Clients with a current mental health issue
Specialist homelessness services (SHS) provide support to people experiencing or at risk of homelessness. The following summarises evidence from the Specialist Homelessness Services Collection about clients with a current mental health issue. For more comprehensive analyses and the most recent data please use the hyperlinks on each evidence statement or the evidence sources at the end of this page.
Evidence summary
Clients with a current mental health issue are the second largest group of specialist homelessness services (SHS) clients, making up around a third of all SHS clients[1].
The number and proportion of SHS clients with a current mental health issue has increased at a rate faster than most other client groups since the data collection began in July 2011[1].
SHS clients with a mental health issue are more likely to be female and living alone or in a lone parent household[1]. The number of female clients with a mental health issue supported each month by agencies has increased faster than males[2].
Clients with a mental health issue receive a median of around 7 weeks of overnight accommodation in a year, noting this may not be continuous[1].
Lack of employment is the factor most strongly associated with receiving SHS support in the future[3]. Around 9 in 10 clients with a current mental health issue aged 15 and older are not working in a paid job. More than half of clients are looking for work (unemployed) and one-third are not in the labour force[1].
Around 7 in 10 SHS clients with a mental health issue are returning clients, that is, they had received assistance from an SHS agency some time since July 2011 onwards[1]. Long-term data show that around a third of clients with a mental health issue received support multiple times over a decade[3].
If you or someone you know needs help, these resources are available:
- Lifeline (Phone: 13 11 14)
- Kids Helpline (Phone: 1800 55 1800)
- Beyond Blue (Phone: 1300 22 4636)
- Head to Health mental health portal.
Mental health is ‘a state of mental well-being that enables people to cope with stresses of life, realise their own abilities, learn and work well and contribute to their community’ (WHO 2024). The term ‘mental health issues’ captures the entire range of mental health concerns, from psychological distress to clinically diagnosed conditions.
Housing and mental health are intertwined. Research has found that among people with a mental health issue, the odds of experiencing homelessness is nearly double that of those without a mental health issue (Nilsson et al. 2019). In Australia in 2020–2022, around 2 in 5 of people aged 16–85 with a history of homelessness had experienced a mental health condition within the past year–almost twice as high as the general population (21%; ABS 2023). A higher prevalence of specific mental health conditions is observed among people experiencing homelessness, including severe conditions such as major depression, bipolar disorder, psychotic disorders and post-traumatic stress disorder (Ayano et al. 2019; Barry et al. 2024; Gutwinski et al. 2021).
Although there is a clear association between mental health issues and homelessness, the experience of one does not necessarily cause the other (Moschion et al. 2021). Research into Australia’s homeless population found that the proportion of people who reported a history of mental health issues before entering homelessness was comparable to that of people who reported developing a mental health issue after entering homelessness (around 15%; Johnson and Chamberlain 2011). People with mental health issues often face vulnerabilities also associated with homelessness, including disability, problematic gambling, and problematic drug and/or alcohol use (Chikwava et al. 2022; Whittaker et al. 2017; Moore et al. 2011; Nower et al. 2015). The interaction between various structural, individual and social factors (for example, housing affordability, behavioural traits, and family dynamics) contributes to the likelihood of both mental health issues and homelessness (Bentley et al. 2011; Johnson et al. 2019).
Providing safe, secure and appropriate housing is fundamental to improving outcomes for people experiencing homelessness and/or mental health challenges (Brackertz et al. 2020; Flatau et al. 2022). Stable housing affords people with mental health issues the opportunity to access appropriate support services for treatment and rehabilitation (Honey et al. 2017; Holland 2018; Maslow 2013; NMHC 2017). It also enhances a person’s capacity to successfully engage in activities that help maintain stable housing, such as employment, studying, and developing social networks (Flatau et al. 2022; Johnstone et al. 2016; van der Laan et al. 2020). However, while housing initiatives can improve some symptoms of mental health issues, these do not always translate into improvements in mental health (Baxter et al. 2019; Onapa et al. 2021).
The diversity of mental health issues and varied pathways out of homelessness make addressing the needs, challenges and circumstances of this cohort complex and multifaceted (AIHW 2023). As such, the types of support and homelessness services required will vary by person and local context (State of Victoria 2021). Establishing an integrated and collaborative support system based on a person-centred approach to service delivery is crucial for facilitating exits out of homelessness while also supporting mental health (Barry et al. 2024; NMHC 2020; Productivity Commission 2020).
About the SHS data – defining clients with a mental health issue
The Specialist Homelessness Services Collection commenced in July 2011.
SHS clients are identified as having a current mental health issue if they are aged 10 years or older and have provided any of the following:
- They indicated that at the beginning of support they were receiving services or assistance for their mental health issues or had in the last 12 months.
- Their formal referral source to the SHS was a mental health service.
- They reported ‘mental health issues’ as a reason for seeking assistance.
- Their dwelling type either a week before presenting to an agency, or when presenting to an agency, was a psychiatric hospital or unit.
- They had been in a psychiatric hospital or unit in the last 12 months.
- At some stage during their support period, a need was identified for psychological services, psychiatric services or mental health services.
Source report | Time periods | Contents |
|---|---|---|
2011–12 onwards | Summarises the characteristics of clients receiving support from specialist homelessness services throughout financial years, including the services requested, outcomes achieved, and unmet requests for services. | |
July 2017 – end of last quarter | Monthly data on the number of clients supported each month since July 2017. | |
3. Specialist homelessness services client pathways: Clients with mental health issues in 2015–16 | 2015–16 | Longitudinal analyses undertaken for a group of SHS clients (aged 18 and older) with a current mental health issue from 2015–16. These analyses examine SHS service use patterns for this group of clients for a period of 4 years before and after 2015–16. |
2011–12 onwards | Customisable demographic data cubes. |
Other reports
Australian Institute of Health and Welfare – Mental health site
The Australian Institute of Health and Welfare (AIHW) has a dedicated website for detailed information about mental health, including the activity and characteristics of Australia’s health and social care services accessed by people with a mental illness. It includes mental health-related services provided by various levels of government, how much was spent, who provided the funds, where mental health services were delivered and safety, quality and monitoring data.
Australian Bureau of Statistics (ABS) (2023) National Study of Mental Health and Wellbeing, ABS website, accessed 7 May 2024.
Australian Institute of Health and Welfare (AIHW) (2023) Specialist homelessness services annual report, AIHW, Australian Government, accessed 22 October
Ayano G, Tesfaw G and Shumet S (2019) ‘The prevalence of schizophrenia and other psychotic disorders among homeless people: a systematic review and meta-analysis’, BMC Psychiatry, 19(370):1–14.
Barry R, Anderson J, Tran L, Bahji A, Dimitropoulos G, Ghosh SM, Kirkham J, Messier G, Patten SB, Rittenbach K, Dallas S (2024) ‘Prevalence of Mental Health Disorders Among Individuals Experiencing Homelessness: A Systematic Review and Meta-Analysis’, JAMA Psychiatry, 81(7):691–699, doi:10.1001/jamapsychiatry.2024.0426.
Baxter AJ, Tweed EJ, Katikireddi SV, Thomson H (2019) ‘Effects of Housing First approaches on health and well-being of adults who are homeless or at risk of homelessness: systematic review and meta-analysis of randomised controlled trials’, Journal of Epidemiological Community Health, 73(5): 379–387, doi: 10.1136/jech-2018-210981.
Bentley R, Baker E, Mason K, Subramanian SV and Kavanagh AM (2011) ‘Association between housing affordability and mental health: a longitudinal analysis of a nationally representative household survey in Australia’, American Journal of Epidemiology, 1(174):753–60.
Brackertz N, Borrowman K and Roggenbuck C (2020) Trajectories: the interplay between housing and mental health pathways, Australian Housing and Urban Research Institute Limited and Mind Australia (AHURI), Melbourne.
Chikwava F, O’Donnell M, Ferrante A, Pakpahan E, Cordier R (2022) ‘Patterns of homelessness and housing instability and the relationship with mental health disorders among young people transitioning from out-of-home care: Retrospective cohort study using linked administrative data.’ PLoS One, 17(9):e0274196, https://doi.org/10.1371/journal.pone.0274196
Flatau P, Lester L, Seivwright A, Teal R, Dobrovic J, Vallesi S, Hartley C and Callis Z (2022) Ending Homelessness in Australia: an evidence and policy deep dive, Centre for Social Impact, Crawley.
Gutwinski S, Schreiter S, Deutscher J 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):e1003750.
Honey A, Nugent A, Hancock N and Scanlan J (2017) ‘It’s hard work, believe me!”: active efforts to optimise housing by people who live with mental illness and access housing assistance’, Australian Journal of Social Issues, 52(4):347–366.
Holland JM (2018) ‘Challenges and Considerations for Housing in the Future’, Family and Consumer Sciences Research Journal, 47(2):124–129.
Johnson G and Chamberlain C (2011) ‘Are the Homeless Mentally Ill? ’, Australian Journal of Social Sciences, 46(1):29–48.
Johnson, G, Scutella R, Tseng YP and Wood G (2018) ‘How do housing and labour markets affect individual homelessness?’ Housing Studies, 34(7):1089–1116, https://doi.org/10.1080/02673037.2018.1520819.
Johnstone M, Parsell C, Jetten J, Dingle G and Walter Z (2016) ‘Breaking the cycle of homelessness: Housing stability and social support as predictors of long-term well-being’, Housing Studies, 31(4):410–426.
Maslow AH (2013) A Theory of Human Motivation, Wilder Publications, Radford.
Moschion J and Ours JC (2021) ‘Do transitions in and out of homelessness relate to mental health episodes? A longitudinal analysis in an extremely disadvantaged population’, Social Science & Medicine, 279 (2021), doi.org/10.1016/j.socscimed.2020.113667.
Moore G, Manias E and Gerdtz MF (2011) ‘Complex health service needs for people who are homeless’, Australian Health Review, 35(4):480–485.
Nilsson SF, Nordentoft M, Hjorthøj C (2019) ‘Individual level predictors for becoming homeless and exiting homelessness: A systematic review and meta-analysis’, Journal of Urban Health, 96(5):741–50.
NMHC (National Mental Health Commission) (2017) Housing, Homelessness and Mental Health: Outcomes from the National Mental Health Commission’s consultation in 2017. Canberra: National Mental Health Commission, Canberra.
NMHC (2020) ‘Vision 2030: Blueprint for Mental Health and Suicide Prevention’, National Mental Health Commission, Canberra.
Nower L, Eyrich-Garg KM, Pollio DE. and North CS (2015) ‘Problem gambling and homelessness: Results from an epidemiologic study’, Journal of Gambling Studies, 31(2): 533–545.
Onapa H, Sharpley CF, Bitsika V, McMillan ME, MacLure K, Smith L, Agnew LL (2022) ‘The physical and mental health effects of housing homeless people: A systematic review’, Health & Social Care in the Community, 30(2): 448–468, https://doi.org/10.1111/hsc.13486.
Productivity Commission (2020) Mental Health, Report no. 95, Productivity Commission, Canberra.
State of Victoria (2021) Royal Commission into Victoria’s Mental Health System, Final Report, Parl Paper No. 202, Session 2018–21, Government of Victoria, Melbourne, accessed 11 February 2022.
Whittaker E, Dobbins T, Swift W, Flatau P and Burns L (2017) ‘First examination of varying health outcomes of the chronically homeless according to Housing First configuration’, Australian and New Zealand journal of public health, 41(3): 306–308.
World Health Organization (2024) Mental Health WHO website, accessed 4 June 2024
Van der Laan J, Boersma SN, al Shamma S, Akkermans R, van Straaten B, Rodenburg G, van de Mheen D and Wolf JRLM (2020) ‘Differences in housing transitions and changes in health and self-determination between formerly homeless individuals’, European Journal of Public Health, 30(5): 900–905.