Introduction by Croakey: A social media campaign busted myths about homelessness to mark World Homelessness Day on 10 October, with the #HomelessTruths hashtag trending nationally in Australia.
The campaign, by organisations working in the sector, spotlighted systemic drivers of homelessness, especially the shortage of affordable and social housing (see a selection of tweets at the end of this post, as well as a video message from five capital city Lord Mayors).
Coinciding with World Mental Health Day, the campaign also reinforced the benefits that would flow for mental health and wellbeing from tackling homelessness.
Meanwhile, Lanie Harris, Communications and Media Adviser at cohealth in Victoria, investigates some of the barriers for homeless people in accessing healthcare, and profiles the work of cohealth’s in-demand Street Doctor (as pictured below).
Lanie Harris writes:
The growing homelessness crisis in Australia is not news and it’s no surprise there is a direct link between poor health and homelessness.
Life on the streets, in squats and squalid rooming houses is deeply damaging both to people’s physical and mental health.
Without access to appropriate, safe and secure accommodation, people are exposed to extreme temperatures, violence, unhygienic living conditions, greater contact with communicable disease and have little control over their living quarters or who they share them with.
Perversely, despite their greater health burden, people experiencing homelessness are less likely to access primary healthcare due to a range of social, physical and logistical barriers.
To respond to the complex health needs of patients experiencing primary homelessness, cohealth has been operating its Street Doctor van one day per week since July 2018.
A cohealth GP, a nurse and a social worker deliver services out of the Street Doctor van as it moves around Melbourne’s CBD and inner city to key locations.
Co-location is key
cohealth’s GP, Dr Kate Coles, said:
We found the most success by co-locating with other services; the mobile laundry, drop-in centres, Centrelink and places people can get a free meal.
The bus has a very basic fit-out, but we take most of the equipment needed for a general practice.
We offer clinical assessment, blood tests, immunisations and wound care. We can write scripts, provide radiology referrals and prepare mental health care plans.”
cohealth’s Street Doctor nurse, Vaan Phongsavan, says the model is successful because it takes health services out of a traditional setting, and delivers them in a less intimidating environment.
She said:
For people who’ve experienced trauma, have a history of institutionalisation, or have had negative experiences with the medical system, going to a mainstream clinic or hospital can be daunting.
cohealth’s Street Doctor program provides free, non-judgemental and easily accessed holistic healthcare, and we can link people to other supports.
They might come to us to get a wound checked out, but during the consult we identify other issues and can refer to other cohealth services; podiatry, physiotherapy, dietetics, social work, family violence counselling and support, refugee health clinics, and dentistry.”
More services needed
Last month the City of Melbourne announced it would fund the Street Doctor Bus for an additional day per week.
Although welcome news, cohealth notes that the Street Doctor program only skims the surface of what is needed.
Coles said:
Street Doctor targets the CBD because of the high concentration of homelessness, but homelessness is an issue from Dandenong, to Footscray, Frankston, Werribee and in the regional centres such as Shepparton, Geelong and Ballarat.
We really need to look at expanding these types of service to other areas to improve the health of the most vulnerable members of the community.”
The existing community health system may offer a way forward in expanding health services to people who are sleeping rough.
Cohealth’s newly-appointed Chief Executive Nicole Bartholomeusz says community health provides an ideal platform from which to deliver highly specialised and targeted services to marginalised groups.
Bartholomeusz also says Governments could immediately improve the health of people experiencing homelessness by addressing the lack of affordable housing that creates homelessness.
She said:
Above and beyond any medical intervention or preventative measure, if we could provide our clients with a safe and secure home, many of their health issues would immediately improve.
People who are homeless access emergency departments at a far higher rate than those who have secure housing. So the burden on our hospital system of not solving homelessness is colossal.
In the absence of sufficient housing, we need to address people’s health needs while they are on the streets, and our Street Doctor program is doing an outstanding job.”
Five barriers to healthcare for homeless people
1. Cost!
Mainstream GPs and clinics don’t always bulk bill, and those that do may not be able to respond to the unique health problems of homeless patients.
Many GP clinics run on thin operating margins so don’t bulk-bill, even for people with healthcare cards.
Practices that do bulk bill low-income earners have to juggle financial viability, so rely on high patient volume and low consult times.
“The base consultation time of seven minutes in that model is generally inadequate to holistically address the complex needs of homeless people,” says cohealth’s Dr Kate Coles.
2. Travelling to health appointments is not easy when you’re homeless
Travelling to multiple appointments across town via public transport is time-consuming and costly. It requires planning and navigation, sometimes without a phone, to let people know you’re running late.
Sometimes people might have a phone, but no internet connection to access Google maps. If you don’t have secure accommodation, you’re also faced with the challenge of what to do with your belongings while you’re gone.
3. Treatment plans often rely on a patient having safe accommodation
Many health problems suffered by people experiencing homelessness are a direct result of their lack of housing, such as pneumonia during the winter months, arthritic joints, infected wounds, diabetes triggered or exacerbated by poor diet.
Clinicians can prescribe medication, provide dressings and outline regimes for the patient to undertake, but following through on those plans is hard if you don’t have a private, clean, safe place to live, and adequate facilities to prepare regular, healthy meals.
4. The chaos of homelessness means making and keeping appointments can be difficult
Not knowing where you’ll be sleeping week to week makes it difficult to plan ahead or prioritise anything other than where you’ll bed down tonight or get your next meal.
Keeping appointments with Centrelink and housing office take precedence over the medical appointments.
Without a home it is hard to store and keep track of immunisation records, Medicare cards, hard copy referrals and other documents required for many health appointments.
5. Medical conditions snowball quickly on the streets, and the Emergency Departments carry much of the burden to respond
Because of systemic and logistical barriers to healthcare, many people who are homeless delay seeking medical help until their conditions are at an advanced stage, requiring more extensive and expensive treatment.
As a result, there is excessive use of emergency departments by people experiencing homelessness for medical conditions that would be better managed in primary care, and chronic diseases are seen at an advanced stage when they require more extensive and expensive treatment.
The additional burden of work and costs on emergency departments and the acute care health services is substantial.
• Here is more information on homelessness resources.
#HomelessTruths 
Mayors speak up
National housing and homelessness campaign Everybody’s Home has joined capital city Lord Mayors and the ACT Chief Minister in calling for a National Housing and Homelessness Strategy to end the growing homelessness crisis facing Australia.
The Mayors and Chief Minister, who represent millions of Australians, sent a delegation to Canberra last month calling for national leadership on the issue.
According to Everybody’s Home campaign spokesperson Kate Colvin, 63 percent of people experiencing homelessness, and 47 percent of all people sleeping rough are living in capital cities.
