessness from becoming persistent (Brackertz et al. 2018). Prevention strategies can be targeted at children and young people who have experienced early life trauma, neglect or abuse, and who may lack strong support networks. See Children and young clients for more information. 

Comprehensive and long-term support

Addressing persistent homelessness requires comprehensive, long-term support for individuals with complex needs. Models such as the housing first approach – which prioritises rapid access to stable housing, followed by comprehensive support services – are widely supported (Mackie et al. 2017; Roggenbuck 2023). Programs with wraparound services result in long-term benefits to the individual (Johnson et al. 2014; Porchak et al. 2023; Zaretzky and Flatau 2013), as well as social and economic benefits such as reductions in healthcare costs, crime and domestic violence (SGS Economics and Planning 2022, Parsell et al. 2023). 

Results from the Journey to Social Inclusion program (J2SI), an Australian Housing First initiative, highlight 4 priorities for assisting people to exit persistent homelessness (Thielking et al. 2020): 

1. Meeting immediate survival needs
2. Obtaining safe, secure and appropriate housing
3. Offering practical support for physical, mental health and social issues
4. Building employability skills and supporting other personal goals.

Effective models include staff who are suitably trained to provide mental and physical health treatment (Porchak et al. 2023; Taylor et al. 2022); provide opportunities for meaningful social connection (Ayed and Clarke 2024; Duchesne and Rothwell 2016; Cole 2023; Cummings et al. 2022); and consider individual factors such as gender, culture and age (Porchak et al. 2023).