Clients with a current mental health issue using specialist homelessness services
- The main reason identified by clients with a current mental health issue accessing services are housing crisis (e.g., eviction) (21%) and family and domestic violence (19%) and inadequate/inappropriate dwelling conditions (13%).
- The most common services required by SHS clients with a current mental health issue are accommodation, assistance sustaining accommodation and accessing other specialist services.
- Relative to the subset of clients requiring a specific service, 51% were provided accommodation, 82% with assistance sustaining accommodation and 67% with other specialist services.
- 49% of clients with a current mental health issue began support as homeless with 38% ending support as homeless.
There is an association between mental illness and homelessness. Broadly, those with a history of homelessness experience substantially higher rates of mental health issues compared to the general population (Fazel et al., 2008, Gutwinski et al., 2021). Of those with a lifetime history of mental illness, those who have a history of homelessness also have an increased likelihood of experiencing mental illness in a given year compared to those without a history of homelessness (54% vs 19%) (ABS, 2008).
Those experiencing concurrent mental illness and homelessness have different onset, mental illness severity/duration, experience different barriers and homelessness trajectories and may require specialist support (Scutella et al., 2014). However, the relationship between mental illness and homelessness is not straightforward. While it has been observed in a 2005–06 Melbourne study that about 30% of those experiencing homelessness had a mental illness, it was estimated that 53% of those wth mental illness developed the illness after becoming homeless (Chamberlain et al., 2007; Johnson & Chamberlain, 2011). This distinction provides differential profiles and affects outcomes such as length and trajectory of homelessness. Those who develop mental illness after homelessness generally become homeless younger and remain homeless longer, compared to those with mental illness prior to homelessness; who tend to cycle in-and-out of homelessness more often (Scutella et al., 2014).
Research suggests that those experiencing mental illness are more likely to experience homelessness (25% vs 10%) during their lifetime (ABS, 2016) with trauma and associated mental illness being a significant factor in long-term homelessness (O’Donnell et al., 2014). However mental illness and homelessness share risk factors which makes determining causality difficult (Chamberlain & Johnson, 2013). The homelessness-mental illness relationship is further complicated by variability in observed prevalence based on the type, duration and severity of mental illness. For instance, compared to more common and less severe conditions, people with more severe and persistent psychotic disorders (such as schizophrenia) are more likely to be homeless relative to the general population (Scutella et al., 2014) and these disorders are associated with worse health outcomes and these clients may require specific housing service needs (Harvey et al., 2012; Morgan et al., 2012).
This section presents an overview of information provided by Specialist Homelessness Services (SHS) agencies on clients identified as having a current mental health issue who received services from specialist homelessness agencies. For a more comprehensive overview of recent data relating to clients, jurisdictional differences, and outcomes, please refer to Specialist homelessness services client pathways: Clients supported in 2015–16 and Specialist homelessness services annual report.
It is important to note, the number of clients supported by Specialist Homelessness Services reflects the agency engagement of people which is not necessarily a reflection of the underlying level of homelessness in Australia (AIHW 2022a). This data pertains to individuals receiving Specialist Homelessness Services, not all those that attempt to access services are able to be provided assistance and not all those who might need support seek it.
Refer to Unmet demand for specialist homelessness services for further information.
All data periods are contained within a financial year beginning July 1 to June 30 in the following year. Additionally, service data is presented from 2011–12 using historical data, while client and service usage data is presented from 2017–18 using each years’ respective annual report data.
Refer to Technical notes: Imputation and weighting for more information.
In the top half of the figure there are two line charts displaying service data for SHS clients with a current mental health issue from 2011–12 to 2021–22.
The left line chart compares clients with a current mental health issue to the total of all SHS clients and can be toggled to display either client numbers or rates (per 100,000). While total SHS client have increased from 236,400 in 2011–12 to 272,700 in 2021–22, rates have remained steady,1058 per 100,000 in 2011–12 to 1062 per 100,000 in 2021–22. However, SHS clients with a current mental health issue have consistently increased from 44,700 / 200 per 100,000 in 2011–12 to 85,200 / 332 per 100,000.
The right line chart shows the proportion of clients with a current mental health issue relative to total SHS clients. Clients with a current mental health issue have represented a larger proportion of total SHS clients since 2011–12 (19%) to 2021–22 (31%).
In the lower half of the figure there are four tabs that can be toggled, WHO, WHY, WHAT and OUTCOMES, that allow viewing of summary data presented for each financial year between 2017–18 to 2021–22. These tabs present three sparkline figures for SHS clients with a mental health issue (WHO) and their main reason for contacting SHS (WHY), three stacked bar charts for their service usage (WHAT), and a side-by-side bar chart showing outcomes by comparing client homelessness at the beginning and end of support (OUTCOMES). These factors have largely been consistent between 2017–18 to 2021–22.
WHO shows that SHS clients with a current mental health issue are; primarily female (60%–63%), aged 25–44 (44%–45%) and provided services in Victoria (38%–40%).
WHY shows that SHS clients with a current mental health issue primarily sought assistance due to; housing crises (e.g., eviction) (20%–25%), family and domestic violence (19%–20%), and inadequate/inappropriate dwelling conditions (11%–13%).
WHAT shows the percentage of clients provided, referred on or neither provided nor referred on for the three primary SHS services required by clients with a current mental health issue. These services are accommodation, assistance sustaining existing accommodation and other specialist services. Percentages are relative to the group of SHS clients with a current mental health issue requiring a specific service, not all these clients. Accommodation was provided to 51%–52% of clients, with 16%–17% referred on and 31%–33% neither provided nor referred for accommodation. Assistance sustaining existing accommodation was provided to 82%–84% of clients, with 3% referred on and 14%–15% neither provided nor referred on for assistance sustaining existing accommodation. Other specialist services were provided to 66%–68% of clients, with 18% referred on and 14%–16% neither provided nor referred for other specialist services.
OUTCOMES shows that 48%–50% of SHS clients with a current mental health issue were homeless at the beginning of support, with 36%–38% being homeless at the end of support. Note that homelessness here refers to more than rooflessness and includes clients: with no shelter or improvised/inadequate dwellings; with short-term temporary accommodation; or couch surfing.).
Refer to source note under Spotlight data figure for data source information.
Source: Specialist Homelessness Services Collection.
Prevalence data: Specialist homelessness services historical data 2011–12 to 2021–22, Table HIST.MH.
Client data (WHO): Age & Sex – Table MH.1. State and territory – 2017–18 to 2019–20, Table MH.2; 2020–21, Table CLIENTS.37; 2021–22, Table CLIENTS.39.
Reason data (WHY): 2017–18, SHS Annual report webpage; 2018–19 to 2019–20, 2021–22, Table MH.5; 2020–21, Table MH.4.
Service data (WHAT): 2017–18 to 2019–20, Table MH.3; 2020–21 to 2021–22, Table MH.2.
Outcome data (OUTCOMES): 2017–18 to 2019–20, Table MH.4; 2020–21 to 2021–22, Table MH.3.
Data files: SHS Annual report data files for 2017–18 to 2021–22. Refer to Homelessness services, Data to access all data files.
In addition to the broad data presented above, SHS clients with a current mental illness also differ from typical SHS clients in a number of ways:
- Compared to other SHS clients, they are consistently more likely to be repeat users of services, have more and longer periods of support and higher proportions of additional risk factors such as being unemployed, a history of homelessness and drug and alcohol issues (AIHW, 2022b).
- Both reasons for requesting SHS and the initial form of accommodation at the beginning of support vary based on whether the client was currently experiencing homelessness or at risk of experiencing homelessness (for example refer to AIHW, 2022a).
The COVID-19 pandemic created significant health, lifestyle and economic challenges in Australia. Housing and homelessness and SHS clients have seen impacts of the COVID-19 pandemic over 2019–20, 2020–21 and 2021–22. In response to the pandemic, states and territories implemented various provisions designed to support jurisdictional SHS and address impacts on housing. Many of the service changes over this time may have influenced the number of clients supported by SHS agencies.
Refer to Specialist Homelessness Services: monthly data, COVID-19 responses for more information on jurisdictional provisions put in place.
The proportion of SHS clients with a current mental health issue continued to trend upward (albeit more slowly than previous years) during 2020–21 although the number of clients was similar to previous years. It is possible this pattern is partially due to moratoriums on evictions due to rental arrears, subsidies for renters, and emergency accommodation for existing homeless introduced during COVID (AIHW 2021). However, it is unclear whether introduced provisions explain the observed decrease in the number and proportion of SHS clients with a current mental health issue observed in 2021–22.
The main reasons for seeking assistance across 2019–20 to 2021–22 were family and domestic violence (19%–20%), housing crisis (20%–21%), and inadequate and appropriate dwelling conditions (13%–14%). During 2020–21 the proportion of short-term/emergency accommodation provided to clients with an identified need was slightly higher than in 2019–20 and 2021–22. Provision of services to assist with sustaining a tenancy or prevent tenancy failure or eviction was also higher in 2020–21 compared with the previous or following year.
Overall outcomes remained fairly consistent in 2020–21 compared to 2019–20 and 2021–22 with 49%–50% of SHS clients with a mental illness beginning support as homeless and 37%–38% remaining homeless at the end of support. Though the proportion of SHS clients with a current mental health issue starting support with no or improvised/inadequate shelter has been decreasing since 2019–20, 2020–21 saw the lowest proportion. However, in both 2020–21 and 2021–22 the proportions of SHS clients experiencing or at risk of homelessness with a current mental illness who ended support in short-term emergency accommodation were slightly lower than the respective proportion who began support in short-term emergency accommodation. In comparison, in 2019–20 the proportions beginning and ending support in short-term emergency accommodation were roughly similar. Notably 2020–21 also saw slightly higher proportions of clients end support in public or community housing despite having similar proportions of clients begin support in public or community accommodation as 2019–20 and 2021–22.
Where do I go for more information?
- Specialist Homelessness Services annual report 2021–22, Clients with a current mental health issue
- Specialist homelessness services client pathways: Clients with mental health issues in 2015–16
- Specialist Homelessness Services annual report, report editions
- Australia’s Welfare: Homelessness and homelessness services
A person is described as at risk of homelessness if they are at risk of losing their accommodation or they are experiencing one or more of a range of factors or triggers that can contribute to homelessness.
Risk factors include:
A specialist homelessness agency client is a person who receives a specialist homelessness service. A client can be of any age. Children are also clients if they receive a service from a specialist homelessness agency.
To be a client the person must directly receive a service and not just be a beneficiary of a service.
Children who present with an adult and receive a service are considered to be a client; children of a client or other household members who present but do not directly receive a service are not considered to be clients.
SHS clients with a current mental health issue are identified as such if they have provided any of the following information:
The client’s homeless status at the beginning and end of their support.
Clients are considered to be homeless if they are living in any of the following circumstances:
A specialist homelessness agency is an organisation which receives government funding to deliver specialist homelessness services to a client. These can be either not-for-profit and for profit agencies.
Specialist homelessness service(s) is assistance provided by a specialist homelessness agency to a client aimed at responding to or preventing homelessness. The specialist homelessness services in scope for this collection include accommodation provision, assistance to sustain housing, mental health services, family/relationship assistance, disability services, drug/alcohol counselling, legal/financial services, immigration/cultural services, domestic/family violence services, other specialist services and general assistance and support.
A support period is the period of time a client receives assistance from an agency. A support period starts on the day the client first receives a service from an agency and ends when:
ABS (Australian Bureau of Statistics) (2008), National Survey of Mental Health and Wellbeing: Summary of Results, ABS website, accessed 26 May 2023.
ABS (2016), Mental health and experiences of homelessness, ABS website, accessed 26 May 2023.
AIHW (Australian Institute of Health and Welfare) (2021) Australia’s welfare 2021: data insights, AIHW, Australian Government, doi:10.25816/zghn-md15. Accessed 26 May 2023.
AIHW (2022a) Specialist homelessness services annual report 2021–22, AIHW, Australian Government, accessed 26 May 2023.
AIHW (2022b) Specialist homelessness services client pathways: Clients with mental health issues in 2015–16, AIHW, Australian Government, accessed 26 May 2023.
Chamberlain, C., & Johnson, G. (2013) Pathways into adult homelessness. Journal of Sociology, 49(1), 60-77, doi: 10.1177/1440783311422458. Accessed 26 May 2023.
Chamberlain, C., Johnson, G., & Theobald, J. (2007). Homelessness in Melbourne: Confronting the Challenge. RMIT University, accessed 26 May 2023.
Fazel S, Khosla V, Doll H, Geddes J. (2008) The prevalence of mental disorders among the homeless in western countries: systematic review and meta-regression analysis. PLoS Med, 5(12):e225, doi: 10.1371/journal.pmed.0050225. Accessed 26 May 2023.
Gutwinski, S., Schreiter, S., Deutscher, K., & 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), doi: 10.1371/journal.pmed.1003750. Accessed 26 May 2023.
Harvey, C., Killackey, E., Groves, A., & Herrman, H. (2012). A place to live: Housing needs for people with psychotic disorders identified in the second Australian national survey of psychosis. Australian & New Zealand Journal of Psychiatry, 46(9), 840-850, doi: 10.1177/0004867412449301. Accessed 26 May 2023.
Johnson, G., & Chamberlain, C. (2011). Are the homeless mentally ill?. Australian Journal of Social Issues, 46(1), 29-48, doi: 10.1002/j.1839-4655.2011.tb00204.x. Accessed 26 May 2023.
Morgan, V. A., Waterreus, A., Jablensky, A., Mackinnon, A., McGrath, J. J., Carr, V., ... & Saw, S. (2012). People living with psychotic illness in 2010: the second Australian national survey of psychosis. Australian & New Zealand Journal of Psychiatry, 46(8), 735-752, doi: 10.1177/0004867412449877. Accessed 26 May 2023.
O’Donnell, M., Varker, T., Cash, R., Armstrong, R., Di Censo, L., Zanatta, P., Murnane, A., Brophy, L., & Phelps, A. (2014). The Trauma and Homelessness Initiative. Report prepared by the Australian Centre for Posttraumatic Mental Health in collaboration with Sacred Heart Mission, Mind Australia, Inner South Community Health and VincentCare Victoria. Accessed 26 May 2023.
Scutella, R., Chigavazira, A., Killackey, E., Herault, N., Johnson, G., Moschion, J., & Wooden, M. (2014). Journeys Home Research Report No. 4. Melbourne: Melbourne Institute of Applied Economic and Social Research. Accessed 26 May 2023.
Data coverage includes the time period 2011–12 to 2021–22. Data in this section was last updated in July 2023.