
Mental health is a fundamental and integral component of the health of individuals, their families, and the population (ABS 2018, AIHW 2020, Schulz & Sherwood 2008, WHO 2018, WHO 2019). Mental health is “a state of well-being in which an individual realises his or her own abilities, can cope with normal stresses of life, can work productively and is able to make a contribution to his or her community” (WHO 2018). Conversely, a mental illness may be defined as a “clinically diagnosable disorder that significantly interferes with a person’s cognitive, emotional or social abilities” (COAG Health Council 2017). The term ‘mental health issues’ captures the entire range of mental health problems and as such, clients with a current mental health issue are a diverse group, as the severity of symptoms differ between individuals.
Mental health issues are common in Australia. In any year, around 1 in 5 Australians aged 16–85 experience a mental health disorder. 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 with mental health issues are particularly vulnerable to experiencing homelessness (Brackertz et al. 2020). Environmental stress associated with experiences of housing instability or homelessness can trigger, exacerbate or magnify mental health issues (Brackertz et al. 2018, CHP 2018, Johnson & Chamberlain 2016, Kaleveld et al. 2018, Walter et al. 2016). Symptoms of mental illnesses that increase psychological distress and impair decision-making in daily life can contribute to worse health outcomes, reduced support and experiences of financial hardship. In this way, people with mental health issues are especially susceptible to entering or maintaining homelessness (Johnstone et al. 2016, Brackertz et al. 2020, Fazel et al. 2014).
People experiencing homelessness with mental health issues require the support of various services. Navigating through these services can be particularly 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, Wood et al. 2016, ABS 2014).
Reporting clients with a mental health issue in the Specialist Homelessness Services Collection (SHSC)
Specialist Homelessness Services (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 information:
- 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.
The coronavirus (COVID-19) pandemic has imposed 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, Ricci-Cabello et al. 2020, Newby et al. 2020). A recent study, for instance, found that pandemic-related changes to social and working conditions were strongly associated with poorer mental health (Dawel et al. 2020). In 2020–21, subsidised mental health-specific services processed by Medicare increased substantially compared to previous years (AIHW 2021a). In terms of support provided by SHS agencies, there has been general upward trend in the number SHS clients with a current mental health issue since the start of the pandemic, especially among females (AIHW 2021b).
Client characteristics