Post-crisis housing for patients experiencing mental health issues

Many people who have been hospitalised as a result of a severe mental health disorder face a significant risk of becoming homeless when they are discharged. A survey of 2,388 people attending psychiatric clinics in inner Sydney homeless hostels found that 21 per cent of patients identified that being discharged from hospital was a key step to them becoming homeless.

Although it is common practice in Australia for those exiting hospital to be monitored by a hospital discharge liaison officer, there can be long delays between discharge and follow up. In addition, follow up services may only be possible if the person has been discharged to a fixed address. If a person becomes homeless after discharge they may slip through any provided support programs.

A 2017 UK inquiry report into suicide found that for ex-NHS hospital patients who went on to commit suicide within the first week of discharge, 21 per cent died on the third day and 19 per cent on the second day. In addition, 12 per cent of all ex-NHS hospital patients who committed suicide did so before their first follow up appointment. The inquiry report suggests that patient follow-up should occur within three days of discharge from a mental health facility in hospital.

Government legislation should require that no person is discharged from a hospital psychiatric ward into inadequate housing or homelessness. However, such legislation would rely on social housing providers (both governments and community housing providers) having sufficient quantities of housing available for people to access when they are discharged. 

Supported housing 

For people experiencing mental health disorders that restrict their ability to find and maintain employment, supported housing programs may prevent them falling into homelessness. Together with housing, such supports may also include drug and alcohol counselling; employment training; financial budget training; and medical support such as help to take medicines regularly.

The Housing and Accommodation Support Initiative (HASI) operates in NSW and is three‐way partnership in service delivery: accommodation support and rehabilitation associated with disability is provided by NGOs (funded by NSW Health); clinical care and rehabilitation is provided by specialist mental health services; and long‐term, secure, and affordable housing and property and tenancy management services are provided by public and community housing (funded by Housing NSW). 

An earlier evaluation revealed that HASI clients had significantly fewer and shorter mental health hospital admissions after joining HASI: improvements included a 59 per cent decrease in the average number of days spent in a mental health inpatient hospital per year; and a 24 per cent drop in the number of admissions to hospital per year. 

Among those who were admitted to hospital at least once both before and during HASI, the average number of days hospitalised per admission decreased by 68 per cent. The NSW Government potentially avoided over $30 million per year on the hospitalisation of HASI consumers (in $2010).

Similarly, the Doorway program delivers supportive housing and links people with persistent mental ill-health who are at risk of, or experiencing homelessness with private rental housing and psychosocial support. The program provides time limited rental subsidy, brokerage and tenancy support, with Doorway program participants renting their housing directly from the real estate agents rather than through head leasing or social housing.

An evaluation of the first Doorway program in 2013 showed 77 people had been accepted into the program, of whom 59 were housed (with 50 still housed at the end of that program). In addition, the average time in bed-based clinical mental health services per participant per year has decreased from 20.4 before housing to 7.5 days in the 12 months since being housed – with the biggest decrease occurring with acute inpatient services (13.9 to 6.6 days) 

In addition, 27 per cent of participants were engaged in paid and unpaid work, an increase from the 16 per cent at the beginning of the program.

The evaluations of HASI and Doorway show these programs can be very effective in supporting people with mental health disorders and preventing episodes of homelessness, and are of real benefit to Australian communities.