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Felicity Reynolds CEO, Mercy Foundation Chair, Australian Common Ground Alliance
FelicityReynoldsCEO,MercyFoundation
Chair,AustralianCommonGroundAlliance
¡ ChronichomelessnessinAustralia¡ TheVulnerabilityIndex&itsroleinHousingFirstapproachesandmeasuringthereductioninthenumberofpeoplewhoarechronicallyhomelessand/orroughsleepers–inAustralia.
¡ HousingFirstandPermanentSupportiveHousing(PSH)inAustralia
¡ TheCommonGroundmodelofPSHinAustralia.
¡ 6monthsorlonger¡ Multipleepisodesofhomelessnessformorethan12months
¡ Generally,singleadults(mayneeddifferentresponsesforyoungpeople).
¡ Oftenhaveco-ocurringphysicalandotherhealthproblems.
¡ Australiahasasatisfactory‘safetynet’thatdealssomewhateffectivelywiththemajorityofpeoplewhobecomehomeless.
¡ Mosthomelesspeopledonotexperiencelongperiodsofhomelessness.
¡ Mostchronicallyhomelesspeopleareoftenroughsleepersandconsidered‘primaryhomeless’.
¡ Chronicallyhomelesspeoplecyclethroughtheservicesystems(health,welfare,justiceetc)formanyyears.
¡ Endingtheirhomelessnessisethicalaswellaspotentiallymorecosteffective.
¡ Noneedto‘assume’anewgroupofchronicallyhomelesspeoplewillappear(butalsoreliantonbetterpreventionandearlierintervention).
¡ DennisCulhane–1999NYStudy-$41,000¡ FelicityReynolds(notmethodologicallyrobust–butSydneyestimate2006$34,000)
¡ SomeAustralianresearch–Flatau¡ Truethatonlyaverysmallgroupusehighnumberofservices(asrecentlynotedbyJohnston,2012)
¡ However,evenmoderateuseovermanyyearscostsalotandweknowhealthproblemsworsenthelongersomeoneremainshomeless.
¡ VulnerabilityIndexprojects(andassistingtomeasurereductionsidentifiedbytheWhitePaper–TheRoadHome).
¡ Permanentsupportivehousing¡ CommonGround(asanexampleofpermanentsupportivehousing).
¡ Otherprojects–someexamplesfromtheMercyFoundation’sGrantstoEndHomelessness.
¡ VIaspracticetoolaswellasprovidingkeyinformationaboutchronicallyhomelesspeople’shealthandserviceneeds.Primaryaim–tohouseandsupportpeopleidentifiedasvulnerableassoonaspossible.
¡ HasnowbeenusedinBrisbane,InnerSydney,Townsville,Mebourne,HobartandWesternSydney.
• TheVIisbasedonastudyconductedbyHwang,O’Connelletal.(1998)
• Thestudyidentifiedthedemographicandclinicalfactorsassociatedwithanincreasedriskofdeathinhomelessindividuals.
¡ Morethan6monthsstreethomelessANDatleastoneofthefollowing:§ EndStageRenalDisease§ HistoryofColdWeatherInjuries
§ LiverDiseaseorCirrhosis
§ HIV+/AIDS§ Over60yearsold
§ Threeofmoreemergencyroomvisitsinpriorthreemonths§ ThreeormoreERorhospitalisationsinprioryear
§ Tri-morbid(mentallyill+abusingsubstances+medicalproblem)¡ Under25riskfactors
§ Alcoholeverydayinpast30§ HIV+/AIDS
§ InjectionDrugUse
• Housinghistory• Health,usualhealthservicesaccessed,EDpresentationsin
thepastthreemonths,hospitalisationsinthepasttwelvemonths,questionsrelatedtophysicalhealthconditions,drugandalcohol,mentalhealth,historyoftrauma.
• Institutionalinvolvement• Demographics• Engagementwithsupportservices• Employment,benefits,citizenship• Photoistaken–(essentialforfollow-up)and‘de-
anonymising’‘thehomeless’.
425
56
148
463321
109
1522peoplesurveyedasatMay2012
¡ 76%male;22%female;1%transgender;1%unknown.
¡ 1074people–Australian;318Aboriginal;28TorresStraitIslander;77NewZealand;272Other.
¡ 54%wereagedbetween36-55.¡ 38%onDSP;36%onNewstart
¡ 28%fostercare;75%policecells;53%prison.¡ Averageageofrespondentsacrossallregionswas43years.
¡ Theaveragelengthofhomelessnessrangedfrom6–15years.Theaverageacrossallregionswas8.8years.
¡ 773hadnotbeenhousedinprevious3years¡ 395hadfailedtenancies3ormoretimesinprevious3years.
¡ 51%reportedbeingthevictimofviolentattacksincebecominghomeless.
¡ 24%reportedlimitedmobility.¡ 29%reportedbraininjuryorheadtrauma.¡ 61%reportedMHcondition;51%reportedanytreatmentforthatMHcondition.
¡ 73%reportedD&Aproblems.With46%havingreceivedtreatment.
Vulnerabilityriskqualifiersacrossregions
Australia-widebyregion
Total63%ofrespondentswerefoundtobevulnerableaccordingtoVIfactors.
Brisbane Townsville SydneyWestern Sydney Melbourne Hobart Total
Sample size total 425 56 463 148 321 109 1522Number of vulnerable 295 36 294 67 204 70 966Cold/wet Weather Injury 24 <5 38 7 36 13 118HIV+/AIDS 12 <5 12 <5 5 <5 29Kidney disease 35 12 27 7 28 5 114Liver disease 94 11 86 19 66 30 3063x ER last 3 months 86 11 54 17 46 16 2303x ER or hospital last year 141 21 116 23 79 31 411*Tri-morbid 176 15 181 53 123 59 607> 60 years old 46 <5 35 11 27 5 124
¡ Ofthetotalrespondents,604(or40%)hadvisitedtheEDinthepast3months.Therewasatotalof1972occasionsofservice.
¡ Thismayrepresentatotalcostof$390,000.¡ 739(or49%)hadatleastonehospitalisationinpreviousyear.2245occasionsofservice.
¡ Basedonaveragecostofaveragelengthofhospitalstay,thisrepresentsapproximately$9.36M.
¡ Importantly,eachregionhasdirectlyfolloweduptoensurepeoplearelinkedtohousingandsupport.
¡ Todate,Brisbane(MicahProjects)havehousedandsupported134people(32%ofrespondents).ThisisaneffectivemeasurementtoolforroughsleepertargetsidentifiedintheFederalgovernment’sWhitePaper.
¡ Sydney–Way2Hometeamhavealsohousedmorethan60frominitialsurvey.Mostrecently28+havebeenhousedinnewCGbuildingatCamperdown.
Whatdoyouneedtobesafeandwell?AfewrandomanswersfromhomelesspeopleinterviewedduringtheWSVIinMay2012.¡ Aroofovermyhead¡ Somewheredryandwarm¡ Goodfood,affordablehousing¡ Myownspace¡ Ahome¡ Helpwithgettingahouse¡ Houseandstability¡ Feedandaroofovermyhead¡ Safeandsecureaccommodation¡ AplaceIcanlivesomyGrandkidscanvisit¡ Roofoverheadandfoodandpeopletotrust¡ Anicequietplace¡ Ahouse,notmycar¡ Moremoneytoliveon¡ Stableaccommodation,closertocommunity¡ Healthcareformymentalhealthandahouseorhome
¡ PermanentSupportiveHousing(scattersite)–someexamplesininnerSydney(includingPlatform70).
¡ Project40–WentworthCommunityHousing(WesternSydney).Originalobjectivewas40chronicallyhomelesspeoplehoused.Now,morethan76peoplehousedANDsupported.
¡ LongtermexampleinNSW–HASI(butpathwayintoitforhomelesspeoplestilldifficult).
¡ Lessonsbeinglearned–re.Needforsystemicinvolvementbyhealthandotherservicesaswellasgeneralistsupportworkers.(asperVIresults).
¡ CommonGround§ ACGA&SA,Vic,NSW,Tas,Qld.▪ SA–2007(now3buildings)▪ Vic–2010–65formerlyhomelesspeople▪ NSW–2011-52formerlyhomeless/10SH/42Affordable▪ Qld–2012▪ Tas–2012
§ Usefulwaytocreateadditionalaffordablehousinginaclimatewithfewaffordablehousingoptionsinthemajorcities.
§ Mixedresidentialmodel(50/50)§ Urbanmodel§ Noclearfundingstreamsyet;individualprojects
• Permanency (for as long as the tenant wants to stay in the housing)creates a sense of stability
• A sense of stability can help to settle people who may have experienced chronic and episodic homelessness and cycle in and out of crisis, temporary and transitional housing.
• this ensures that people with a history of chronic homelessness live in the building alongside workers and students who also need affordable housing.
Above: Tasmanian building plan
• Support workers work closely with tenants to sustain tenancies and link them with other needed community health and support services.
• The provision of that support is differentiated from the tenancy management, but co-ordinated to maximise the chances of people avoiding eviction.
• Good security and safety in the building is promoted – using various security measures; for example - 24/7 concierge or front desk staff.
• Common Ground supportive housing is not a program or an institution.
• It is a housing option that ensures tenants who need it receive ongoing support services.
• Sites are often co-located with business and social enterprises and can make an active and positive contribution to the local neighbourhood.
§ All States have funded CG differently§ South Australia – Government and corporate§ Victoria – Government ($8.7 million savings by Grocon and
sub-contractor – significant contribution)§ NSW – Place to Call Home program (Federal/State & $1
million savings by Grocon)§ Tasmania§ Liverpool Street : Place to Call Home Program (Federal/State) § Campbell Street : National Economic Stimulus Package Funding§ Queensland: Nation Building Economic Stimulus
(&Grocon)
§ Need to develop robust private investment models§ Funding concierge/security § Funding ongoing support
¡ Whatdoweneedbeforewecantakethesemodelstoscale?
¡ HowcanweworktogethertocreatemorePSHopportunitiesthatwillendpeople’sexperienceofchronichomelessness.
¡ Howmuchevidencedowereallyneedtounderstandthathousing(withsupport)formsaplatformonwhichchronicallyexcludedpeoplecanregaintheirlives?
¡ Havewereachedaparadigmshiftyet?No.
