Housing is good health care. There is overwhelming evidence that poor health is both a cause and a consequence of homelessness. We also know that the longer a person experiences homelessness, the more serious the effects on their health and wellbeing.
That is why we believe that housing, and health care, and support, is key to ending homelessness. Many of our clients are typically disengaged from primary health care services and often do not access care to treat or manage the extent of their health issues prior to engaging with us. Recognising this as a critical gap in the system, we provide access to integrated health services at most of our Launch Housing sites, funded primarily through philanthropic partners and Homes Victoria. Each of our programs are pilots, supported by ongoing monitoring and evaluation.
Onsite health practitioner access is available at our Southbank Crisis Accommodation site and our women’s only crisis accommodation in East St Kilda, Elizabeth Street Common Ground supported residential housing, our residential Better Health and Housing Program delivered in partnership with St Vincent’s Hospital and Brotherhood of St Lawrence, and as part of our Housing First and assertive outreach programs.
This year, we directly supported over 500 people with their health and wellbeing needs, through medical emergency responses, assisted referrals to general practitioners and health professionals (dental, optometry and allied health), and ongoing chronic health management, particularly with mental health.
Early trends from these integrated programs demonstrate (see Program Highlights) improved use of community healthcare services which is reducing costs to, and pressures on the wider health sector by decreasing avoidable ambulance callouts and hospital admissions.
Wider research also supports these findings. A study of two St Vincent’s Hospital Melbourne homelessness health programs found that both programs achieved significant cost savings to the sector. The first program, which provided access to community nurses and primary health care drop-in services, resulted in a net cost decrease in emergency department and hospital admissions by $2,793 per client after 24 months.
The second program found that the provision of sub-acute care as part of an integrated program generated a net cost reduction of $3,827 per client after 12 months. After 24 months post-contact, this increased to a cost reduction of $11,621 per client.
Key initiatives within our Health and Wellbeing portfolio are generously supported by the DGP Foundation and individuals and families who wish to remain anonymous.
Program highlights
The Nursing Response at Southbank project
The nurses at our Southbank Crisis Accommodation site supported over 126 clients this year. Southbank has the most established and integrated onsite health services, offering therapeutic support and clinical nurses throughout the week. Nurses are available on-site between 8am to 8pm with clinic hours from 10am – 6pm.
Over the years, Southbank has seen an increase in the number of clients with high health needs being referred to our site as a result of having dedicated healthcare services onsite. While this has been beneficial to clients, it has put pressure on nurses and reinforces the need for additional and ongoing funding to meet demand.
A recent evaluation of the nurses’ support concluded that nurses have had a significant positive impact on clients with multiple and complex health needs and who are disengaged from mainstream health providers. Nurses use every client engagement as an opportunity to build trust and rapport which is critical to supporting improved health outcomes. Having nurses onsite also reduced ambulance call outs and presentations at emergency departments.
“[My] health overall is probably the best it’s been in the last three or four years … and my mental health is probably the best that’s been in about ten years. I wasn’t even aware of half the services they’ve been able to put me in contact with and they were invaluable. They help me plan and all that sort of stuff and you know just supporting me with everyday health and everything in helping managing stress and all that sort of stuff.”
– Southbank Project Client
Many of our clients present with complex histories of trauma and substance use, as well as significant mental and physical health needs. Our Southbank Crisis Accommodation is trialling a therapeutic Alcohol and Other Drugs (AOD) program alongside the nursing program to better support people with complex needs.
The AOD team at Southbank supported 174 clients this year. Our team use a harm reduction approach which is compassionate, non-judgemental and realistic. We also facilitate a secondary Needle & Syringe Program onsite and all our staff are trained in overdose prevention and response, supported by our multidisciplinary team including clinical nurses. Together these programs enable our clients to use safely on site while working on their AOD goals in a trauma informed and person-centred environment.
Our focus for next year is to engage an onsite mental health practitioner to work in partnership with our clinical nurses and AOD team to properly meet the needs of our clients.
This year, the Alcohol and Other Drugs (AOD) team supported a 43-year-old woman who presented as having complex medical issues associated to her substance use, as well as ongoing trauma associated with conflict amongst her family and separation from her young child. The team assisted her through strong advocacy surrounding her health needs and support requirements. This has resulted in her acceptance in a short-term detox stay which has transitioned into a long-term AOD recovery program. The client said this is the first time she has attempted long-term recovery options since she started using alcohol over 20 years ago. The client continues to work on her recovery in the long-term rehabilitation residential service with the goal of staying sober and reunifying with her son.
The Nursing Response at Southbank would not have been possible without the vision and generosity of the Shine On Foundation who have entirely funded the program since 2016.
Cornelia Program
Pregnant women experiencing homelessness are more vulnerable as they face multiple challenges including reduced access to private rental, higher risk of family violence, less access to medical support, and poor access to nutritious food. These challenges can all have negative impacts on maternal and neonatal health. Collaborative responses between health and housing service providers can help produce better outcomes for a woman and her baby.
The Cornelia Program was established to support pregnant women presenting to homelessness services who required urgent, specialised, and longer-term health and housing supports that meet their complex challenges. The program is a partnership with Royal Women’s Hospital and HousingFirst, primarily funded by philanthropy. It is breaking the cycle of homelessness by providing housing and antenatal support to expectant and new mothers. This program demonstrates the importance and intersection of health and wellbeing.
This year, Cornelia supported 57 women and 30 babies, including 24 women from culturally and linguistically diverse backgrounds, and eight Aboriginal and Torres Strait Islander women.
The program supports women’s health needs as a priority and helps them build their independent living skills before finding them long-term housing. Affording private rental is difficult for many of these single mothers and community housing offers an alternative option.
The program has positively impacted the health of the women and babies, by supporting women to access pre- and post-natal care and to build strong mother-child connections in a safe environment, supported by a community. This year, Cornelia assisted 30 women to move into long-term secure and affordable housing that provides them a foundation to build a new life.
The Cornelia Program won two awards this year—the Urban Developer 2022 Excellence in Industry Leadership Award and the Victorian Protecting Children’s Award.
“I have not felt alone due to the continuous support from the Cornelia team as well as the super complementary information/education sessions. Being well informed is so important to me as a first-time mum and has helped me feel more in control of my pregnancy journey.”
– Cornelia Program Resident
Women and their babies in the Cornelia Program are generously supported by Paul Ramsay Foundation, Frank Montagnese Foundation, donors to Families and New Beginnings and generous individuals and families who would prefer to remain anonymous.
Elizabeth Street Common Ground
Launch Housing commenced a new, philanthropically funded, partnership with St Vincent’s Hospital in June 2022, with two nurses supporting 52 clients, 91% of the residents at Elizabeth Street Common Ground.
The program delivers strong health and housing outcomes for residents. The partnership with St Vincent’s Hospital is also helping to improve utilisation of the healthcare system by reducing unavoidable ambulance call outs and hospital admissions.
Long-term housing provided through Common Ground allows the onsite nurses to build relationships and trust with residents over time. These connections and support are enabling residents to improve their capability to independently manage chronic health conditions and advocate for their needs—things that had been challenging to achieve previously.
Residents have responded very positively to the nurses’ friendly, trustworthy, and practical approach.
The program also focuses on preventative care through health promotion activities. In October, the nurses hosted a Mental Health Day event with mindfulness and art therapy.
The nurses also hosted a successful Dental Health Day with stories of people, who hadn’t seen a dentist in many years, now living pain free and no longer embarrassed to smile. Health promotion activities like these lay the groundwork that encourage and support residents to access mainstream services.
Dental health care is one of the most challenging services for people experiencing homelessness to access and yet one of the most important health services for prevention and early detection of other significant health issues. Supporting access to dental health care is a priority for all our clients in the coming years.
“We had many returning patients… who were interested in pursuing both help for chronic illnesses and getting on top of new or acute issues. Preventative health has remained of interest to our patients…We have had a high level of interaction and follow up with tertiary health services for residents with complex chronic conditions and frequent presentations.”
– Elizabeth Street Common Ground Nurse
The Elizabeth Street Common Ground nursing program has been made possible through the generosity of the Brian & Virginia McNamee Foundation who have funded the program since its inception.
Better Health and Housing Program
Through integrated housing and health support, the Better Health and Housing Program (BHHP) supports housing, health and wellbeing outcomes for people experiencing chronic homelessness and co-occurring health conditions through a six-month residential service.
The program is a partnership with St Vincent’s Hospital Melbourne, Brotherhood of St. Laurence and Homes Victoria and commenced in August 2022. To date, we have supported 43 residents. Residents noted that the program offers them a secure base, encourages a social environment, and provides care that enables them to take challenging steps towards housing and health goals.
We are currently undertaking an evaluation, and as outlined below, early results show strong health and housing outcomes for residents.
Residents with planned exits from BHHP reported improvements in wellbeing, measured using the Personal Wellbeing Index (PWI-A) (International Wellbeing Group 2013). Upon entry, this group’s average score was 44.6 out of 100, which rose to 74 at exit, almost equalling the Australian mean score of 75.3. This is a significant outcome considering all residents had experienced chronic homelessness and were considered high acuity, with urgent and complex needs requiring immediate support.
Residents with both planned and unplanned exits took positive steps towards better managing their health. Upon exit, nearly all residents, with planned exits, were connected with a general practitioner (GP) (10 of 12 residents, 83%) – an improvement from entry where only seven out of 12 residents had links with a GP. Further, 74% of residents identified improvement in the management or resolution of one or more health issues, with 37% of clients noting improved management of mental health issues.
Early data on service utilisation from St Vincent’s Hospital (as at September 2023) shows that residents were four times less likely to present to the emergency department and three times less likely to require an acute hospital admission. Further analysis of this data will be undertaken, and findings shared in our next report.
These results show that providing integrated health care and housing support not only delivers better outcomes for our clients, but also increases capacity in the wider healthcare system by helping people before their conditions become an emergency.
Homelessness to a Home
The Homelessness to a Home (H2H) program supports people with a long history of rough sleeping to find good housing outcomes connected to ongoing support (see also Impact Measure two).
Our H2H program consortia consisted of Launch Housing, MIND, Uniting Vic/Tas, Victorian Aboriginal Community Services Association Ltd (VACSAL), cohealth and Bolton Clarke. Together, we worked with 25% or 449 of the total 1,800 H2H program participants state-wide.
Clients who were referred to H2H from other Launch Housing services were known to us for an average of eight years, indicating that they have been accessing homelessness services and experiencing chronic homelessness for close to a decade.
The longer a person experiences homelessness, the more serious the effects on their health and wellbeing. Access to primary health care is not only considered an effective way to address chronic mental and physical health issues but it is also a preventative measure to tertiary care. However, many clients were initially reluctant to seek care due to previous negative experiences.
Program nurses were able to develop trust and rapport with clients by providing continuity of care, flexibility, and material aid. Clients became open to having a nursing assessment and health care coordination as part of their support.
Analysis of program data showed that in 2022, of 382 clients who received support, 320 people (84%) had a dual diagnosis of Alcohol and Other Drugs (AOD) and mental health that impacted their life and housing situations. 199 people (52%) had tri-morbidity of AOD, mental health and chronic illness. As a result of clients accessing the program’s holistic and multi-disciplinary support services, their untreated, undiagnosed, and longstanding health issues were identified and addressed.
The program is also demonstrating significant housing outcomes for this group with 86% of our clients stably housed at Sep 2023. This is an especially noteworthy result, given the complex physical and mental health challenges the group has faced. The H2H approach demonstrates the importance and impact of ongoing health and housing and support services to end homelessness.
“Generally, it takes several months to engage with a new client. Workers need time to engage and understand the clients, clients need time to adjust to their new situation and feel safe and build trust with workers, and to think about what type of support suits them best.”
– Homelessness to a Home nurse
A small number of clients participating in the Homelessness to a Home program were generously supported by Lord Mayor’s Charitable Foundation to keep their housing when they were unable to continue paying rent due to participating in rehabilitation programs or similar. In normal circumstances, these people would have lost their housing, pushing them back into homelessness when they exited the program.