Key findings

Over the study period 2012–13 to 2022–23:

  • Around 14,000 people received specialist homelessness services (SHS) support in their last year of life; around 8,700 males and around 5,300 females.
  • Annually, the death rate of SHS clients was 1.4–1.7 times that of non-SHS clients; around 1.7–2.3 times for males and 1.0–1.4 times for females (controlling for the age profile in both groups). 

  • Among the 14,000 SHS clients who died, around one-quarter (25%) were aged 45–54 at death; around 1 in 16 (6.2%) were children and young people aged under 25.

  • Among SHS clients who died, more than half experienced homelessness in their last year of life; around 56% or 7,800 people had experienced either rough sleeping or another form of homelessness.
  • Accidental poisoning and suicide were the most common underlying causes of death among SHS clients, together accounting for around one-quarter to one-third of all deaths each year within the study period. 
  • People who received SHS support in the last year of life accounted for around 1 in 7 accidental poisoning deaths, 1 in 19 deaths by suicide, and 1 in 25 land transport accident deaths.

Experiencing or being at risk of homelessness is associated with a higher risk of adverse health, social and economic outcomes (AIHW 2025; CHP 2019; Fitzpatrick et al. 2013; Gordon et al. 2025; NSW DCJ 2021; Hwang et al. 2009). Australian studies have found that people experiencing homelessness die an average of 22 to 33 years younger than those who are housed (Knaus 2024; Tuson et al. 2024; Zordan et al. 2023).

Data presented in this article are about people who have died and who had received support from an SHS in the year prior to their death. Examining the experiences of homelessness and causes of death among this group contributes to understanding critical health and support needs.

  • Data were sourced from the NACS linked dataset. Linkage rates and SHS data coverage issues in the early years of the collection mean that the results may be an underestimate of people receiving SHS support in their last year of life.
  • The term ‘SHS clients’ is mostly used throughout for ease of reading. 
  • The term ‘study period’ is used through this article to mean the total period 2012–13 2022–23 and findings are presented as a single figure. 
  • Data are also presented for annual financial year periods. Results are generally shown as a range to reflect the range of results among the various financial years.
  • Causes of death information for later years is subject to change.
  • This article will be updated when causes of death data for later years is finalised.  

Results presented may differ to other AIHW publications due to the linked dataset, small differences in methodologies and/or time periods. See the footnotes on each source table for more detail and/or the Technical notes.

Specialist homelessness services and clients

Specialist homelessness services (SHS) provide a variety of services to assist people who are experiencing homelessness or who are at risk of homelessness, ranging from general support and assistance to immediate crisis accommodation. Annually, around half of all SHS clients are at risk of homelessness when they first start support (that is, not experiencing homelessness). Around two-thirds of SHS clients are female, with around 2 in 5 females experiencing homelessness at the start of support. While fewer SHS clients are males, around half are experiencing homelessness at the start of support (AIHW 2024a).  

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Specialist Homelessness Service clients who died

Around 14,000 people received SHS support in their last year of life over the study period; around 8,700 males and around 5,300 females.

Annually, the death rate of SHS clients was up to 1.7 times the rate of non-SHS clients; around 1.7–2.3 times for males and 1.0–1.4 times for females (controlling for the age profile in both groups). 

Over the study period, around 14,000 people received SHS support in the last year of life. More male SHS clients died (around 8,700 people) than females (around 5,300) (Supplementary table 1.1).

In 2022–23, the age standardised death rate among SHS clients (883 per 100,000 clients) was around 1.6 times the rate for non-SHS clients (507). The death rate for male SHS clients (1,338 per 100,000 clients) was almost twice the rate for male non-SHS clients (595); the difference among females was less pronounced (603 and 429, respectively) (Supplementary table 1.1).

For years 2012–13 to 2022–23 (Supplementary table 1.1):

  • The age-standardised death rate among male SHS clients was between 1.9 and 2.6 times the rate of female SHS clients, noting that male SHS clients were more likely to be experiencing homelessness and death rates among people experiencing homelessness were higher than non-homeless clients (see the section Experience of homelessness in the last year of life below).
  • The age-standardised death rate among SHS clients was consistently higher than non-SHS clients for both males and females, with the rate difference more marked in males (around 1.7–2.3 times for males and 1.0–1.4 times for females).

Figure 1: People who received SHS support in the last year of life, 2012–13 to 2022–23

Line chart showing the increase over time in the number and percentage of people who received SHS support in the last year of life.

Line chart showing the increase over time in the number and percentage of people who received SHS support in the last year of life.

Source: NACS linked dataset, Supplementary table 1.1.

Age at death

Among the 14,000 SHS clients who died, around one-quarter (25%) were aged 45–54 at death; around 1 in 16 (6.2%) were children and young people aged under 25.

Around 1 in 9 (11%) of all females who died in Australia aged 25–34 were SHS clients in their last year of life, the highest proportion among females; females aged 15–24 was the next highest (8.5%).

Around 1 in 14 (7.4%) of all males who died in Australia aged 35–44 had been SHS clients in their last year of life, the highest proportion among males; males aged 25–34 was the next highest (7.0%).

Over the study period, among the 14,000 people who received SHS support in the last year of life (Supplementary table 1.2):

  • Almost half (45%) were aged 35–54 years (6,300 deaths)
  • Around 1 in 8 (12%) were people aged 25–34 years (1,700 deaths)
  • Around 1 in 77 (1.3%) were children aged 0–14 years (180 deaths).

The age profile of people who died and received SHS support in the last year of life in part reflects the age profile of people receiving SHS support; that is, SHS clients tend to be younger than the Australian population. The median age of SHS clients in 2022–23 was around 30 years (derived from AIHW 2024b).

For years 2012–13 to 2022–23, age at death profiles were similar among male and female SHS clients; around a quarter were aged 45–54 at death. Between 2019–20 and 2022–23, the proportion of SHS clients aged 55 and over at death increased while the proportion aged 35–44 decreased (Figure 2, Supplementary table 2.2).

Specialist homelessness services clients among all deaths in Australia

Over the study period, people who had received SHS support in the last year of life made up around (Figure 2, Supplementary table 2.2):

  • 1 in 17 people who died aged 15–24 (5.8%)
  • 1 in 9 females who died aged 25–34 (11%)
  • 1 in 14 males who died aged 35–44 (7.4%).

Figure 2: People who received SHS support in the last year of life, by age and sex, 2012–13 to 2022–23

Line chart showing the increasing number of people who received SHS support in the last year of life, particularly among clients aged over 55.

Line chart showing the increasing number of people who received SHS support in the last year of life, particularly among clients aged over 55.

Note: Some data are not published (n.p.) for confidentiality reasons.

Source: NACS linked dataset, Supplementary table 1.2.

Experience of homelessness in the last year of life

The housing situation of SHS clients described in this section is based on Homelessness status and other housing categories (also described in detail in the Data presentations and derivations section), using a cascading hierarchy, that is:

  • rough sleeping includes any experience of rough sleeping in the year prior to death
  • other homelessness includes any other experience of homelessness (except rough sleeping), including couch surfing and short-term or temporary accommodation
  • not homeless includes housing situations limited to clients being at risk of homelessness
  • not stated, all housing situation data was missing or unknown.

The housing situation of SHS clients is recorded at 3 different time points: the week before presentation, at presentation and at the end of support. Some people may have experienced periods of homelessness in their last year of life without receiving SHS support in the same year. Therefore, the following may be an underestimate of SHS clients who experienced homelessness in the year prior to death.

Among SHS clients who died during the study period, more than half experienced homelessness in their last year of life; around 56% or 7,800 people had experienced either rough sleeping or another form of homelessness.

A higher proportion of SHS clients who are rough sleeping at some point during their contact with services die each year (0.7–1.0%), compared with clients experiencing other forms of homelessness and housing situations (0.3–0.5%).

SHS clients who were known to be rough sleeping in their last year of life had a median age of death of 47 years (Supplementary table 1.3). This was similar to clients experiencing other forms of homelessness (47 years), but younger than for those clients not experiencing homelessness (55 years). Over the study period, among the 14,000 people who received SHS support in their last year of life:

  • Around 5,400 (38%) did not experience homelessness in their last year of life
  • Over 3,300 (24%) experienced rough sleeping and a further 4,500 (32%) experienced another form of homelessness in their last year of life.

Annually, around 12–15% of all SHS clients experienced rough sleeping and around 3,300 of these clients died. The median age at death among SHS clients who experienced rough sleeping in the last year of life was 47 years; 47 for males and 44 for females. The median age at death was similar for people experiencing other forms of homelessness (47 years, 48 and 44, respectively); however, much younger than clients not experiencing homelessness (55 years, 56 and 53, respectively) (Figure 3, Supplementary table 1.3).

Between 2012–13 and 2022–23, the proportion of SHS clients rough sleeping who died fluctuated between 0.7% and 1.0%, and was higher for males (0.9%–1.4%) than females (0.4%–0.7%). For males and females, the proportion of SHS clients rough sleeping who died was roughly double both other forms of homelessness and other housing situations for most years (Figure 3, Supplementary table 1.3).

Figure 3: People who received SHS support in the last year of life, by homelessness status and sex, 2012–13 to 2022–23

Line chart showing the median age at death for people who experienced homelessness or rough sleeping in their last year of life has been 50 years or under from 2012–13 to 2022–13.

Line chart showing the median age at death for people who experienced homelessness or rough sleeping in their last year of life has been 50 years or under from 2012–13 to 2022–13.

Note: Clients are hierarchically reported in only one homelessness status in the following order: rough sleeping, other homeless, not homeless and not stated. Homelessness status relates to a client's experience in the 12 months prior to death.

Source: NACS linked dataset, Supplementary table 1.3.

Cause of death

Underlying cause of death refers to the disease or injury that initiated the train of events leading directly to death, or the circumstances of the accident or violence that produced the fatal injury. Broad cause of death refers to a broader grouping of underlying causes of death. See the Technical notes for more information.

Accidental poisoning and suicide were the most common underlying causes of death among SHS clients, accounting for around one-quarter to one-third of all deaths each year within the study period.

In 2022–23, people who received SHS support in the last year of life accounted for around 1 in 7 accidental poisoning deaths, 1 in 22 deaths by suicide, and 1 in 25 transport accident deaths.

Over the study period, Injury and poisoning was the most common broad cause of death among people who had died and received SHS support in the last year of life (38%) (Supplementary table 1.4). Deaths due to injury and poisoning are due to causes external to the body (for example, intentional self-harm, transport accidents, falls, poisoning; ICD-10 classifications V01–Y98). See Causes of Death, Australia methodology for more information (ABS 2023).

Underlying causes of death among SHS clients

Among SHS clients for years 2012–13 to 2022–23 (Figure 4, Supplementary table 1.5):

  • The most common underlying cause of death among SHS clients was consistently accidental poisoning (14–20% of deaths), followed by suicide (10–15%) and coronary heart disease (6.2–8.8%). For more information on accidental poisoning see Injury in Australia: Accidental poisoning.
  • Among males, the most common underlying cause of death was consistently accidental poisoning (15–22%), followed by suicide (11–16%) and coronary heart disease (7.4–10%).
  • Among females, accidental poisoning (11–17%) and suicide (8.8–16%) were consistently the two most common underlying causes of death, with rankings changing between years. These top two causes were followed by a mix of other causes including coronary heart disease, liver disease and lung cancer.

Figure 4: People who received SHS support in the last year of life, by the top 10 underlying causes of death, 2012–13 to 2022–23

Rank chart showing accidental poisoning, suicide and coronary heart disease were consistently the leading underlying causes of death among people who received SHS support in the last year of life.

Rank chart showing accidental poisoning, suicide and coronary heart disease were consistently the leading underlying causes of death among people who received SHS support in the last year of life.

Note: The category ‘other ill-defined cases’ in this table (ICD-10 codes R00–R94, R96–R99, I46.9, I95.9, I99, J96.0, J96.9, P28.5) includes symptoms, signs and unspecified circulatory or respiratory conditions.

Source: NACS linked dataset, Supplementary table 1.5.

SHS clients among all deaths in Australia, by underlying cause

As a proportion of all deaths across the years 2012–13 to 2022–23, SHS clients accounted for (Supplementary table 1.5):

  • around 1 in 7 (14–18%) deaths from accidental poisoning
  • around 1 in 19 (4.2–6.2%) deaths due to suicide
  • less than 1 in 100 (0.4–0.7%) deaths from coronary heart disease.

Male SHS clients accounted for around 14–17% of all males who died by accidental poisoning and around 3.6–5.5% of male deaths by suicide. Female SHS clients accounted for around 13–19% of all females who died by accidental poisoning and 5.3–11% of all female deaths by suicide (Supplementary table 1.5).

Future analyses

This is one of a series of articles examining health and specialist service use prior to death, with a specific focus on people with housing insecurity, drug and/or alcohol issues and risk factors associated with specific causes of death, particularly suicide. This article uses the AIHW-funded NACS to deliver these important insights.

Data