Building a Lived Experience Peer Workforce in Homelessness: a conversation with SA Mental Health Commissioner David Kelly and the Toward Home Alliance Sonder peer practitioners
Lived experience in SA’s homelessness sector
The relationship between poor mental health and homelessness is bidirectional. The high levels of mental illness and trauma that are a common feature of homelessness operate both as a cause and consequence; housing and poor mental health do not merely ‘go together’, they strongly influence each other (Wood et al, 2016).
For Aboriginal people the situation is compounded by the transgenerational impact of trauma that can be traced back to colonisation and the displacement of people from their traditional lands, the separation of children from their families, and policies and services that conflict with Indigenous values and culture (AIHW, 2019).
In recent years, there has been a paradigm shift in the way that the homelessness sector has considered the concepts of inclusion and the elevation of the voice of homeless people. However, traditional approaches to community engagement which are predicated on an ongoing power imbalance have been evaluated by lived experience writers as being inadequate and limiting (Loughhead et al, 2020).
The South Australian Housing Authority (SAHA) invested in lived experience workshops in 2019 to inform the South Australian Housing and Homelessness Strategy. People with lived experience talked about the need to go beyond ‘customer voice’ to see people experiencing housing challenges as having the capacity to be the architects of their own futures. Solutions that increased empathy were highlighted including the importance of lived experience workers – “someone who had walked a mile in my shoes” and could help navigate the housing system without judgement. This role was seen as a valuable way of utilising the expertise of people who had experienced housing challenges and could then act as a mentor to others who might be stuck in homelessness (TACSI, 2019).
South Australia’s homelessness sector draws on the experience of the lived experience peer workforce in mental health services. While the integration of lived experience and peer work in homelessness services lags behind the growth of the lived experience peer workforce in mental health services, there are a number of similarities and shared benefits (Tseris, 2019):
- The impact of shared experience and the ability of peer practitioners in homelessness services to empathise and develop mutual trust and understanding allows service users to address barriers affecting their transition to secure housing;
- Peer practitioners have been found to have positive impacts on service users’ levels of hope, empowerment and quality of life; and
- The influence that peer practitioners are able to exert within their own services to develop professional practice that is informed by the lived experiences of service users.
Mental health specialist, Sonder has well developed lived experience support systems and a mature workforce embedded across it’s mental health services. Sonder is bringing this expertise into the Toward Home Alliance (THA).
Further, SA Mental Health Commissioner David Kelly, has been exploring the similarities, shared themes, differences and opportunities across the mental health and homelessness sectors over the last five years. Through a conversation with Toward Home Alliance peer practitioners the unique benefits and strengths that lived experience peer practitioners contribute to homelessness responses were identified and opportunities for ongoing investment and development in this work explored.
The conversation
THA Sonder peer practitioners, Annie Smith, Diana Dimitrov, Dan Duggan and a staff whose preference is to remain anonymous, shared their experiences as peer practitioners in the homelessness sector and highlighted the work that is needed to build a thriving peer workforce in the South Australian homelessness system. Senior Sonder peer practitioner Kat Elsby also spoke to the interplay between mental health and homelessness peer work, and the organisational and sector commitments needed to undertake successful peer work.
You can’t underestimate the power of relationships when you’re in a system that isn’t working well… language is important… us, who have lived experience and used services can translate the system speak – Annie
David reflects that ‘while all peer work is founded upon mutuality and non-hierarchical relationships, there are some features of the lived experience of homelessness peer work that are interpreted and deployed in unique ways.’
This largely centres on the imperfect and complex nature of the homelessness and housing systems, which are being further challenged by the growing housing and cost of living crisis. This position also reflects the reality of Australia’s homelessness systems, which are so often the catch-all for other system failures – the last line of defence and crisis response for those with experiences of poverty, unresolved trauma and health issues.
I think there’s a big lack of services for people undergoing intense, traumatic experiences on the spot… we call the police, the police come; they get detained or into an emergency response on the spot, and are released the next day…
All of THA’s peer practitioners agree that holding hope and relationships with people in crisis whilst trying to navigate the system, is critical.
Despite the clear strengths and importance of embedding multi-disciplinary teams like the Toward Home Wellbeing team, into the homelessness workforce, ‘red tape, silos and paperwork’ between systems still exist. And whilst the excellent work of services like the Urgent Mental Health Care Centre and after-hours mental health supports play a critical role in diverting people away from hospital EDs and jail, peer practitioner Dan says clients still struggle to get the help they need:
So many of our clients don’t fit a sweet spot on the venn diagram… Mental health say it’s alcohol and other drugs (AOD); and AOD says it’s mental health.
THA’s peer practitioners told us that in the face of numerous system failures and service gaps, those working in the homelessness sector are forced to ‘hold’ this crisis.
Unfortunately, this often reinforces low client expectations of the service system, with Dan reflecting that “a lot of people won’t engage with services because they feel it will make them worse”.
Diana noted that “systems fatigue” is a real barrier to engagement for service users. All peer practitioners agree it is particularly common for those with persistent and chronic experiences of homelessness. Peer practitioners have a valuable role in helping people transcend these:
It’s about breaking down the barriers in the system, so people can get the outcomes they want – Kat
In an imperfect system where many will not receive the services they need and the housing outcomes they want and deserve, homelessness lived experience peer practitioners have a pivotal role to play as they:
- Translate and guide people through in the foreign land of housing, health and income systems, processes and jargon;
- Act with courage – they are prepared to go where no other workers are able to go, can walk alongside people, and are prepared to stay there longer;
- Support life beyond service land, knowing that the hard work of stable housing and recovery happens in real life and community not in the strict bounds of service provision;
- Recognise and validate the existing strengths, interests and resources of the people they support;
- Promote and normalise opportunities for recreation and social life – even when things aren’t necessarily going well;
- Disclose their own stories with purpose and only when it helps;
- Pay attention to context and try to understand the why of behaviour; and
- Model a different way of dealing with tough challenges and offer hope for the future.
The importance of the ‘way’ peer work is undertaken, including assertive outreach and consistent engagement was emphasized: ‘because we do a lot of outreach, our strength is engagement and being able to link people into more formal services’ *anonymous
All four peers agreed that a key feature of their roles is the understanding and relatability they bring to situations. They note that the ability to ‘empathise from experience’ not only helps to build rapport but also, through conversations about what worked for them in similar situations, opens up potential pathways to a different future.
Peer practitioners have a critical role to play in designing and improving service responses . Their capacity to model hope and demonstrate how adversity can be navigated, naturally builds connection and trust with people seeking and/or in need of supports:
“What I always thought of as deficits, give me insights into another person’s suffering.. they are the expert of their story, and I find it a privilege to participate in that’’ – Annie
Call to action
As the homelessness sector continues to foster an emergent lived experience workforce, the Toward Home Alliance recognises that greater commitment is needed.
In addition to bringing lived experience more fully into governance and decision making, the Alliance has the opportunity to facilitate pathways out of homelessness, through a recovery journey that includes the possibility of paid lived experience roles. For the THA lived experience peer practitioners, a pivotal stage in this journey is access to learning and education:
The turning point for me around self actualisation, has been education.. particularly, the training to be a mental health peer practitioner at TAFE. The nature of the course involves a lot of self reflection, and entering into the role of peer practitioner, my experience in both good and bad times is able to be disclosed purposefully – Annie
Diana, who completed Centacare’s Certificate IV in peer work also reflects on the important role education played in her journey. Her training has provided her with the capacity to understand and respond to context:
Context helps to understand behaviours, why choices are being made, and how we can empower people if we encourage them to look for context – Diana
Whilst the homelessness sector is still ‘catching up’ to our peers in mental health, we now have an opportunity and responsibility to build on our learnings and invest in the lived experience workforce. SYC is leading the sector-wide development and implementation of a lived experience framework and resources for the homelessness and DFV alliances. However, system readiness is critical and agencies now need to do the hard work of building support at the governance level and developing lived experience policies, frameworks and recruitment, training, supervision and support strategies that will enable safe and sustainable growth.
The evidence regarding the impact of a lived experience workforce is well established and the growth of the lived experience workforce in the homelessness sector is inevitable. The South Australia Housing Authority’s public commitment to the principle of lived experience and the implementation of the regional partnership model provides a unique opportunity to fast-track the full expression of lived experience in the homelessness sector, ensuring tangible client, service and system benefits in the process. As Diana states, ‘we have a seat at the table, and people need to recognise that’.
References
Australian Institute of Health and Welfare 2019. Aboriginal and Torres Strait Islander people: a focus report on housing and homelessness. Cat. no. HOU 301. Canberra: AIHW.
Loughhead, M, McIntyre, H, Hodges, E & Procter NG (2020), Lived experience leadership for organisational and systems change: a scoping review of concepts and evidence, University of South Australia and Lived Experience Leadership and Advocacy Network SA, Adelaide.
The Australian Centre for Social Innovation (2019), Summary of Lived Experience Workshops Lived experience perspective informing the South Australian Housing and Homelessness Strategy, Adelaide
Tseris, E (2019): The Expansion of the Peer Adviser Workforce: Opportunities and Challenges for Social Work, Australian Social Work, DOI:10.1080/0312407X.2019.1675734)
Wood, L., Flatau, P., Zaretzky, K., Foster, S., Vallesi, S. and Miscenko, D. (2016) What are the health, social and economic benefits of providing public housing and support to formerly homeless people?, AHURI Final Report No.265, Australian Housing and Urban Research Institute, Melbourne.
To learn more about the Toward Home Wellbeing service, visit sonder.net.au/toward-home
Looking for support?
Call us on 1800 809 273 (9am – 5pm Monday – Friday) and find out how we can help.
If you require urgent housing support after hours, please call Homeless Connect on 1800 003 308. If you are in immediate danger, please contact 000 for police, ambulance and fire.