Mental health and homelessness - Housing coupled with support brings health and economic benefits

Mental health problems are far more common among people who are homeless. Not having a safe place to sleep causes further anxiety and stress on top of this, access to mental health services is a challenge and people often miss the opportunity to participate in earlier types of community based treatment and support.

“While around one in five people in the general population will have a mental health issue at some point in their life, the majority will never need hospitalisation. However, among our study of people who had been homeless, 17% were admitted to hospital with a mental health diagnosis within a two-year period. Schizophrenia, delusional disorders and mood disorders were the most common,” says Associate Professor Lisa Wood from the Centre of Social Impact UWA in a paper being presented at the 18th International Mental Health Conference in Queensland this week.

“As a result of homelessness and the inability to access early mental health support, many people who are homeless cluster together in Emergency Department (ED) presentations and lengthy psychiatric admissions,” noted A/Professor Wood.

Research compared hospital data from the year before and the year after people were provided with public housing, and looked at the economic impacts for the health system.

“Our research demonstrated huge reductions in ED presentations, inpatient admissions and psychiatric care among people with mental illness, once they were provided with public housing,” observed researcher Shannen Vallesi.

“In the year following entry into public housing, there was a 43% decrease in the proportion of people accessing psychiatric care. For those who were admitted for psychiatric care, the average length of stay reduced six days."

The most dramatic reduction in health service use was among a subgroup of people who had been supported by a National Partnership Agreement on Homelessness (NPAH) Mental Health program.

For this group, there was an average cost saving of $84,135 per person largely due to significant reductions in psychiatric admissions. The NPAH program provides support for people who have been hospitalised for mental illness, assisting them to access and maintain suitable long-term accommodation.

"The research evidence is compelling, it shows that hospital admissions for mental health can be substantially reduced when housing is coupled with support; a huge saving to our over-stretched health system,” saysDr Amanda Stafford an ED consultant at Royal Perth Hospital.

The research also highlights the importance of supporting people to keep their public housing tenancy, as it can be a huge adjustment after life on the streets. “Our research showed that supporting people to the 12-month mark in public housing is critical, and the proportion being admitted to hospital for psychiatric care decreased the longer people have been housed," says researcher Shannen Vallesi.

One person who knows well the struggles of homelessness and adjusting to life afterwards is Jonathan Shapiera, who was homeless and then housed during the study period.

“No-one sets out to become homeless. I had a great job but the contract closed abruptly and I lost my income, my marriage and my rental property. I then ended up on the streets with my son. The insecurity and fears of living on the street compounds the daily trauma," says Jonathon.

"We spent 2 ½ years living on the street. The ‘fight or flight’ shell that builds up around you to enable you to survive on the street then falls away post-homeless. That’s when the realisation of the experience becomes evident and depression really sets in. Post-Homeless Stress Syndrome is a form of PTSD, but this is under-recognised as part of the aftermath of homelessness.”

The research shows the health, economic and quality of life benefits of combining support with housing; it achieves long term benefits not only for people experiencing homelessness but the community as a whole.

“Mental illness among people who are homeless cannot be solved by applying a medical model in isolation. Without housing and other support, the revolving door between mental health and homelessness remains," says Dr Stafford.