Felicity Reynolds CEO, Mercy Foundation

10 December 2013

As well as the Mercy Foundation, the organisations that have worked to do VIs in Australia as well as the important follow-up work to get people housed: Micah Projects, Brisbane

Homeground, Melbourne

Way2Home, Sydney

RUAH, Perth

Wentworth Community Housing, Western Sydney

Common Ground Tasmania

.....and many other housing & homelessness partner organisations with whom those services have worked.

Chronically street homeless people in Australia make up a small % of the total homeless population – but they are one of the most vulnerable groups of people in Australia.

Homeless people have a much higher morbidity and mortality rate than the rest of the population.

The VI has not only provided useful data, but has provided a methodology for local responses that ensure people are prioritised for housing and support.

Understanding chronic homelessness in Australia

About the Vulnerability Index Summary results from cities/locations What has been happening since the VI

projects/Registry Weeks? Housing types and PSH What do you need to be safe and well (quotes

from participants in Western Sydney).

Relatively small problem – (which means it is potentially solvable).

Success to date – rough sleepers now 6% (ABS 2012) – was 11% of total homeless people in 2001.

Power law distribution (next few slides). High cost - various cost studies. High morbidity and mortality.

Australia has a moderately satisfactory safety net.

We could do better. That said, the majority of people who

experience homelessness – experience it quite briefly (many don’t even realise they would be counted as ‘homeless’).

Homelessness does not have a ‘normal distribution’.

If homelessness doesn’t have a normal distribution – then why would we distribute our funding and services using a normal distribution?

Eg. a normal distribution assumes that the bulk of people have moderate support needs. Smaller numbers have high or low needs.

Power-law tells us that the bulk of homeless people have moderate and low needs.

We need to be careful not to ‘over-service’ people with relatively low needs (eg. they may simply need affordable housing) and not ‘under-service’ that smaller group of people with quite high needs.

Does everyone who becomes homeless need crisis accommodation, a case manager and a transitional housing option? Pathologising every homeless person hides the fact that poverty and unaffordable housing is the root cause of most homelessness in Australia.

Yet (conversely) – shouldn’t we know who is chronically homeless, what their health and housing needs are and offer high quality and professional support services (& housing) to our most vulnerable citizens?

VI based on research by Hwang and O’Connell

Registry Week methodology from the 100khomes campaign.

Each community works together to identify and survey street homeless people over 3 mornings.

Not anonymous – important to know who and where to follow-up.

Community services then work together to prioritise with appropriate housing and support the most vulnerable.

VI – 8 vulnerability factors that place homeless people at risk of dying than people who housed.

So far, been done in 7 cities/regions in Australia. Brisbane, Inner Sydney, Western Sydney, Townsville, Melbourne, Hobart, Perth.

6 months homelessness or longer and…… End Stage Renal Disease History of Cold Weather Injuries Liver Disease or Cirrhosis HIV+/AIDS Over 60 years old Three of more emergency room visits in prior

three months Three or more ER or hospitalisations in prior year Tri-morbid (mentally ill+ abusing substances+

medical problem)

• Housing history

• Health

– Usual health services accessed

– ED presentations in the past three months

– Hospitalisations in the past twelve months

– Questions related to physical health conditions

– Drug and alcohol

– Mental health

• History of trauma Institutional involvement

• Demographics

• Engagement with support services

677

56

171

530

321

226

535

2386 people surveyed as at November 2013

191

City/Region Number of Interviews Vulnerable count % vulnerable

Brisbane 677 446 66

Hobart 229 143 62

Melbourne 536 343 64

Nepean (Western Sydney) 176 95 54

Perth 191 130 68

Sydney (Inner city) 530 356 67

Townsville 56 36 64

Total 2395 1549 65

28% had been in foster care 75% had spent time in police cells 53% had been in prison Half of the number surveyed had not been

housed at all in the past three years 26% had been housed/re-housed 3 times or

more 6% had been housed/re-housed 10 times or

more.

61% reported a mental health condition 51% reported having received treatment for a

MH condition 73% reported drug/alcohol abuse 46% reported having received treatment for

drug/alcohol abuse 51% had been the victim of a violent attack 24% reported a disability that limited their

mobility. 29% reported a brain injury or head trauma.

# Surveyed 530 Total vulnerable 356 From those vulnerable:

Tri-morbid 214 (60%)

3x ER or hospital last year 140 (40%)

3x ER last 3 months 65 (18%)

> 60 years old 60 (17%)

HIV+/AIDS 12 (3%)

Liver Disease 101 (28%)

Kidney Disease 33 (9%)

Cold/Wet Weather Injury 46 (13%)

What’s been happening………

• The VI has been designed to identify those who are most vulnerable, have

significant health issues and are at a higher risk of dying

• While the VI was designed in Boston, our experience in Australia shows that

there are synergies with the Australian population

• We know that housing is critical to addressing presenting health conditions and

reducing mortality risk

• In Brisbane 222 people of the 654 now surveyed have been permanently housed.

• Inner Sydney has seen more than 190 people permanently housed – through

Way2Home Outreach service. 26 people who were on the VI register were

prioritised for PSH in Common Ground at Camperdown. 72 People have been

housed by Platform 70. In addition, 62 housed by AAOS.

• Melbourne has housed: 86

• As at end 2012 Hobart had housed: 35

The Australian government target is to reduce rough sleeping by 25% by 2013

Follow-up made possible and easier. Overwhelmingly – people completing VIs

have stated that they want housing asap. Measurable results. Understanding who was

homeless and who is now housed offers a way for local communities to track progress in ending/reducing chronic homelessness.

Significant research from overseas (less so in Australia) that a Housing First methodology works well for chronically homeless individuals. That said – should usually also be matched with ongoing support to sustain housing – if needed. (See next slide PSH).

Housing can be an effective health intervention (eg. Dr O’Connell and his wish to write a prescription for housing).

Stairway model (crisis, medium, transitional) does not work as well for people with high needs. (Support needs that may never go away).

Whilst Housing First is a methodology for housing chronically homeless people – permanent supportive housing (PSH) is a way by which people with high (and possibly ongoing) needs can be supported to sustain housing.

A range of models: Single site (all tenants have support needs); CG % of tenants have support needs); scatter site (eg. Project 40).

All models offer support – preferably consumer driven.

A roof over my head

Somewhere dry and warm

Good food, affordable housing

My own space

A home

Help with getting a house

House and stability

Feed and a roof over my head

Safe and secure accommodation

A place I can live so my Grandkids can visit

Roof over head and food and people to trust

Somewhere permanent to live

Housing – so that I can have my children restored

Stable home

Permanent accommodation and employment

Stable accommodation, close to doctors and services

A house with a backyard

A home for me and my son

A house for my baby

A stable living environment that would enable my partner

to look for work

A warm house, 1 bedroom, close to shops and transport.

Further information Felicity Reynolds CEO, Mercy Foundation 02 9911 7390 Felicity.reynolds@mercyfoundation.com.au