Alison Barrett writes:
The housing crisis is a critical mental health concern, according to a recent report by the National Mental Health Commission.
The report – a “collection of stories provided through an experience-informed lens” – reflects on a decade of mental health reform activity, since the creation of the Commission in 2012.
In a chapter on the social determinants of mental health, it says the safety, stability and security that comes from having a home is fundamental to optimal mental health and to leading a contributing life.
“The intersection between homelessness and mental ill health is a key concern for the Commission,” it says.
In 2017, the Commission supported a national consultation on housing issues in relation to mental health, conducted by the Australian Housing and Urban Research, which identified a lack of affordable, safe, and appropriate housing for people with lived experience of mental ill health.
“Although housing, homelessness and mental health are interrelated, they are separate policy areas, and this contributes to poor housing and mental health outcomes,” says the report.
“Housing security has become a priority in a decade during which people have been affected by COVID-19 health directives, loss of homes in floods and fires, and an increasing lack of low-cost housing stock.”
In a quote featured in the report, former Commissioner Professor Wendy Cross says:
Insecure housing contributes to adverse mental health outcomes for everyone, and more so for those living with mental illness. A fundamental human need is that of safe and secure shelter. If we cannot meet this most basic of human living requirements, we will never achieve other fundamental needs such as a sense of belonging, self-esteem and achievement.”
Although awareness of the “relationship between social problems and mental health problems” has increased in the past decade, people interviewed for the report had not noticed an “obvious difference” to the delivery of mental health services.
“Health services lack the resources to address social needs, and take a ‘Band-Aid’ approach that does not drive sustainable improvements in mental health,” the report states.
The recommended solution is to enable “social services and health services to work more effectively together”, noting this will have “far-reaching implications for policy, planning and funding but it is essential”.
The report also makes clear that timely access and appropriateness of mental health services, funding and staffing levels to meet demand and sustain services are some of the challenges still facing Australia’s mental health system.
In a joint statement in the report, CEO Christine Morgan and Chair Professor Ngiare Brown wrote:
The amplification of the voices of lived and living experience, their families, carers and kin are at the heart of our work, as we seek to facilitate and promote their experience and expertise together with those directly providing services.”
While a significant level of change has occurred in Australia’s mental health and suicide preventions systems, “there is still a long way to go to build person-centred systems” available, accessible and affordable to all Australians, Brown and Morgan write.
To achieve person-centred and recovery-oriented care – “central to the mental health reform agenda” – service providers need to work in partnership with families and consumers, according to the report.
“Participation strategies must be flexible and inclusive, and able to recognise the variation in consumers and their needs. We need to get better at harnessing the power of individual experience as a measure of progress in mental health reform,” the report states.
The report also highlights that it “can take many years before change at a decision-making level is experienced” by service users/consumers.
Participants in the review – people “who had worked with or contributed to Commission activities” – reported feeling as though “they were part of making change happen” over the past ten years of mental health reform.
The overall mood from participants, including people with personal experience of mental illness, family members, carers, people who have used public and private mental health services and health professionals working in service delivery “was one of hope”, the report states.
They reported that participation and leadership of lived experience, peer workforce, community awareness and local community initiatives were all areas of advancement.
In addition, approaches to person-centred and family-inclusive mental healthcare have improved in the past decade.
However, progress is not moving forward substantially in some areas, including:
- timely access
- appropriateness of services
- responses to suicide risk
- staffing levels to meet demand
- secure funding to sustain services.
Longer wait-times, fragmented services and complex needs are some of the barriers to accessing appropriate care at the right time. This is especially true for regional and rural areas.
“Services developed and integrated at the local level were experienced as being best able to meet needs in the context of local community issues and resources,” the report states.
Value of connections and communities were highlighted as an important theme and initiatives to build community connections would be welcome.
“The current approach to health services as individual and time-limited were contrasted with the long-lasting value of local relationships and healthy community,” the report states.
While telehealth and online services help some people, they are not for everyone and it is important to acknowledge “there can be no one-size-fits-all approach to digital services”, according to the report.
Concerns about digital accessibility as well as digital literacy were identified, particularly for people in remote and regional locations and older Australians.
Supporting frontline workers
Of particular concern is the response to people’s suicide risk – “this was identified as an area where there is a great deal to be done and no immediate experience of positive change”.
Participants emphasised an “urgent need” for improvement in services to “identify, assess and respond to people in psychological distress and develop safe spaces for them to regain stability”.
Timely follow-up care and support following a suicide attempt is critical in preventing further suicide attempts.
The report highlighted that without appropriate acute crisis intervention services, the response tends to fall on frontline workers – paramedics and emergency departments – who are under-resourced and over-burdened.
Frontline workers need to be better supported through education and strategies to ensure sufficient staff available.
However, some participants raised concerns about the police being tasked as first responders to suicide and mental health risk.
One participant commented that they were found by police after a suicide attempt and as there was nowhere to take them, they “spent the night at the police station” where they did not feel safe.
Having police as first responders is particularly concerning for Aboriginal and Torres Strait Islander people.
A person with lived experience, who is a peer worker and therapist, said: “I hate that we live in a society where police respond to mental health crises. People with guns should never be around people with mental health issues.
“People need to be comforted, they need human contact, they need to be heard. Sending the police out to people who have been traumatised, people who have experienced violence, people from First Nations communities just doesn’t work.
“When that is your background, the police are not your friends. They are not people you trust. When they smash down your front door and strip search you, they just add to the trauma.”
Lived experience and peer workforce
While participants reported improvements in the inclusion, participation and leadership of lived experience and peer workforce, they said there was some disconnect between lived experience and clinical approaches.
In addition, inconsistencies existed in embedding peer workers and lived experience.
“There is a tendency for co-production to stop at the design stage – effective co-production in service delivery requires lived experience workers in positions of influence throughout an organisation”, the report states.
The report also highlights a need for better representation and recognition for the diversity of people with lived experiences in mental health.
The report acknowledges limitations in the method used in this study, primarily that it cannot represent the whole experience of Australia’s mental health system or identify all priorities for people with mental health and suicide prevention.
However, it “presents a snapshot of the experiences of a small group of people, who are a sample of the diversity in the mental health and suicide prevention sectors”.
beyondblue 1300 224 636 www.beyondblue.org.au
13Yarn 13 92 76 13yarn.org.au
Kids Helpline 1800 551 800 kidshelpline.com.au
QLife 1800 184 527 https://qlife.org.au/
Check-In (VMIAC, Victoria) 1800 845 109 https://www.vmiac.org.au/check-in/
Lived Experience Telephone Line Service 1800 013 755 https://www.linkstowellbeing.org.au/
Also read this recent Croakey article: Putting homelessness on the agenda for long COVID policy
See Croakey’s archive of articles on housing and health.