Our focus on Health and Wellbeing

Homelessness in Australia has become a health emergency. People sleeping rough are dying — alarmingly younger than the general population and often from conditions that are easily treatable. They have higher rates of suicide and are more likely to have a mental health condition and post-traumatic stress disorder.

Those with complex health and mental health needs are also more likely to experience homelessness for longer periods and are often repeat service users. The way our system is currently structured there simply isn’t enough integrated, targeted support or appropriate housing for people. That’s why we have been working with our partners and the philanthropic community to develop and test new solutions to ending homelessness for people sleeping rough. Read more about the issue and solutions to address it in our Insights Paper Series on Health and Homelessness here.

Providing an integrated health and homelessness response is critical to end homelessness. Many of our clients are unable to access mainstream health services, that are already overburdened. Our most effective programs are providing clients with much needed healthcare and wellbeing supports embedded into our core homelessness support services.

We do this by integrating nurses and alcohol and other drugs (AOD) support at our crisis accommodation sites, investing in supportive housing models that integrate long-term care coordination, providing individualised healthcare plans, and supporting people with complex physical and mental health needs. However, one of the most significant challenges we still face is access to appropriate, timely and ongoing mental health care for our clients. We continue to advocate for the people we work with so that their needs are taken into consideration as part of the mental health system reforms underway in Victoria.

We also measure and track wellbeing outcomes of clients in our programs. We use the Personal Wellbeing Index (PWI) tool to allow clients to self-identify their personal wellbeing, so that case managers can identify, tailor and coordinate their service needs.

Key points

This year we continued to expand our health supports, including our AOD program, across our sites and services.

• 2,350 clients had access to a nurse and health supports through a Launch Housing service
• 672 people had access to AOD support
• The Better Health and Housing Program delivered long-term, sustainable and scalable value to the Government with cost-savings estimated to be between $11.8 million and $18.6 million over a 10 year period.
• 346 H2H clients housed by the end of the program.

Meeting people where they are at

We are primarily a housing and homelessness service, nonetheless our work very often involves partnering with health services to provide much needed healthcare to people experiencing homelessness.

For people sleeping rough on the streets of Melbourne, accessing healthcare is challenging, or even impossible. Managing complex or chronic health issues like diabetes or getting treatment for injuries and wounds is difficult when you don’t have a safe place to live or access to a phone or a place to store medication. Negative experiences with mainstream services also prevent people from seeking the vital healthcare they need.

That’s why we meet people where they are at. We bring healthcare to them.

We provide an integrated health and homelessness response for people experiencing homelessness who have complex physical and mental health needs. Our programs — including Melbourne Street to Home, Assertive Outreach teams and the broader Rough Sleepers Initiative (RSI), and the From Homelessness to a Home (H2H) Program — bring much needed healthcare to people sleeping rough on Melbourne’s streets.

We also take a harm minimisation approach for people experiencing homelessness who use alcohol or other drugs. The aim of this approach is to accept people as they are, support them without judgement, recognise that substance use is often a result of trauma and a way to cope, and then assist people to manage their substance use in a way that reduces physical and emotional harm, the risk of premature death and the risk of losing their housing.

Melbourne Street to Home: Bringing healthcare to people sleeping rough

The Melbourne Street to Home (MS2H) team understands the many ways in which health and housing issues are related and works with people sleeping rough who have extremely complex physical and mental health needs. MS2H has an integrated health response, with community health nurses from Bolton Clarke as core team members, assessing clients’ health needs and referring and supporting clients to specialist services if required.

Launch Housing supports some clients over the course of many years while they wait for appropriate housing to become available and in their first year after moving into a new home. For example, we worked with a woman for over five years providing intensive health and transitional housing supports. This year, when she was finally able to move into secure housing, she underwent — and recovered from — two surgeries resulting from chronic health issues. The surgery and successful recovery would not have been possible for her previously without having a safe home in which to recover.

Assertive Outreach, Rough Sleeper Action Plan (RSAP) and Rough Sleepers Initiative: Every client has access to a nurse

We have one of the largest homelessness assertive outreach programs in Melbourne and provide care and connection for people sleeping rough in Melbourne CBD, and the Cities of Port Phillip, Stonnington, Frankston, Dandenong and Yarra. Our assertive outreach teams offer assessments, case management, pathways into emergency and crisis accommodation and housing. They also provide critical practical support to implement ‘Advance to Zero’ in seven LGAs, identifying people who should be on the local By-Name-List (BNL – a shared list between partner agencies with every person sleeping rough by name in a local area; an innovation created through our Advance to Zero Initiatives) and helping coordinate care and services the individual needs.

To make it easier for people sleeping rough to access healthcare, Bolton Clarke nurses are embedded into our outreach teams. Nurses provide important medical support to people sleeping rough, including wound care management, access to vaccinations, mental health supports, and can also refer and support clients to access other health services, including dentistry.

Housing First programs: Long-term, wraparound support with stable housing

Programs like Homelessness to a Home (H2H), which supported people with long-term history of sleeping rough into housing, show how multidisciplinary approaches can deliver effective health and homelessness responses.

“The accommodation with that wrap around support does give good outcomes… We can’t start to address some of their really well entrenched difficulties, challenging types of behaviours, the drug and alcohol, mental health, unless they’ve got a secure accommodation and roof over their head.”

H2H Case Worker

While the H2H program ended this year, an evaluation of the program found that 95% of all clients were in stable housing on 1 September 2023, and 93% of clients in stable housing sustained a tenancy for longer than 12 months. These outcomes are rarely seen in homelessness programs, especially for people with a long-term history of sleeping rough.

The effectiveness of the H2H program was underpinned by its unique approach to combining access to stable housing, with fully funded, integrated multi-agency services including healthcare, First Nations specific supports, mental health support and long-term case management support. At Launch Housing, we led a multi-disciplinary consortia of six organisations that provided support to 25% of the H2H clients funded across Victoria. The effectiveness of this integrated partnership approach was clearly demonstrated in the evaluation, and we will continue to advocate for Housing First programs that support and fund a true, multi-disciplinary approach to ending homelessness.

Integrating nurses and AOD support at crisis accommodation sites

Chronic health, mental health issues and AOD use as a result of long-term homelessness are the most common health conditions experienced by people sleeping rough. These health problems escalate every night a person is without a home.

By integrating nurses and AOD support at crisis accommodation sites, we can make healthcare more accessible. Our crisis accommodation sites — at South Melbourne, Southbank, Bob’s Place, and East St Kilda — all have multidisciplinary teams to provide health support to clients.

Building on the evidence from our pilot programs, this year, we expanded our AOD support to sites including Bob’s Place in Dandenong and Elizabeth Street Common Ground.

Southbank Crisis Accommodation: Engaging at the right time

At our Southbank Crisis Supported Accommodation, we provide holistic health and wellbeing supports, including nurses and AOD services. This year, 412 people had access to services from nurses and the AOD team at our Southbank site.

Through the Better Health Network (BHN), nurses arranged a visiting General Practitioner (GP) to hold half-day clinics on site every Thursday. This has been a significant addition as it recognises the barriers for people accessing arranged appointments in mainstream services, allowing crisis residents to see a GP in the comfort of their own accommodation, with the support of the nurses they have the relationship with, enabling people to address concerns with no delay or barrier to access.

Knowing when to offer healthcare to someone in crisis is hugely important, and something that our teams do well. Our teams know that it’s not just about providing access to healthcare — it’s important to know when to bring healthcare to a person in crisis.

Our teams understand that when people present to our crisis sites, there is trauma and often a lack of trust of mainstream service providers. Depending on each person’s circumstance, it can take days, weeks, even months to build trust and for people to feel settled and safe enough to engage with our healthcare teams.

The nursing response at Southbank received generous support from Metro Trains Melbourne. We thank you for your commitment to supporting people experiencing homelessness with essential health supports.

Bob’s Place: Addressing much needed, often neglected issues like dental health

Through a partnership with Bolton Clarke, a community health nurse is also embedded in our Dandenong crisis supported accommodation site, known as Bob’s Place. It offers short stays, intensive case management, and advocacy for families, couples and singles.

We link clients to services including allied health, optometry, podiatry and, importantly, dental. For people experiencing homelessness, oral health can be a significant issue. Dental health is difficult to access in the mainstream system and is often not considered emergency or essential. Linking clients to dental services can be life changing and shows how holistic healthcare can lead to better physical and mental health outcomes.

This year, we committed to further strengthening how we do things at Bob’s Place. We established an Advisory Group to help us better navigate the particularly complex intersection of harm reduction, working with families, working with pregnant women, engaging child protection, and AOD.

Specialist women’s services: Recovery from trauma and violence

Our women’s only crisis accommodation site offers crisis accommodation, case management and advocacy to women experiencing homelessness in Melbourne.

This site is one of the only non-refuge, crisis accommodation services in Victoria to employ and accommodate women only. It supports women who don’t meet the criteria for other crisis accommodation who have past histories of family violence, existing substance use or ongoing contact with current or former partners who use violence. It also offers services to trans and gender diverse individuals who identify as female. Our multidisciplinary teams provide a holistic approach to support and care for women by helping them connect to healthcare, counselling and many other services.

This women’s only crisis site is separate to Viv’s Place, which is a long-term supported, community housing for women and children escaping family and domestic violence. You can read more about Viv’s Place here in our Families and New Beginnings Theme.

“They saved me in so many different ways, I couldn’t be happier with the support I received, they just kicked goals.”

Client

This year, we welcomed a nurse practitioner onto our multidisciplinary team. The nurse has been a valuable addition to the team and has helped women by:

• Conducting bloodwork and STI checks.
• Providing Centrelink medical certificates, ensuring women in crisis have a 3-month exemption for looking for work while facing homelessness.
• Connecting women to other support services, such as the Mental Health Nurse and AOD
• Re-engaging women with the health system, with some not having contact with a GP for more than two years.

The nurse and the broader team work together to provide wraparound support for women staying on site. It’s a service that we know is hugely valuable for women experiencing homelessness.

Many women at the site, and across many of our other programs, have experienced trauma and violence, including family and domestic violence. Medical practitioners on site are often supporting women whose health issues stem from family and domestic violence.

The connection between family and domestic violence and homelessness is something we address in our Families and New Beginnings focus.

Investing in trauma-informed, supportive housing models

Long-term supportive housing that is trauma-informed and provides flexible, individualised services helps people better access support and stay out of homelessness.

Our long-term supportive housing models — including Elizabeth Street Common Ground — reduce barriers to accessing healthcare and support people to get out of homelessness.

Elizabeth Street Common Ground: Nurses supporting the wider ESCG community

Elizabeth Street Common Ground (ESCG) provides 65 studio apartments and delivers on-going support to improve residents’ health, wellbeing and lifestyle. Residents have access to 24-hour support on site to ensure they get the care and support they need in a harm minimisation environment.

The program delivers strong health outcomes for residents in partnership with St Vincent’s Hospital Melbourne. Nurses at ESCG provide health supports to residents as well as visitors and the wider ESCG community, including through a virtual ED video link up with Northern Hospital, nurses are increasing resident access to health interventions while reducing unnecessary ED presentations.

Creating community is an important part of what we do at ESCG. This year, we established a peer support group, a community network to support residents manage their health, share experiences and build connection. We also held barbeques, games afternoons, and other community gatherings.
Supporting clients to address their substance and addiction issues through a harm minimisation lens is also a priority. This year, we strengthened our AOD response at ESCG with the introduction of the AOD Outpost role and training seminars co-facilitated by nurses.

The nursing response at ESCG is made possible by generous donations from the Brian & Virginia McNamee Foundation. Thank you so much for your commitment to improving residents’ health and wellbeing.

Better Health and Housing Program: A safe place to recover

In Australia, there is no other program like the BHHP. The partnership between the Brotherhood of St. Laurence, Launch Housing, St Vincent’s Hospital Melbourne (SVHM) and Homes Victoria is an example of the powerful impact an integrated approach to health and homelessness can make.

The BHHP is unique because it gives people who are experiencing chronic homelessness and have chronic health conditions a home for six months, with access to specialist healthcare, care coordination and help to find long-term housing.

“It’s like a gift from God”, said 45-year old Teo, a resident at BHHP. When Teo entered the program, he had a long history of homelessness, including several serious health issues – trauma and multiple injuries from a 2019 motor vehicle accident. Once he was at the BHHP with his own room, a sense of security and stability, and access to individualised health support, Teo started to recover.

Teo is now living in a unit, where he enjoys making meals for himself and watching the footy. The support Teo received at BHHP set strong foundations for living independently and maintaining his home.

“The world, you can say, is your oyster once again”, as Teo puts it. Read more about Teo’s story here.

A recent evaluation of BHHP showed that program is empowering individuals to break the cycle of chronic homelessness and poor health. An economic analysis, done as part of the evaluation, demonstrated that the program had profound impacts on residents while also reducing government costs in the long term.

The BHHP was shown to deliver long-term, sustainable and scalable value to government with cost-savings estimated to be between $11.8 million and $18.6 million, or $200,700 and $314,800 per-participant, over a 10 year period.

The evaluation highlighted sustainable health, wellbeing and housing outcomes for residents, including improved health and homelessness service utilisation after leaving BHHP, delivering value and costs savings to the Victorian Government.

The evaluation covered 22-months of the program from inception until May 2024. During that period, 71 people entered the BHHP and 59 had exited, with 35 planned exits with their individualised care plans fulfilled and 24 unplanned exits but had still achieved meaningful health and housing improvements.

The evaluation established that more than a quarter of residents resolved a health condition while living at BHHP, a 50% increase in number of health conditions had been actively managed from entry to exit, subjective wellbeing scores across all Personal Wellbeing Index domains showed statistically significant improvements (p<0.05), and 91% of residents with a planned exit secured housing outcomes.

The evaluation also looked at organisation-wide service utilisation data across SVHM and Launch Housing and found that BHHP improved service utilisation for residents. Comparing six months pre-and-post BHHP, residents with a planned exit showed a 76% decrease in emergency department presentations, an average increase from 1.58 to 5.96 contacts with community mental health services and an average decrease from 1.08 to 0.5 acute unplanned admissions.

Launch Housing service utilisation data showed that in the six months following program exit, there was a considerable reduction in crisis-driven homelessness support provided to residents with a planned exit.

The full evaluation report is expected to be released in late 2024.

Looking ahead to next year

Housing is good healthcare. Stable housing has positive impacts on a person’s physical and mental health and wellbeing. Integrated health and housing supports delivers significant benefits for people experiencing homelessness and has huge cost savings for government.
It’s a solution we know works.

Looking ahead, we will continue advocating for further integration of health and homelessness support in Melbourne, specifically ongoing funding for the Better Health and Homelessness Program and our embedded nurses. We are also working with partners across Melbourne to explore additional supported housing in areas of greatest needs.

We can’t do it all alone. Our partnerships with health services, donors and local, state and federal government agencies are key to delivering this integrated approach to health and homelessness.

Key initiatives within our Health and Wellbeing portfolio are generously supported by the Percy Baxter Charitable Trust, RO Fund, a sub-fund of Australian Communities Foundation, and individuals and families who wish to remain anonymous.