Clients with complex care needs

Three groups of clients have been identified as having complex care needs—clients with a current mental health issue, clients with problematic drug and/or alcohol use, and clients with disability. Of the 1,215 ex-serving ADF SHS clients, just over 2 in 5 (43%, or 520 clients) had at least 1 complex care need, and 14% (167 clients) had 2 or more.

Although the 3 groups showed differences in service use and needs, these common patterns emerged:

  • Higher service use—higher number of support days, more likely to use accommodation, and to stay for more nights, compared with clients who did not have complex care needs.
  • Higher rates of homelessness at both the start and end of support, compared with clients who did not have complex care needs.
  • Of the clients who listed their main reason for seeking assistance as a health reason, nearly all had at least 1 complex care need.
  • Wide range of services used, and multiple complex care needs:
  • Substantial level of overlap between the 3 client groups, particularly for clients with a current mental health issue and clients with problematic drug and/or alcohol use.
  • Higher proportion of these clients needing other specialist services.

The results for these 3 groups of clients are further examined in this section, although the small number of clients with disability among ex-serving ADF SHS clients does not allow for analysis of further breakdowns of results for this group.

Clients with a current mental health issue

During the reporting period between 2011–12 and 2016–17, 37% of ex-serving ADF SHS clients experienced a current mental health issue. The proportion reporting a current mental health issue increased from 21% in 2011–12 to 39% in 2016–17. Further information about how clients are classified as having a current mental health issue can be found in the Technical Notes.

Among the 451 ex-serving ADF SHS clients who experienced a current mental health issue, compared with the 764 clients who did not have a current mental health issue (Table 12):

  • 49% were homeless at the start of support, compared with 44% of clients with no mental health issue.
  • 43% were homeless at the end of support, compared with 39% of those with no mental health issue.
  • 9% identified their main reason for seeking assistance at the start of support was related to a health reason, compared with 2% of those with no mental health issue.
  • 33% had problematic drug and/or alcohol use, compared with 8% of those with no mental health issue.

Among ex-serving ADF SHS clients who experienced a current mental health issue, the proportion who needed a service was higher than clients with no mental health issue for nearly all types of services:

  • 77% indicated a need for accommodation of any type, compared with 56% of clients with no mental health issue.
  • 49% indicated a need for assistance to sustain housing tenure, compared with 31% of clients with no mental health issue.
  • 15% indicated a need for drug and/or alcohol services, compared with 2% of clients with no mental health issue.
  • 34% indicated a need for other specialist services, compared with 13% of clients with no mental health issue.

Ex-serving ADF SHS clients who experienced a current mental health issue during the reporting period used SHS more and for longer than clients with no mental health issue:

  • 43% had 91 or more days of support, compared with 23% of clients with no mental health issue.
  • 49% used accommodation services for at least 1 night, compared with 32% with no mental health issue.
  • 40% had accommodation for 6 nights or more, compared with 22% with no mental health issue.

A higher proportion of ex-serving ADF SHS clients who had experienced a current mental health issue had a support period end because their needs were met, compared with clients with no mental health issue (71% and 57% respectively). One in 4 (26%) ex-serving ADF SHS clients who experienced a current mental health issue had a support period end because they were referred to another organisation, compared with 9% of clients with no mental health issue.

Table 12: Demographic and service profile of ex-serving ADF SHS clients, by mental health status, 2011–12 to 2016–17

 

Clients with a current mental health issue (%)

Clients with no current mental health issue (%)

Proportion of all ex-serving ADF SHS clients

37

63

Housing situation at the start of support

Homeless

49

44

At risk of homelessness

51

56

Services which clients were assessed as needing

Accommodation (any type)

77

56

Sustain housing tenure

49

31

Drug and/or alcohol services

15

2

Other specialist services

34

13

Reason support period ended

 

 

Referred

26

9

Needs met/goals achieved

71

57

Max service period reached/service withdrawn

11

5

No longer requested assistance, did not turn up, lost contact

53

46

Institutionalised, incarcerated, deceased, other

13

8

Notes

  1. Unless otherwise stated, the denominators used for calculating percentages in the table above are 451 for clients with a current mental health issue and 764 for clients with no mental health issue.
  2. Clients with a current mental health issue includes all clients categorised as having a current mental health issue at any point from 1 July 2011 to 30 June 2017.
  3. Housing situation at the start of support is the housing situation of a client during the financial year in which the client first received SHS support. Percentages have been calculated using the total clients as denominator excluding not stated (denominator of 420 for clients with a current mental health issue, 662 for clients with no mental health issue).
  4. Other specialist services include: health/medical services, specialist counselling services, and other specialised services.
  5. If a client has more than 1 support period, a reason is recorded for the end of each support period. The numerator for the percentages of reason support period ended counts reasons that all support periods have ended. The denominator is the total clients in the subgroup (with or without a current mental health issue) less the number of clients whose only reason or reasons for support periods ending is not stated. The denominator is 434 for ex-serving ADF SHS clients with a current mental health issue and 710 for ex-serving ADF SHS clients with no mental health issue.

Source: AIHW analysis of linked PMKeyS–SHSC data 2011–12 to 2016–17.

Clients with problematic drug and/or alcohol use

During the 6-year reporting period, 18% of clients (214) were identified with problematic drug and/or alcohol use.

A higher proportion of ex-serving ADF SHS clients with problematic drug and/or alcohol use were homeless, compared with clients without this use (Table 13):

  • 58% were homeless at the start of support, compared with 43% of clients without this use.
  • 54% were homeless at the end of support, compared with 38% of clients without this use.

Ex-serving ADF SHS clients with problematic drug and/or alcohol use (214 clients) also had a different profile of needs compared with clients without this use (1001 clients) (Table 13):

  • 14% indicated that their main reason for seeking assistance related to a health reason, compared with 2% of clients without this use.
  • 86% needed any type of accommodation, compared with 59% of clients without this use.
  • 75% needed short-term accommodation, compared with 41% of clients without this use.
  • 35% needed mental health services, compared with 8% of clients without this use.
  • 43% needed other specialist services, compared with 16% of clients without this use.

Ex-serving ADF SHS clients with problematic drug and/or alcohol use also used more support for longer than clients without problematic drug and/or alcohol use:

  • 51% had 91 or more support days across the 6-year reporting period, compared with 26% of clients without this use.
  • 68% had accommodation for at least 1 night, compared with 32% of clients without this use.
  • The length of accommodation services was longer for clients with problematic drug/and or alcohol use—22% had 91 or more nights of accommodation, compared with 8% of clients without this use.
  • 18% received more than $400 in financial assistance across the reporting period, compared with 13% of clients without this use.

A higher proportion of ex-serving ADF SHS clients with problematic drug and/or alcohol use (70%) had a support period end because their needs had been met or their goals were achieved, compared with clients without this use (60%).

Table 13: Demographic and service profile of ex-serving ADF SHS clients, by problematic drug and/or alcohol use, 2011–12 to 2016–17

 

Clients with problematic drug/alcohol use (%)

Clients without problematic drug/alcohol use (%)

Proportion of all ex-serving ADF SHS clients

18

82

Housing situation at the start of support

Homeless

58

43

At risk of homelessness

42

57

Housing situation at the end of support

Homeless

54

38

At risk of homelessness

46

62

Services which clients were assessed as needing

Accommodation (any)

86

59

Short-term accommodation

75

41

Mental health services

35

8

Other specialist services

43

16

Support days provided (across the 6-year period)

Up to 5 days

12

31

6 to 45 days

24

30

46 to 90 days

13

14

91 to 180 days

19

11

Over 180 days

32

14

Nights of accommodation provided (across the 6-year period)

No accommodation

32

68

Up to 5 nights

10

9

6 to 45 nights

25

11

46 to 90 nights

10

3

91 to 180 nights

11

4

Over 180 nights

11

5

Notes

  1. Unless otherwise stated, the denominators used for calculating percentages in the table above are 214 for ex-serving ADF SHS clients with problematic drug and/or alcohol use and 1001 for ex-serving ADF SHS clients without problematic use.
  2. Clients with problematic drug/alcohol use includes all clients categorised as having problematic drug/alcohol use at any point during the reporting period.
  3. Housing situation at the start of support is the housing situation of a client during the financial year in which the client first received SHS support. Percentages have been calculated using the total number of clients as denominator excluding not stated (denominator of 193 for clients with problematic drug and/or alcohol use and 889 for clients without this use).
  4. Housing situation at the end of support is the housing situation of a client during the financial year in which the client last received SHS support. Percentages have been calculated using the total number of clients as denominator excluding not stated (denominator of 190 for clients with problematic drug and/or alcohol use and 849 for clients without this use).
  5. Other specialist services include: health/medical services, specialist counselling services, and other specialised services.
  6. If the support period start or end dates are outside of the reporting period for a financial year, total days are calculated using a start date of 1 July and an end date of 30 June. Days of support in the table above are calculated by summing all support days received by the client between 1 July 2011 and 30 June 2017.
  7. For ex-serving ADF SHS clients, the calculation of nights of accommodation includes all clients, regardless of whether all their support periods were closed. The length of accommodation for a client is calculated by adding each night of accommodation (short term/emergency, medium and long term accommodation) provided across all support periods between 1 July 2011 and 30 June 2017. The length of accommodation for a client only includes nights provided to the client, and does not include nights of accommodation in which the client was referred to another agency.

Source: AIHW analysis of linked PMKeyS–SHSC data 2011–12 to 2016–17.

Young men with complex care needs

Over the 6-year reporting period, 13% of ex-serving ADF SHS clients (159) were men aged 17–34 who had complex care needs (identified as having 1 or both of a current mental health issue and problematic drug and/or alcohol use). Compared with all other ex-serving ADF SHS clients:

  • a higher proportion of young men with complex care needs were homeless at the start of support—60% compared with 44% for all other clients
  • young men with complex care needs had more support days—28% received over 180 days of support, compared with 16% for all other clients
  • young men with complex care needs had a shorter length of ADF service—89% had served for less than 5 years, compared with 59% for all other clients. Of the 159 young men with complex care needs:
    • 46% served for less than 1 year
    • 18% served for between 1 and less than 2 years
    • 9% served for between 2 and less than 3 years
    • 8% served for between 3 and less than 4 years
    • 7% served for between 4 and less than 5 years
  • young men with complex care needs were less likely to be a DVA client than all other clients—74% compared with 64% for all other clients
  • a higher proportion of young men with complex care needs discharged involuntarily (for non-medical reasons)—55% compared with 33% for all other clients
  • a higher proportion of young men with complex care needs were unemployed at the start of support—56% compared with 43% for all other clients.

Clients with disability

The measure of disability in the Specialist Homelessness Services Collection (SHSC) identifies those who always or sometimes need help or supervision with 1 or more core activities (self-care, mobility and communication) due to a long-term health condition or disability. The measure of disability was introduced to the SHSC in 2013–14, so data are only available for 4 of the 6 financial years of the reporting period.

In the current analysis, clients have been categorised as having disability if they were identified as having disability in any of the individual financial years of the 4-year reporting period. Across the 4-year period between 2013–14 and 2016–17, 4% (or 32 clients) of ex-serving ADF SHS clients were identified as having disability.

The small number of clients with disability among ex-serving ADF SHS clients does not allow for further analysis of this group.