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.auTraining objectives Lesson 1 of 10 Lesson 1: Homelessness and mental illness Homelessness represents the most severe form of housing need. The Australian Bureau of Statistics (ABS, 2012(opens in a new tab)) defines people as homeless when their living arrangement reflects any one of these three conditions Front of card Their DWELLING is INADEQUATE Click to flip Back of card Living in a tent or sleeping out or in a structure not meant to be used as a dwelling Click to flip Front of card They have NO EXTENDABLE LEASE Click to flip Back of card Couch surfing, living in accommodation provided by a homelessness service, staying in a caravan park or a boarding house with only short-term leases Click to flip Front of card They have NO PRIVATE DOMESTIC SPACE Click to flip Back of card Living in a severely overcrowded dwelling Click to flip Australians who have been homeless during their lives are more than 3 times more likely to have experienced mental illness compared to those who have never been homeless (ABS, 2008(opens in a new tab)). Specialist homelessness service user data shows: 1/3 of all people seeking housing assistance experience a mental illness. 69 per cent of service users experiencing mental illness are repeat users. 1/2 of service users experiencing mental illness also experience domestic violence and/or use alcohol or other drugs. almost 1/2 of service users who come from prison experience mental illness (AIHW,2021(opens in a new tab)). shutterstock_1016671648.jpg There is a two-way relationship between homelessness and mental illness RELATIONSHIP Poor mental health can make it harder to cope with housing problems arrow right arrow left Housing problems or homelessness can make mental health worse Mental illness is a risk The impacts of mental illness combined with negative community attitudes and inadequate service responses can put people experiencing mental illness at risk of homelessness: Behavioural, emotional and cognitive changes resulting from mental illness may make managing finances and maintaining neighbour relations difficult. Isolation and unstable relationships can exacerbate housing crises by limiting access to health care, emotional support and financial assistance. Poor physical health can limit a tenant’s capacity to clean and maintain a home. Inability to maintain employment may make housing unaffordable. Discriminatory attitudes to mental illness may limit access to available accommodation options. Hospitalisation can also lead to loss of housing (AHURI, 2019(opens in a new tab), Brackertz et al, 2020(opens in a new tab)). Homelessness heightens some risks Homelessness heightens people’s risk of acute and chronic physical and mental illness and premature death: Homelessness and lack of safety and security can exacerbate people's risk of trauma, psychological distress and hypervigilance. Increased substance use, unemployment, inability to access services and difficulties of homelessness can all worsen one's physical and mental health (Davis et al, 2020(opens in a new tab)).Lesson 2 of 10 Lesson 2: Housing’s role in well-being and mental health recovery Safe, secure, affordable and appropriate housing is critical for wellbeing and mental health recovery. Picture of feet in socks in front of fire, next to a mug that is wearing a furry coat of some sort. Housing is a social determinant of health Housing is a social determinant of people's mental and physical health because it forms a substantial part of their social and physical environment, while also standing as their largest and most unavoidable household expenditure (World Health Organization, 2014(opens in a new tab), 2018(opens in a new tab)). Research demonstrates how meeting each aspect of housing need has mental health benefits: For links to research mentioned above click Box 1, Box 2, Box 3 and Box 4. For links to research mentioned above click Box 1,(opens in a new tab) Box 2(opens in a new tab), Box 3(opens in a new tab) and Box 4(opens in a new tab).Lesson 3 of 10 Lesson 3: Overview of the Australian housing system People with a mental illness in need of housing find themselves in a housing system characterised by three key tenures: Home ownership/purchase Private rental accommodation Social housing Home ownership/purchase Homeownership or home purchase is the most dominant tenure in Australia with 67 per cent of dwellings owned with or without a mortgage ((opens in a new tab)ABS,2021(opens in a new tab)). However, it is important to note that the level is trending downwards. The current level of homeownership/purchase reflects: a decrease in home purchase for younger households and a decline in the level of outright home ownership for those near retirement (AIHW, 2022(opens in a new tab)). This is a departure from the expectations and experiences of post World War II generations of Australians. Private rental accommodation Private rental accommodation is the second largest and fastest growing tenure in Australia, representing 26 per cent of dwellings nationally (ABS, 2022(opens in a new tab)). The decline in affordable home purchase has meant people are renting longer and, in some cases, permanently. However, the private rental market has its own challenges: A lack of affordable rent for low-income households For households totally reliant on income support, there is almost NO private rental which is within affordability benchmarks: ...only five rentals were affordable for a single person on JobSeeker out of more than 45 000 listings. Just one is affordable for a person on Youth Allowance. All are rooms in share houses. Couples out of work single parents on Centrelink payments and people on the Disability Support Pension all face a market where 0.1 percent of rentals are affordable while a person on the Age Pension can afford 0.1 percent of listings (Anglicare Australia 2022, p.4(opens in a new tab)) This means poorer households often need to share accommodation, rely on emergency relief for food, utilities and other items, or go without. Image of magnifying glass hovering over text in the shape of a house. Insecure tenure Compared with home owners or renters in Europe, private renters have much less rights to stay as long as they want. This is referred to as a lack of a secure tenure. An estimated 29 per cent of tenants can be asked to move at a month's notice (Choice, National Shelter, NATO, 2018(opens in a new tab)). Residents of boarding houses, caravan parks and hotels are least secure under state and territory tenancy laws. Limited consumer protection Private renters have limited redress when they have problems. This is illustrated in terms of reluctance or inability of renters to complain about increased rent or needed repairs. Half of private renters live in a home that needs repair (Choice, National Shelter, NATO, 2018). Social housing Social housing is the term applied to housing managed by state and territory governments or community organisations. It is the smallest tenure in Australia, currently representing 3.6 per cent of all dwellings (AHURI, 2022(opens in a new tab)). Income-based rents Social housing rents vary according to household income. In general, social housing rents are set around a quarter of a tenant's income. Adding complexity to setting social housing rents, the income of household members who are not party to the tenancy agreement also affect the amount of rent payable. Social housing rents are capped at market rents. However, because allocations are highly targeted, most social housing households in Australia do not pay market rents. More security of tenure Social housing leases are generally renewable providing tenants: 1. Meet their tenancy obligations (namely, they pay rent and avoid property damage and neighbour complaints) AND 2. Demonstrate an ongoing need for affordable housing (for example, they cannot afford private market rents) .Lesson 4 of 10 QuizLesson 5 of 10 Lesson 4: Taking account of mental health and assessing housing need Be aware of people's mental health in all you do As with all service work, it is important to make sure that housing-related work is trauma informed and reflects recovery-orientated practice. These are things to keep in mind when assessing housing needs and helping people access and sustain their housing. Focus on the individual person Avoid deficit language and labelling. Remember homelessness, poverty and mental illness are experiences BUT they do not define who a person is. Keep in mind, people's mental health can be made worse by everyday interactions where people feel patronised or disrespected or blamed. Ensure people are well informed Clarify housing options, application processes and timeframes to maximise transparency and manage expectations Build an understanding of rights and obligations and options for redress and advocacy around tenancy complaints or instances of unmet service needs Support individual choice even if that choice is constrained Encourage an active role in articulating preferences and assessing housing options Work to improve people’s sense of personal control. and safety wherever possible Recognise the strengths of people living with mental illness Acknowledge people’s strengths, including their informal supports and capacities to identify and access housing options and maintain their housing. Take care of yourself as a worker Take advantage of opportunities for professional supervision Consciously identify and use stress management strategies. Document and report unmet needs Seek support and advice from managers and peers when needed For further reading on trauma-informed recovery-oriented housing practice consult research and resources by Mind Australia(opens in a new tab) and Wellways(opens in a new tab). Useful questions for assessing housing need When determining people's living situation, consider questions designed to assess the urgency, nature and complexity of their housing needs. Urgency of the housing need Are they homeless or at risk of homelessness? Are they sleeping out or in a car? Are they couch surfing? Are they staying in temporary accommodation? Are they having problems paying the rent? Do they feel safe at home? (e.g., do they face domestic violence, overcrowding or physical health issues?) Are they stuck in a hospital? Nature of the housing need What is the nature of their housing need? Are they wishing/willing to share? What type/size of house do they need? What are they able to afford? What are people’s locational needs to social supports, services and jobs? Do they have pets? Do they need a garden? How do they feel about near neighbours? Complexity of the housing need Are there other issues that represent barriers to accessing or sustaining housing? Think about discrimination Think about issues relating to mental or physical health or disability. Can they clean, garden or maintain a house? Do they have mobility or noise sensitivity issues? What is their tenancy history, skills and knowledge? Have they previously been homeless or had tenancy breaches? Do they have housing debts? Do they have rental references? Do they need help to apply or sustain a tenancy? Do they have family or cultural obligations for visitors? Are there other factors (such as domestic violence, alcohol and drug use) that make their living arrangements or housing unstable? In your day to day work, consider using or modifying an existing housing needs assessment tool. For example, consider Wellways Housing Action Plan(opens in a new tab) or the Wellways (2019)(opens in a new tab) housing resource for NDIS applicants/participants.Lesson 6 of 10 Lesson 5: Accessing housing system Lesson aims This lesson explains how to help people who are homeless when they are seeking private rental and social housing and when they are planning to buy a place of their own It acknowledges the specific issues faced by people living with mental illness and offers possible responses. Help when people are homeless Because people who experience mental illness are more likely to experience or be at risk of homelessness than the general population, it is important to know how to respond to them. Here's two key things to know and do when helping people access assistance from a homeless service: Know how to contact homelessness service system It is important to know if there are homeless services available in your location as they are designed as the first port of call for all urgent housing needs. If you do not know about your local services, there are central access points which provide information and referral to homelessness services in each state and territory.. Links to information about these access points for homelessness services in each State and Territory are included in the map at the end of this lesson. Make an appropriate referral To make an appropriate referral, it is important to understand the local availability of homeless services and their type of assistance and target group. It is useful to keep in mind that: Services may focus on crisis intervention, post crisis support and/or prevention and early intervention. Some services target young people, people experiencing family and domestic violence and/or First Nations people. Some offer basic, short-term interventions such as advice and information, meals and shower, laundry facilities, overnight and short-term housing. Some offer more specialised, time intensive services such as financial advice and counselling, professional legal services and transitional housing whilst waiting for a social housing priority allocation. Typically, these services provide case management and case coordination. Ask the person in housing need if they have preferences or previous service experiences. Homelessness services are sometimes experienced as unsafe and alienating places by service users (Brackertz et al., 2020(opens in a new tab)). This may be a particular issue for First Nations people relying on mainstream service providers without suitable staff, facilities and service models. Build good working relationships with staff in homelessness services. These relationships can be helpful in understanding what assistance is offered and likely issues faced by clients. They can also help ease the referral process for yourself and the person in housing need. An appropriate referral tries to find the best fit for the people you are working with, informing them about available options and the processes involved and maximising choice where possible. Helping people access private rental People with mental illness often depend on the private rental market because they cannot afford to buy a home or because there is a lack of social housing where they want to live or there are long wait times for local social housing. Here's three things to consider when helping people access private rental accommodation: Know about available assistance and how to access it The Australian Government provides Commonwealth Rental Assistance(opens in a new tab) as part of Centrelink's income support assessment and payment processes. State and Territory governments provide additional financial help to private renters, including bond assistance and tenancy information and advice services. Links to information about State and Territory governments' private renter assistance are provided in the map at the end of this lesson. Identify challenges in accessing private rental People may experience extra issues accessing the private rental market because of their mental illness. For instance: They may have difficulty making a rental application. This can occur when people are experiencing homelessness or are living in an institution such as hospital or prison. It can occur when stressed or unwell. It can also be because they lack references or rental history or have difficulty attending open inspections. They may find that real estate agents and landlords are unwilling to rent to them or assist if they are unwell during their tenancy. They may lack capacity to find information about available rentals or private rental assistance. These are in addition to the issues of affordability, lack of secure tenure and limited consumer rights, which affect private renters more generally. Understand how to respond to these challenges These are key things you can do to help someone experiencing difficulty with accessing private rental accommodation: Provide information about real estate agents and rental vacancies, available private renter assistance, tenancy rights and obligations and role of real estate agents and landlords Where available/needed refer to specialist housing workers to assist Help prepare rental applications and rental references Assist with transport to attend open inspections Build relationships with local real estate agents, landlords, boarding houses, caravan parks and hotels. In the process, provide information about mental health issues, including appropriate actions to take and individuals to contact when people do not feel well. Helping people access social housing Social housing is often considered the most appropriate housing option for people living with mental illness on a low-income because of its more affordable rents and its greater security of tenure. Here's three things to keep in mind in helping people access social housing: Know about eligibility and priority application processes To assist people access social housing as quickly as possible, it is critical to learn about eligibility criteria, priority allocation policies, requirements for supporting evidence and application processes. identify people who can assist with supporting evidence. develop relationships with people receiving, assessing and making offers of social housing within government and community managed social housing at a local level. Information about social housing and priority allocation policies for each State and Territory is included in the map at the end of this lesson. Identify access challenges for people living with mental illness People living with mental illness may face extra challenges in preparing social housing applications. This may be because: They are homeless or living at a hospital or prison. They have debts or have had other difficulties previously as social housing tenants. They are unwell and find application processes stressful or hard to navigate. They find that social housing providers have little understanding of mental illness. Understand how best to respond to these challenges Helpful responses include: Communicating clearly about social housing access process, wait times, housing and locational choices and the range of local social housing providers Assessing past social housing history and identifying any related issues that require attention to facilitate appropriate allocation and establish a sustainable tenancy. Providing information about rights and expectations as a social housing tenant. Referral to specialist housing workers to assist with applications or direct support in preparing applications and rental references where available and needed. Practical assistance with transport where required to attend inspect offers and meet with social housing providers. Liaison with support services, health professionals and social housing providers if ongoing coordination of housing and support is required. Advising social housing providers about mental health issues and what to do and who can help when people are unwell. Helping when people plan to buy a home People with psychosocial disability may plan to buy a house. This could include current homeowners who, due to support needs or a desire to lower housing expenses, are seeking to relocate. They could be buying a house with family support or in partnership with someone else. Here's three areas of assistance that would be useful when considering moving and buying a house: Help with financial decisions People should be encouraged to seek professional legal and financial advice when buying a home. They should also be fully informed about the range of homeownership assistance available from the Australian Government(opens in a new tab) as well as the State and Territory governments. Links to information about home ownership assistance from States and Territory governments are listed below on the map. Sometimes they may need support to access the information, financial advice and legal services they need. If concerned about their cognitive capacity to make such decisions, always seek advice. Practical and emotional support People may need practical help moving if unwell. They may also need emotional support in making decisions to buy and move their house. Overview of housing assistance The following map includes useful links on housing assistance provided within each State and Territory. This includes homelessness services, private renter assistance, social housing and help for home buyers. Map of Australia containing links to services in each state and territory. This State and Territory level assistance is in addition to the Australian Government's Commonwealth Rental Assistance (opens in a new tab)to low income private renters and home buyers through the National Housing Investment Finance Corporation(opens in a new tab).Lesson 7 of 10 Lesson 6: Sustaining housing Lesson aims This lesson illustrates how to help sustain housing for people living with mental illness. This is important because: 1 It is often very difficult to find housing which is affordable and suitable for people's needs, especially when living on a low income and in need for health and support services. 2 Research by Mind Australia and the Australian Housing Urban Research Institute shows that people living with mental illness sometimes have extra difficulty sustaining their housing, a fact that often results in a downward spiral in their mental health (Brackertz et al, 2020(opens in a new tab)). Scenarios The three scenarios below highlight how people living with mental illness can be supported to sustain their housing: SCENARIO 1 highlights the value of planned approach from the beginning of a tenancy. SCENARIO 2 highlights the importance of addressing issues as they arise. SCENARIO 3 features a crisis intervention with a pending eviction. SCENARIO 1 Jack is 18 years old and has recently exited juvenile detention. He has been recently diagnosed with schizophrenia. He spent much of his childhood in out of home care. He has limited literacy and domestic skills, few friends and has never rented before. Jack loves being active, outdoors and likes hip-hop. Timely coordinated response Pre-release, Jack found a place he liked in a supported housing service run by an NGO for young people without family support. He has a furnished bedsit located near shops and services and his rent is set at 25 per cent of his Centrelink payment. His building has a mix of young people and has a communal recreation space as well as day to day support from a concierge service. Because he has limited experience managing his money, Jack has agreed that his rent is paid automatically. Plans in place if unwell The Youth Foyer can contact Jack's mental health provider if they have concerns about his health. This arrangement was discussed and agreed with Jack at the beginning of his tenancy. Life beyond housing/support Because his housing and support are in place, Jack is able to focus on making a new life. He is trainee with the Council’s parks and gardens. His mentor has encouraged him to partake in a literacy and hip-hop music writing program at his local TAFE. He has also joined a local basketball team with some of his neighbours. SCENARIO 2 Jan, a 45-year-old home owner, experiences depression, anxiety and chronic pain. She finds it hard to leave the house, make decisions, clean or do her washing or gardening. Her stove has not worked for years, and she has been without hot water all winter. She finds it hard to organise quotes and worries about the cost of repairs. Her hoarding problem has grown to the extent where she can’t have visitors stay or people share a meal like she used to. It is also difficult now for her cleaner to work and she has no space to enjoy her passion for crafting. Since she left paid work, she decided to get a dog for company. It is a strong energetic pup which she finds difficult to walk and which digs her garden, muddies her floors and progressively chews her belongings. Jan's family encourage her to come and live with them but she is reluctant to do so because she likes her independence. Timely coordinated response Jan agrees with friends and family to discuss her situation with her case coordinator and health care providers and together they agree on a new approach. Activating support outcomes This response means helping Jan activate her informal and formal supports. It features asking friends to help organise house repairs assistance from a specialist hoarding assistance service organising a gardening service a daily walk with a neighbour to the dog park and obedience training with her dog Over time, these strategies have enabled her to cook and eat better food, to shower regularly, to improve her social connection and fitness and to allow space for cleaning, the establishment of a craft room and a more pleasant environment for visitors. SCENARIO 3 Tim, a 30-year-old man living with psychosis, is faced with eviction from his social housing unit after 18 months. Tim has a history of cycling in and out of hospital and men's shelters and is on a treatment order. He spends most of his time listening to heavy metal music and gaming. Neighbours report that they often can’t sleep and feel frightened because of Tim's yelling and his loud music. His mental health service has also become aware he is not complying with his treatment order, and they discover on a home visit the pending eviction notice. Coordinated crisis response With his agreement, the mental health worker rings the social housing provider. Together they talk with Jack. He agrees to health workers to administer injections regularly in his home with Police present. Jack also agrees to use headphones for his music. The social housing provider agrees to stop his eviction and offers Tim a three-month lease. If Tim meets his tenancy obligations, the lease will be renewable. The mental health worker also undertakes to work with Tim to fully explore if he has the support he needs to manage living independently and build the life he wants. Tim also agrees that the social housing providers can contact Tim's mental health service if they are worried he is unwell. Tenancy sustained and savings Tim remains a social housing tenant rather than being made homeless. This arrangement also lessen the chance of being arrested or needing to taken to hospital. Practice reflection These scenarios highlight the importance of 1 attending to the person and individualising responses. 2 remaining respectful, creative and hopeful when the circumstances are very challenging. 3 taking opportunities for prevention, early intervention and crisis intervention. 4 collaborating with the person living with mental illness, service sectors and informal supports. 5 advocating whenever needed.Lesson 8 of 10 Lesson 7: NDIS help to access and sustain housing For people with severe mental illness and complex needs, the NDIS may provide the best support needed to access and sustain their housing. In some cases, it may also provide some assistance with specific housing needs where they cannot be met by mainstream housing options. The NDIS offers capacity building, housing and living supports that could be used to help NDIS participants access and sustain suitable housing. Flip cards. Capacity Building Support Click to flip Back of card Capacity Building Support offers help for people to "find and maintain an appropriate place to live". Click to flip Front of card Assistance with Daily Life(opens in a new tab) Click to flip Back of card Assistance with Daily Life provides individual help with personal everyday tasks to enable people to live as independently as possible. Click to flip Front of card Supported Independent Living(opens in a new tab) Click to flip Back of card Supported Independent Living is help or supervision with daily tasks in a person’s home while building their skills. Click to flip Front of card Individualised Living Option(opens in a new tab) Click to flip Back of card An Individualised Living Option is a package of assistance that lets a participant choose a home environment with set up supports that best suit them. Click to flip Front of card Short Term Accommodation(opens in a new tab) Click to flip Back of card Short Term Accommodation provides funding for support and accommodation for a up to 14 days away from a person’s usual home to support carers or try new things. Click to flip Front of card Medium Term Accommodation(opens in a new tab) Click to flip Back of card Medium Term Accommodation provides 90 days accommodation whilst waiting for a long-term housing solution in private rental, social housing, home ownership or Specialist Disability Accommodation. Click to flip Front of card Specialist Disability Accommodation(opens in a new tab) Click to flip Back of card Specialist Disability Accommodation is designed for extreme functional impairment or to enable better or safer delivery of supports. People living with psychosocial disability alone are currently not prioritised for this assistance. Click to flip Front of card Home Modifications For more guidance on how to use the NDIS to access and sustain housing consult the Wellways (2019) resource: Housing Risk and Homelessness for NDIS participants with psychosocial disability: A National Disability Insurance Scheme providers handbook.Lesson 9 of 10 Quiz Start quizLesson 10 of 10 Certificate of completion Picture of a brick wall Complete our feedback survey and download a certificate of completion for your records. Button: GO TO SURVEY