People experiencing homelessness and those at risk of homelessness are among Australia’s most socially and economically disadvantaged (see Glossary). Homelessness can result from many factors, such as whether a person is working, experience of family and domestic violence, ill health (including mental health) and disability, trauma, and substance misuse (Fitzpatrick et al. 2013).

Homelessness can expose people to violence and victimisation, result in long-term unemployment, and lead to the development of chronic ill health. Some health problems can cause a person to become homeless. For example, poor physical or mental health can reduce a person’s ability to find employment or earn an adequate income. Alternatively, some health problems are a consequence of homelessness, including depression, poor nutrition, poor dental health, substance abuse and mental health problems. Recent studies have also found that people experiencing homelessness also experience significantly higher rates of death, disability and chronic illness than the general population (Australian Human Rights Commission 2008).

Profile of people experiencing homelessness

On Census night in 2016, more than 116,000 people enumerated in the Census were homeless, up from 102,000 in 2011. Of these, 58% were male, 58% were aged under 35, and 20% identified as Aboriginal and Torres Strait Islander Australians (ABS 2018). Almost half (44%, or 51,100) were living in severely crowded dwellings, more than 21,200 (18%) were living in supported accommodation for the homeless, and 8,200 (7.0%) were sleeping rough. The rate of homelessness has fluctuated over time—from 51 per 10,000 population in 2001 to a low of 45 in 2006, increasing to 48 in 2011 and 50 in 2016 (ABS 2018).

The General Social Survey provides additional information on people experiencing homelessness in Australia. In 2014, an estimated 2.5 million people aged 15 and over had experienced homelessness at some point in their lives; 1.4 million of these had experienced at least 1 episode of homelessness in the previous 10 years, and 351,000 had experienced homelessness in the previous 12 months (ABS 2015a).

Of those who had experienced homelessness in the previous 10 years:

  • 1 in 7 (14% or an estimated 198,000 people) reported the tight housing market/rental market as the reason for their most recent experience of homelessness
  • 13% (an estimated 190,000 people) reported financial problems as their reason for experiencing homelessness.

Information is also available from government-funded specialist homelessness services (SHS) across Australia that provide services supporting people who are experiencing homelessness or who are at imminent risk of homelessness. In 2018–19, around 290,000 clients received assistance from SHS, with around 112,000 clients homeless when they first began support (AIHW 2019).

For further information about the profile of people experiencing homelessness and the support provided by specialist homelessness services, see Homelessness and homelessness services.

Health impact of homelessness

While the causes of homelessness vary, there is a growing amount of research on the impact of insecure housing on health, and the associated costs to the health system (Davies & Wood 2018; Zaretzky & Flatau 2013). There are various forms of homelessness, including rough sleeping (the most visible form of homelessness), couch surfing, short-term or temporary accommodation, and severe overcrowding. 

Meeting basic physical needs such as food, water and a place to sleep can be the most important day-to-day priority for people experiencing homelessness, especially those rough sleeping, and subsequently health needs are often not considered until an emergency arises (Wise & Phillips 2013). While rough sleeping is the least common form of homelessness in Australia (ABS 2018), the longer-term impacts of rough sleeping on health are typically more profound due to issues such as poor nutrition, living in harsh environments and high rates of injury (Fazel et al. 2014). 

Severe overcrowding is a less obvious, but most common, form of homelessness in Australia, and is associated with different health impacts. For example, severe overcrowding places stress on the infrastructure of the dwelling, such as food preparation areas, bathrooms, laundry facilities and sewerage systems. It may lead to more rapid transmission of infectious disease and induce psychological stress (AIHW 2014).

Regardless of the form of homelessness, international research on the gap in life expectancy consistently reveals large differences among those who are experiencing homelessness compared to those who aren't—more than 30 years in the United Kingdom and the United States (Maness & Khan 2014; Perry & Craig 2015), and more than 10 years for people in marginal housing in Canada (Hwang et al. 2009).

More recent research has shown that much of this gap is due to conditions which could be effectively treat1.ed with appropriate health care (Aldridge et al. 2019). A study from Scotland found that interactions with health services increased in the years prior to becoming homeless, with a peak in interactions around the time of the first assessment as homeless—particularly for services related to mental health or drug and alcohol misuse (Waugh et al. 2018). The authors submit that the pattern of health service use suggests that health services could play a role in preventing homelessness by identifying risk factors, and early intervention.

Self-assessed health

In 2014, an estimated 1 in 4 (26%) people in Australia who had ever experienced homelessness assessed their health as fair or poor, compared with 14% of those who had not experienced homelessness (ABS 2015a). (Note that the data source is limited to people who had experienced homelessness but who were living in private dwellings at the time of the survey.)

In general, a higher proportion of people who reported at least 1 experience of homelessness had a health condition or disability compared with those who had never had an experience of homelessness (Figure 1). People who had experienced homelessness were more likely to report having a mental health condition or a long-term health condition, with depression, back pain or back problems, anxiety and asthma the most commonly reported long-term conditions.
 

The vertical bar graph shows the self-assessed health status for people who had not experienced homelessness as well as for those who had experienced homelessness in the past. The graph shows that there was a higher proportion of individuals reporting a long-term health condition, a mental health condition or disability amongst those who had experienced homelessness in the past compared with those who had not experienced homelessness.

 

Specialist Homelessness Services clients – health services

In 2018–19, around 33,000 clients of SHS who were homeless when they first presented to an SHS agency for assistance identified health-related reasons for seeking support, with around 1 in 10 (11%) of these identifying medical issues as a reason for seeking assistance. Some people had more than 1 health-related reason for seeking support (Figure 2):

  • 23,800 clients identified mental health issues
  • 11,700 clients identified medical issues
  • 9,700 clients identified problematic drug or substance use
  • 4,500 clients identified problematic alcohol use.
     

The stacked vertical bar graph shows the number of male and female clients who were homeless at first presentation to a specialist homelessness service by health related reasons for seeking assistance. The most common health related reason for seeking assistance was mental health issues, followed by medical issues, problematic drug or substance use and problematic alcohol use. In each instance each of these issues was more common for males than for females.

SHS agencies provide various services to clients, from accommodation to more specialised services such as health or medical services. When an SHS agency is unable to provide specialised services, clients can be referred to another agency, with health-related services among the most commonly referred service types.

In 2018–19, SHS clients who were homeless at first presentation needed a range of health-related services—more than 14,300 clients needed health/medical services and 13,000 needed mental health services (Table 1). Note that individual clients may have more than 1 need and SHS data does not cover whether referred clients eventually received the health care needed.

Table 1: Number of clients who were homeless at first presentation, by health-related service need, 2018–19

 

Number of clients

Provided as percentage of need identified

Referred only as percentage of need identified

Not provided or referred as percentage of need identified(a)

Health/medical services

14,307

56.8

20.6

22.6

Mental health services

12,997

44.4

21.9

33.7

Drug/alcohol counselling

5,673

43.9

20.1

36.0

Source: Specialist Homelessness Services Collection 2018–19, unpublished.

(a) Includes clients who refuse a service.

Barriers to health care

While the impact of homelessness on health is known to be substantial, an unstable housing situation also presents challenges for the delivery of effective medical care, including barriers to referrals and follow-up care (Davies & Wood 2018).

In 2014, people who had experienced homelessness at least once in the previous 10 years were more likely to report experiencing a barrier to accessing health care when needed (13% of those who had experienced homelessness compared with 4.4% of those who had not experienced homelessness) (ABS 2015a). Among those who were unable to obtain health care when needed, 2 in 5 (40%) identified cost of service as the main barrier to access, followed by long waiting times or a lack of available appointments (ABS 2015a).

Illness and poor health can itself be a barrier to receiving health care. For example, mental illness can influence both attending appointments and the effectiveness of health care provided (Davies & Wood 2018). Feeling stereotyped or judged can also have an impact.

Physical barriers pose further challenges. For example, being able to afford public transport to attend appointments, having no mailing address or phone to receive appointment reminders, and being able to keep medications secure are difficulties faced by people in transient housing such as rough sleeping, couch surfing or short-term accommodation.

Where do I go for more information?

For more information on the health of people experiencing homelessness, see:

See Homelessness services for more on this topic.

References

ABS (Australian Bureau of Statistics) 2015a. General Social Survey: summary results, Australia, 2014. ABS cat no. 4159.0. Canberra: ABS.

ABS 2015b. Microdata: General Social Survey, Australia, 2014, TableBuilder. ABS cat. no. 4159.0.30.004. Canberra: ABS. Findings based on AIHW analysis of ABS TableBuilder data.

ABS 2018. Census of Population and Housing: estimating homelessness, 2016. ABS cat. no. 2049.0. Canberra: ABS.

Australian Human Rights Commission 2008. Homelessness is a human rights issue. January 2008.

AIHW (Australian Institute of Health and Welfare) 2014. Housing circumstances of Indigenous households: tenure and overcrowding. Cat. no. IHW 132. Canberra: AIHW.

AIHW 2019. Specialist Homelessness Services annual report 2018–19. Cat. no. HOU 318. Canberra: AIHW.  

Aldridge RW, Menezes D, Lewer D, Comes M, Evans H, Blackburn RM et al. 2019. Causes of death among homeless people: a population-based cross-sectional study of linked hospitalisation and mortality data in England. Wellcome Open Research 2019 4:49.

Davies A & Wood L 2018. Homeless health care: meeting the challenges of providing primary care. The Medical Journal of Australia 209(5):230–234.

Fazel S, Geddes J & Kushel M 2014. The health of homeless people in high-income countries: descriptive epidemiology, health consequences, and clinical and policy recommendations. The Lancet 25; 384 (9953):1529–1540.

Fitzpatrick S, Bramley G & Johnsen S 2013. Pathways into multiple exclusion homelessness in seven UK cities. Urban Studies 50:1.

Hwang SW, Wilkins R, Tjepkema M, O'Campo PJ, Dunn JR 2009. Mortality among residents of shelters, rooming houses, and hotels in Canada: 11 year follow-up study. BMJ 2009; 339:b4036.

Maness DL & Khan M 2014. Care of the homeless: an overview. American Family Physician 89: 634–640.

Perry J & Craig TKJ 2015. Homelessness and mental health. Trends in Urology & Men’s Health 6(2):19–21.

Waugh A, Clarke A, Knowles J & Rowley D 2018. Health and homelessness in Scotland. Edinburgh: The Scottish Government.

Wise C & Phillips K 2013. Hearing the silent voices: narratives of health care and homelessness. Issues in Mental Health Nursing 34(5):359–67.

Zaretzky K & Flatau P 2013. The cost of homelessness and the net benefit of homeless programs: a national study. Australian Housing and Urban Research Institute. Viewed January 2020.