Understanding homelessness

Homelessness is more than lacking a physical address

Homelessness is a multifaceted problem. There are no easy ways to prevent young people from becoming homeless, or to support them in the transition out of homelessness.

The current service system is largely set up to intervene at the point of crisis, which often overlooks the many factors that predispose young people to homelessness. There is also no central source that accurately reflects the Australian homelessness landscape, making it difficult to effect positive change.

Dr Jess Heerde is on a mission to change the status quo. “In the next five years, I am seeking to establish a comprehensive evidence base that informs the multisectoral change that needs to happen,” she says.

Through her world-first study, she will build a comprehensive national database to provide an unprecedented 10-year snapshot (2011-2021) of the health and wellbeing of 600,000 young homeless Australians.

Her study will capture the rates and causes of mortality among this group, as well as healthcare usage, to inform prevention and interventions to shape policy and drive multisystemic change.

“I've had in my career, six young people, that I know of, who have passed away. It’s a topic that we don't talk about a lot, and we don't shed any light on. We need to bring it out of the shadows,” says Dr Heerde.

Many young Australians who experience homelessness carry lifelong shame and stigma, which can trigger recurring problems that impact their life chances and trajectory. “We know the effects of trauma that young people might be experiencing prior to their homelessness, and trauma that they may have experienced while they’re homeless, have cumulative impacts down the track,” Dr Heerde says.

“One of the things I hope comes out of this study is we get a comprehensive picture of the health issues young homeless people are experiencing and their access to healthcare, and set up multisectoral approaches and systems that address these needs and that they can access on an ongoing basis,” she says.

The bigger picture

Armed with the support of a National Health and Medical Research Council (NHMRC) Emerging Leadership Investigator grant, Dr Heerde’s data linkage project will provide insights on how to improve health services and engagement within this cohort.

“Health for young people who are experiencing homelessness is not just a point in time – it’s a long-term issue – it will continue well into their adulthood,” she says.

Dr Heerde envisages a more integrated system and multidisciplinary approach to healthcare to ensure young people are not stretched over multiple services with different caseworkers for various issues.

“Constantly needing to tell stories is a common theme, and young people just get a bit fed up. Once they've told their story multiple times, they often transition to giving a truncated version to the next person which doesn't necessarily give that health professional all the information that they need to provide appropriate or sustained treatment,” Dr Heerde says.

The impact of COVID

Dr Heerde says the current public health crisis is presenting unique challenges around reengaging homeless young people who were already disenfranchised with support systems.

“It is an interesting nexus in that we need public health measures to keep people safe, but some of those, unfortunately, have had negative implications for homeless young people. I’ve heard reports of young people feeling disconnected from the services that they had been engaged in prior to the COVID pandemic, due to the restrictions that we've had to keep everyone safe. A new challenge is how to reengage young people,” she says.

Dr Heerde says there is a lot of motivation on the ground from service sector staff to keep pushing through these challenges. Multiple innovations have been introduced, including vaccination buses and vaccination services set up at the Melbourne Town Hall specifically to target marginalised groups, including the homeless.

“Experiencing homelessness means young people already have a lot of personal circumstances to navigate and remembering a date when you have to come back for a COVID vaccine is difficult.”

Towards a better future

Dr Heerde says there is no short-term fix when working with young people who have experienced homelessness, or the trauma that results from these circumstances.

“It has to be long-term, and it has to be multidisciplinary. We can't just focus on housing – housing is important – but there's so much more than just having an address,” she says.

“We need to support young people to build life skills, address their immediate and long-term health issues, to be able to support themselves, and build their skills to gain employment or enter education.”

She believes there is a role for higher education to play for those young people who still have unstable housing but wish to study. “One of the barriers that many young people have, in addition to dealing with the health consequences of homelessness, is entering a system where they haven't gained the pre-qualifications needed to undertake the study they would like to complete,” she says.

Dr Heerde dares to imagine that one day prevention of homelessness will become the focus rather than solely crisis support services. “We can't just expect young people to get on their two feet and achieve what they want to achieve without the support that they need to get there.”

“The responsibility is with us as a society to support these young people, who have had terrible times, often through no fault of their own, to get where they want to be. They have dreams too – let’s support them to achieve them,” she says.