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Housing, Homelessness and Mental Health START COURSE DETAILS Description This training is designed for people interested in learning more about the interplay between housing, homelessness and mental health. Duration: Approximately 45 minutes (you can close the training and pick up where you left off at a later date). Last updated: September 2021 Content and links in this training were correct at the time of publication. We check these regularly; however, if you find broken links or errors please contact transitionsupport@flinders.edu.au
Training objectives Lesson 1 of 6 Training objectives This module is for people who want to learn more about the interplay between housing, homelessness and mental health. It covers the importance of housing for mental health, the impacts of homelessness on mental health, and what the NDIS provides in terms of housing and supports. By the end of this module you will: • Understand the importance of housing for mental health • Understand the impacts of homelessness on mental health • Understand what the NDIS provides in terms of housing and supports Assumed knowledge This module is for people who want to learn more about the interplay between housing, homelessness and mental health. There is no assumed knowledge for this module. We have other training modules that cover NDIS topics which may be relevant to this module. They can be found on the training page of our website.
The importance of housing for mental health Lesson 2 of 6 Secure housing is vital to mental health and wellbeing. It plays an essential role in creating a safe, secure and sustainable environment and provides the opportunity for people to achieve their goals, contribute to their community, and live the life they want. Housing in Australia An unintended consequence of deinstitutionalisation has been an increase in the number of people with mental illness who are homeless or inadequately housed. Data on supported accommodation programs show that mental illness can be a direct and indirect contributor to homelessness. Lack of service access makes people experiencing homelessness with mental health problems one of the most marginalised groups. A number of supported housing programs designed for people with lived experience of psychosocial disability are operating in Australia and have been shown to be effective. However, such programs have very limited capacity. There is a shortage of supported housing with integrated mental health support. Most people with lived experience of mental ill health rent in the private market, yet many experience discrimination, insecure tenure and housing unaffordability. The social housing system does not adequately monitor and consider the mental health of tenants, missing opportunities for early intervention by linking people with appropriate supports before a crisis. Antisocial behavioural policies in several Australian states and territories can disadvantage people with lived experience of mental ill health, due to issues around behaviour management. As mental or physical worsens, the likelihood of living in precarious or unaffordable housing, or living in poor-quality homes increases, as does the likelihood of experiencing a forced move. Factors which can create or contribute to housing issues for people with psychosocial disability include structural trends in the Australian housing system, such as: - an increase in private rental - declining stocks of social housing - lack of affordable housing for low-income households - falling rates of home ownership Social housing Social housing (i.e. public and community housing) provides affordable and accessible short and long-term rental housing for people on low incomes. Social housing is owned and run by the government and not-for-profit agencies. It is essential that people with psychosocial disability have access to safe, affordable and accessible housing, including social and supportive housing; however, this housing is highly rationed. Housing and people with a disability People with a disability (and their family members with care responsibilities) may be at risk of homelessness because of low incomes, limited engagement with the labour market and restricted capacity within the private rental sector. Around a third of households receiving the Disability Support Pension experience rental stress. Housing and people with psychosocial disability People with histories of trauma and psychosocial disability are often at increased risk of losing housing or never gaining adequate stable housing, due to complexities around managing their mental ill health. Supported housing can include residential disability support services that are specifically designed for those with mental ill health as well as group homes providing supervised care. Essential components of supported housing include it being: - secure - affordable - reliably supported by staff with adequate training and resources.
Exploring homelessness Lesson 3 of 6 Homelessness is the most severe form of housing instability. Mental health and homelessness are complex and intertwined, with mental health conditions posing a risk factor for homelessness. Definitions of homelessness Click on the tiles below to find out more about who may identify as homeless: Front of card: image of person sleeping rough Back of card: People who are sleeping rough (i.e. on the streets) Front of card: 4 people looking into the distance. Back of card: People who temporarily stay with friends and relatives Front of card: neon sign reading “vacancy” Back of card: People who sleep in hotels, short‐term and crisis accommodation and in boarding houses Front of card: car Back of card: People who sleep in cars The A. B. S. identifies the following categories to distinguish homelessness: • Primary homelessness includes people without conventional accommodation such as those who ‘sleep out’, or use derelict buildings, cars, railway stations, for shelter. • Secondary homelessness refers to people who frequently move from temporary accommodation such as emergency accommodation, refuges, temporary shelters. People may use boarding houses or family accommodation but on a temporary basis. • Tertiary homelessness includes people who live in rooming houses or boarding houses on a medium or long-term basis, where they do not have their own bathroom and kitchen facilities, and tenure is not secured by a lease. Read more about A. B. S. definitions of homelessness here. Drag to sort different types of homelessness into the correct categories: Both mental ill health and homelessness are often misunderstood and stigmatised. Many people with mental illness face stigma, discrimination and social exclusion which impacts their ability to access private housing and perhaps also social housing. Experiencing homelessness exacerbates trauma and psychological distress, and the combination of mental ill health and homelessness can lead to other factors including substance dependency, relationship instability, experience of violence and lack of formal and informal support, which reinforces the connection between health and homelessness. Homelessness and mental ill health For some people, the stress and dislocation of homelessness can result in their first episode of mental ill health. Homelessness may exacerbate previous mental illness and encourage psychiatric distress, anxiety, fear, depression, and sleeplessness. Social, economic and health risks increase the longer a person is at risk of homelessness, or remains homeless. There are many unmet needs among those experiencing homelessness and psychosis. Picture of a person looking forlorn. Risk factors People with severe and persistent mental ill health are overrepresented in people experiencing long term homelessness. Read more here. People who have more than one condition (a 'dual diagnosis') are more at risk of experiencing homelessness. People with mental illness or brain injury have an increased likelihood of higher relative homelessness risk. According to the AIHW, affective disorders including depression, anxiety, bipolar, schizophrenia, and substance abuse disorders are among the most common types of mental illness in the homeless population. Mental ill health can lead to cognitive and behavioural problems that make it difficult to earn a stable income or to carry out daily activities to encourage stable housing. Picture of a person looking confident. Psychosocial disability and homelessness Psychosocial disability is the disability type most associated with homelessness. There is a high correlation between mental ill health and having experienced homelessness among people aged 25 to 54 (A. B. S.). Adults who report having a mental illness in the last six months were more than twice as likely to have experienced homelessness at some point in their lives and almost three times as likely to have been homeless in the past decade. People who are homeless and experience mental illness are more likely than the rest of the population to encounter the criminal justice system (Parliament of Australia). Picture of a person looking pensieve. People experiencing both homelessness and mental ill health represent a hard-to-reach group for service providers. Ineffective service responses can worsen experiences of mental health and homelessness, by exacerbating trauma and stigma, and decreasing people's confidence in the system. The housing, homelessness and mental health systems are not well integrated, resulting in people entering and dropping out of support services repeatedly without recovering. Cycling between services leads to an accumulation of disadvantage and people can experience a strong downward trajectory. Homelessness and mental health recovery People with psychosocial disability who have chronic and complex care needs require access to wrap around supports, in a non-threatening and supportive atmosphere to address their basic needs (e.g. food and shelter), and provide accessible care. For people with psychosocial disability, stable, appropriate and affordable housing is a critical component of successful treatment and recovery from mental illness. Appropriate housing can improve mental health by facilitating independence, social relationships and networks. Experiencing homelessness can be related to lower levels of perceived recovery in people with mental ill health. Once people are housed, they can begin to address issues that have contributed to their homelessness and/or been exacerbated by it, including psychological distress and post‐traumatic stress disorder. Stable housing is crucial to clinical improvement; episodes of illness may undermine such stability. Picture of a person with a substantial beard. Specialist homelessness services refer to specialist homelessness agencies and the assistance they provide. This includes support to maintain an existing tenancy or to deal with particular housing issues. Agencies can be specialised and directed towards clients with specific needs, including safety issues, substance use, mental health, physical health, gambling and neighbourhood issues. Support is provided for clients largely by case management that addresses the clients’ identified goals. 27 per cent of people who accessed specialist homelessness services in 2016–17 had a current mental health issue (Parliament of Australia). Specialist homelessness service providers vary by states and territories. Browse My Community Directory for accommodation assistance across Australia.
Housing and the NDIS Lesson 4 of 6 Housing and living arrangements (e.g. choosing where, how and with whom to live) can influence our quality of life. A well-designed home in the right location can allow for more independent living arrangements, increased community connection and access to informal supports. Most participants will continue to access housing in the private market (by owning or renting), or through social housing. Although the NDIS cannot pay a person's rent, there are different types of home and living supports that the NDIS can fund. Housing supports within the NDIS Housing needs can be addressed both directly and indirectly by the supports and services within a participant’s plan. The NDIS may fund temporary accommodation, supported living and capacity building supports such as assistance with tenancy management. The NDIA can work with mainstream services and states and territories to facilitate access to the NDIS for a person experiencing homelessness, and to develop a coordinated plan of supports; however, it can be difficult to access NDIS support without a fixed address. States and territories remain responsible for homelessness responses, including the provision of social and community housing. Checkboxes: • The NDIS must consider individual participants’ housing arrangements to support mental health recovery for people with psychosocial disability. • Homelessness and unstable housing can undermine participants’ mental health and can impede their ability to make full and effective use of their NDIS support arrangements. • NDIS workers must determine whether a participant may be at risk, or facing future risk, of housing instability. Identifying these factors and conducting a thorough risk assessment at the early stages of planning and throughout plan implementation provides an opportunity for early intervention. Key questions around what people’s housing needs are and where they live should be asked. • Unaddressed psychosocial stressors can significantly impact on tenancy management. A person with a psychosocial disability may need support to manage the practicalities of a tenancy, and issues around tenancy. Peer workers can provide support to assist people to settle into a new tenancy. • When a participant doesn't have a fixed address, the NDIS can refer the person to a homelessness service provider. It is crucial that the NDIS is implemented in close coordination with state and territory supports and services for people experiencing homelessness and providers of various forms of supported and social housing. Picture of a face What the NDIS can provide help with The NDIS has a webpage with information about housing supports. All requested housing supports must meet the reasonable and necessary criteria in order to be funded. Learn more about reasonable and necessary criteria in our online training module. Front of card: Assistance with Daily Life Back of card: Assistance with Daily Life is a support category in a participants’ Core supports budget. This is for assistance or supervision of personal tasks during daily life that enable people to live as independently as possible. These supports are provided individually to participants and can be provided in a range of environments, including their own home. Read more here. Front of card: Home Modifications (HM) Back of card: Home Modifications (HM) are changes to the structure, layout or fittings of a participants’ home, so they can safely access it and move around comfortably. The NDIS can fund home modifications to make a participant's home accessible. Modifications to rental properties require written agreement from the property owner. Read more here. Front of card: Individualised Living Option (ILO) Back of card: An Individualised Living Option (ILO) is a package of supports that lets a participant choose the home they live, in the environment they have chosen and set up supports that best suit them. Read more here. Front of card: Supported Independent Living (SIL) Back of card: Supported Independent Living (SIL) is help or supervision with daily tasks in a person’s home to help them live as independently as possible, while building their skills. It includes things like having a person to help with personal care tasks, or cooking meals. Read more here. Front of card: Short Term Accommodation Back of card: Short Term Accommodation, including respite, is funding for support and accommodation for a short time away from a person’s usual home. It covers the cost of their care in another place for up to 14 days at a time. They might have a short stay with other people, or by themselves. It’s often funded when their usual carers aren’t available, or to try new things. Read more here. Front of card: Medium Term Accommodation Back of card: Medium Term Accommodation gives participants somewhere to live while they are waiting for a long term housing solution. The NDIA will only fund it if a person is waiting for their disability related supports and have a confirmed long term housing solution. The NDIA usually fund Medium Term Accommodation for up to 90 days. Read more here. and learn more about eligibility criteria here. Front of card: Specialist Disability Accommodation (SDA) Back of card: Specialist Disability Accommodation (SDA) is a range of housing designed for people with extreme functional impairment or very high needs. SDA homes are constructed to be more accessible for participants. They enable better or safer delivery of other supports a person may need. SDA usually involves a shared home with a small number of other people. Read more here. Side profile of a man wearing a cap. What the NDIS doesn’t cover NDIS participants are responsible for day-to-day living costs. This includes rent, groceries, utilities, telephone or internet costs, as well as general household items (e.g. a bed, fridge or cooking utensils). Short quiz about Javier, who experiences psychosocial disability. What can a mental health worker do to help someone who is experiencing homelessness? - Prospective participants who are at risk of, or who are experiencing homelessness, should be identified. - A trauma-informed lens should be used throughout discussions. Having this type of lens means being aware of the impact of various traumatic life events and experiences which impact people over the life-course (e.g. being removed from parents, experiencing substance abuse issues). - There may be a lack of understanding around what the NDIS can provide for people experiencing homelessness. Workers should support prospective participants to break down the complexities of the NDIS, and explain how the NDIS works and how it can best benefit them. - Workers should liaise with, and provide referrals to mainstream services to coordinate accommodation supports for people at risk of, or experiencing homelessness. - Tenancy literacy (i.e. information around the management of a tenancy) should be developed with participants, to help them remain in suitable accommodation. - Mail may be redirected to a local post office if a prospective participant does not have a fixed address. - With the participant’s consent, an NDIS worker can list themselves as a contact on the person's file so they are able to call the NDIS without the client being present. Emailing a copy of a consent form to the National Access Team (NAT@ndis.gov.au) as well as verbally listing themselves as a contact is best practice to ensure future contact can be made. - SAHSSI has a list of practical considerations for people experiencing homelessness. - Centrelink can make some payments weekly instead of fortnightly for people who are homeless or at risk of homelessness. Centrelink may provide assistance with bonds to help people get started in the private rental market.
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