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How the response to homeless people varies between Darwin, Sydney and Brisbane

In the first of two Croakey articles that examine services for homeless people, Caroline Chen reports on a recent analysis suggesting people receive very different types of services depending upon whether they are in Sydney, Brisbane or Darwin, and depending upon whether homelessness is framed as a health issue or a law and order issue.

Chen is a health communications graduate from the University of Sydney, who is volunteering for a stint as Croakey’s first intern.

The second article in this series will examine some recent lessons from Victoria, and highlights differences between the response to homelessness following disasters and the response to the “personal emergencies” faced by homeless people every day.

 ***

Government outreach policy for rough sleepers a work in progress

Caroline Chen writes:

For people who are homeless, the type of services offered may vary considerably according to where they are based, a recent analysis suggests.

People who are homeless in Darwin get quite different treatment from those who are homeless in Sydney, for example.

Homeless people in Sydney may benefit from a comprehensive assertive outreach service that not only provides much-needed housing, but also assistance in maintaining a home and improving physical and mental health states.

The situation is similar in Brisbane where outreach is available to people on the street and post-housing, though the capacity for delivering health services is somewhat limited by lack of professional support.

In Darwin, assertive outreach does not address housing or health care issues but rather focuses on preventing ‘antisocial’ behavior by ‘moving on’ people who dwell in public places. Those who are visitors are also encouraged to ‘return to country’.

One of the questions this raises is whether law and order perspectives dominate policies for Indigenous people (in the NT anyway) rather than a more holistic health and welfare approach employed in other places.

The report, The Role of Assertive Outreach in Ending ‘Rough Sleeping’, by Rhonda Phillips and Cameron Parsell of the Australian Housing and Urban Research Institute, examines how assertive outreach can be realised and implemented in Australia and to what extent it is achieving its policy objectives thus far.

Assertive outreach refers to actions that deliberately and strategically work towards ending a person’s state of homelessness. It specifically targets those who are ‘sleeping rough’, which includes people who are literally homeless and those who may be sleeping in derelict buildings, cars and/or public areas.

The Australian Government aims to reduce the current rate of overall homelessness by half and offer supported housing to all rough sleepers who seek it by 2020. In order to achieve this goal, assertive outreach has become the core approach for homelessness strategies implemented across the country.

The report researches assertive outreach case studies from Sydney, Brisbane and Darwin.

Assertive outreach in Sydney and Brisbane consisted of street-based outreach to prioritise and assist vulnerable people to exit rough sleeping, and post-housing outreach to help them to sustain their tenancies and achieve better health, social and economic wellbeing.

While both cities worked toward the common goal of permanently ending rough sleeping at a policy and practical level, Sydney excelled by recruiting a multidisciplinary team comprising of peer support workers, non-specialist housing outreach workers and hospital-supported health professionals for a highly integrated response.

The Brisbane program only staffed non-specialist housing outreach workers to perform both street-based and post-housing approaches, and enlisted the help of the government Homeless Health Outreach Team and a community nurse to collaborate with and support them on a short-term basis.

The outcomes, informed by review of early outcomes and service-user feedback indicate that although the assertive outreach efforts were mainly focused on housing provision, the program on the whole was generally successful. User perspectives showed that the persistent and assertive approach of workers was a desired feature of the programs: workers actively approached users, assumed responsibility of the entire housing application process and helped participants to address other personal problems without being disrespectful or coercive.

The primary issue that confronted the practices was the programs’ restricted capacity to supply enough housing. The limited availability of social housing resulted in a constant state of more people requiring housing than could be provided. Furthermore, only a small number of those who achieved housing were reunited with family or moved into non-social housing options.

The distinct model of assertive outreach adopted by Darwin is mainly a product of its local context. Firstly, the target population itself is a barrier to the type of assertive outreach that is practised in Sydney and Brisbane. Darwin has a significant homeless population – up to 2000 persons on any given night and the majority of these people are Aborigines or Torres Strait Islanders who practise activities such as public dwelling, drinking and temporary travels.

To add to the matter, housing is significantly more scarce in Darwin, making accommodation provision virtually impossible. For these reasons, assertive outreach is not conceptualized as a model to achieve permanent housing for rough sleepers in Darwin.

Assertive outreach in Darwin is a policy response to ‘antisocial’ behavior – a term which encompasses activities that are associated with rough sleeping, public intoxication, transience and short-term visiting. The Program is driven by law and order considerations, managed and funded by the Department of Justice and not integrated within the health policy framework.

The program features short term ‘move on’ interventions that proactively engage those living in public places and implements measures to move them. Rough sleepers are negotiated with, encouraged and assisted to, but not coerced into exiting public spaces. The service also includes ‘return to country’ – a user pays service that assists visiting dwellers to travel back to their homes outside of Darwin through providing travel arrangements and assisting in document provision. It has been shown to play a positive role in helping people to access their homes and communities.

Resources and support to help rough sleepers address their housing, economic, social and health issues are extremely limited under the Darwin assertive outreach model.

Rhonda Phillips, one of the study’s authors, believes there are three things that should be given more attention when planning future homelessness approaches.

“Firstly, it should always be kept in mind that Indigenous public place dwellers have unique characteristics that require unique responses,” she says.

“Secondly, service workers must understand the importance of working towards improving the sense of self-agency amongst service users – this should be done by empowering them to increase their personal strengths and self-motivation. Outreach services alone cannot guarantee individual outcomes so programs should not just work towards delivering services that are ‘done’ to people. Service users should determine themselves what they are ready for and make their own decisions.

“And last of all, there should be an increased range of different housing and support systems implemented to accommodate for the wide range of disability and health issues homeless people are often faced with, and also to help service users secure permanent housing at the end of the process.”

Analysis of the assertive outreach case-studies in Sydney, Brisbane and Darwin have helped identify the crucial factors for an assertive outreach program to successfully address the issue of rough sleeping in Australia.

Core principles include the integration of timely access to abundant housing, incorporation of multi-disciplinary health services to address chronic health problems and functional impairments that are often experienced by rough sleepers, on-going client-centered support, encouragement for the client’s setting of personal and housing goals, recognition of the unique nature of public place dwelling by Indigenous persons and incorporating their diverse needs and local context into policy responses, and keeping in mind the important interplay between policy, service provider and customer to bring about successful outcomes.

The significance of non-housing factors such as psychological nourishment and spiritual development for homelessness approaches is also discussed by Martin Seager in his recent article Homelessness is more than houselessness: a psychologically-minded approach to inclusion and rough sleeping. The full article, which argues the difference between a ‘house’ and a ‘home’, and the fundamental need to place more emphasis on working towards the latter, is freely accessible.

***

Caroline Chen’s previous Croakey article was: Why we need healthy housing policy

 

 

 

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Summer reading 2020-2021
Tasmanian election 2021
Testing Croakey News category 1
The Croakey Archives
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#IHMayDay 2014
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Croakey Conference News Service 2013 – 2019
2013 conferences
Australian Centre for Health Services Innovation Forum 2013
Australian Health Promotion Association Conference 2013
Closing the Credibility Gap 2013
CRANAplus Conference 2013
FASD Conference 2013
Health Workforce Australia 2013
International Health Literacy Network Conference 2013
NACCHO Summit 2013
National Rural Health Conference 2013
Oceania EcoHealth Symposium 2013
PHAA conference 2013
2014 conferences
#IPCHIV14
AIDA Conference 2014
Congress Lowitja 2014
CRANAplus conference 2014
Cultural Solutions - Healing Foundation forum 2014
Lowitja Institute Continuous Quality Improvement conference 2014
National Suicide Prevention Conference 2014
Racism and children/youth health symposium 2014
Rural & Remote Health Scientific Symposium 2014
2015 conferences
#CPHCEforum
#CRANAplus15
#HSR15
#NRHC15
#OTCC15
Population Health Congress 2015
2016 conferences
#AHHAsim16
#AHMRC16
#ANROWS2016
#ATSISPEP
#AusCanIndigenousWellness
#cphce2016
#CPHCEforum16
#CRANAplus2016
#IAMRA2016
#LowitjaConf2016
#PreventObesity16
#TowardsRecovery
#VMIAC16
#WearablesCEH
#WICC2016
2017 conferences
#17APCC
#ACEM17
#AIDAconf2017
#BTH20
#CATSINaM17
#ClimateHealthStrategy
#IAHAConf17
#IDS17
#LBQWHC17
#LivingOurWay
#OKtoAskAu
#OTCC2017
#ResearchTranslation17
#TheMHS2017
#VMIACConf17
#WCPH2017
Australian Palliative Care Conference
2018 conferences
#6rrhss
#ACEM18
#AHPA2018
#ATSISPC18
#CPHCE