Home in Mind: finding a fit-for-purpose mental health response for homeless youth

by Douschka Dobson – Senior Policy and Advocacy Officer, Melbourne City Mission; Kristin Simondson – Mental Health Peer Worker, Melbourne City Mission; and Rikki Morgan – Policy Analyst, Orygen.

This article was originally published in the April 2024 edition of Parity magazine. Learn more about Parity including how to access full editions.

‘There was just nowhere for me to be safe. If there is nowhere to go to be safe it feels like the only way out is to die.’

– Lived Experience Advisor

The burden of homelessness and mental ill-health is disproportionately experienced by young people.

Young Australians aged 12 to 24 years make up 23 per cent of the homelessness population. (1) In 2022-23, almost 12,000 young people aged 15 to 24 years presented alone to a specialist homelessness service (SHS) in Victoria. (2)

Many of these young people have complex mental health and wellbeing issues that are intrinsically linked to adverse childhood experiences, including experiences of homelessness at a young age, social exclusion and isolation.

While mental health can act as a driver of homelessness for young people, extended periods of homelessness have also been shown to erode their mental health. Limited access to housing for young people experiencing homelessness is a fundamental driver of mental ill-health. Conversely, those with significant mental ill-health are often having to resort to unsafe or unsuitable housing options due to the lack of supported housing and difficulty in accessing mental health supports.

‘It was stressful, I was struggling with my mental health. Not having a comfortable place to call home and go back to each day was definitely exacerbating that. I think the reality is that, in the current approach to mental health … something really needs to change to make it possible for more young people who have been in circumstances like I was [to get better].’

– Lived Experience Advisor

Unaccompanied young people who are experiencing homelessness continue to fall through the cracks of Victoria’s mental health system.

‘The system doesn’t give you much to work with, it makes you feel like you’re not a person.’

– Lived Experience Advisor

There are several structural and policy barriers, both at a government and service level, that impact on the ability of unaccompanied young people experiencing homelessness to access mental health care. These include:

• Requirements for a ‘fixed address’ which means some young people who cannot provide evidence of identity and an address have difficultly being admitted into, and discharged from, mental health care.
• Rigid clinical catchment areas that make continuity of care difficult for young people who are transient (noting that the removal of these rigid boundaries is a component of the new service system recommendations of the Royal Commission into Victoria’s Mental Health System).
• Requirements of parental consent for young people under 16 years and the reliance on caring family and social networks to support young people to navigate and engage with services and systems.
• Funding models that are contingent on appointment presentations and occasions of service, which mean young people who are transient can be seen as too complex for services due to fluctuating and often inconsistent attendance.

There are significant impacts from these barriers for the individual young people, the homelessness and mental health sectors, and the broader society.

‘Hospitals, 000, Lifeline are not on my care plan. If people are ending up in hospitals, it is because nothing else is working.’

– Lived Experience Advisor

The impacts of these barriers include:

• An over-reliance on a youth homelessness workforce, one which lacks specialist mental health expertise and resourcing, to respond to complex mental health presentations.
• A failure to provide timely and effective mental health support and care to young people experiencing homelessness.
• A strong sense of distrust of the mental health system by young people experiencing homelessness.

Finding a Home in Victoria’s Royal Commission into Mental Health System

Victoria is leading other jurisdictions across Australia when it comes to mental health reform. The Royal Commission into Victoria’s Mental Health System has resulted in recent investments totalling $6 billion to transform the mental health system. The Royal Commission also highlighted the need to develop a new state-wide youth mental health services approach, driven by lived experience, innovation and research.

The Royal Commission recommended the establishment of 500 supported housing places for young people experiencing mental ill-health. However, beyond that, there was little outlined in its Final Report to address the systemic, policy, structural and funding barriers to mental health services supporting the currently invisible demographic of unaccompanied young people experiencing homelessness.

In response, MCM and Orygen have partnered on an ambitious policy research project, Home in Mind, to develop a strong, fit-for-purpose youth mental health and wellbeing response for unaccompanied young people experiencing homelessness in Victoria.

This project will seek to understand the gap in policy, services and practice, and to map a way forward with evidence-based recommendations that aim to:

• address funding, policy and structural barriers and improve access to tailored youth mental health services and supported housing that responds to their specific needs
• increase understanding in youth mental health services of the specific needs of unaccompanied young people experiencing homelessness
• address housing instability as a fundamental driver of mental ill-health.

Home in Mind will ensure that the voices, insights and distinct needs of unaccompanied young people experiencing homelessness are included in the implementation of the Royal Commission reforms.

Endnotes

1. Australian Bureau of Statistics (ABS) 2021, Census 

2. Australian Institute of Health and Welfare, Specialist Homelessness Services Annual Report 2022-23. 

This article was originally published in Parity magazine. Learn more about Parity including how to access full editions.