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Mental health and homelessness

Mental health and homelessness

Working as part of the Toward Home Alliance, Sonder delivers Toward Home Wellbeing, a specialist, wraparound service which focuses on supporting people experiencing homelessness by addressing complex health needs affecting their ability to gain or sustain housing.

Many of the clients supported by Sonder’s Toward Home Wellbeing service have numerous complex and chronic health conditions, often exacerbated through experiencing homelessness, resulting in unmanaged and untreated health conditions that affect the person’s entire wellbeing.

People accessing the service are generally experiencing moderate-complex health needs, with most requiring multi-agency support to address these concerns. Many people have reported experiencing difficulties in accessing the right healthcare support or have struggled to meet complex eligibility and requirements.

To best support this client group, Toward Home Wellbeing is a multi-disciplinary team made up of mental health practitioners, registered nurses and care coordinators, as well as peer practitioners, who have their own lived experience of homelessness. Specialist Aboriginal roles are also included in the team, these individuals use their own experience to provide culturally safe and inclusive support. Further information about each role is included below –

  • Mental Health Practitioners – experienced and have clinical expertise in delivering mental health treatment in a way that is trauma-informed.
  • Peer Practitioners – using their own lived experience of homelessness and mental health issues to support clients through a shared understanding of the difficulties many people face, bringing a unique and authentic view to supporting people that assists in building trust and understanding.
  • Care Coordinators – oversee the support and help people connect with services, including mental health friendly GP’s, advocating to tertiary services, finding psychological therapy services, all whilst working towards other health and housing outcomes.
  • Registered Nurses – directly refer to emergency services, advocate for clients at services using a medical lens, assist with medication and consider physical wellbeing and appropriate housing alongside mental health.

Mental health concerns facing people experiencing homelessness

Since Sonder’s Toward Home Wellbeing team commenced delivering services, referrals have been received from the other Toward Home Alliance service segments for various chronic health concerns, including issues regarding a person’s mental health.

Many clients accessing Toward Home Alliance services have multiple and complex difficulties with mental health concerns, including:

  • Being mistrustful and fearful of mental health services, due to poor past experiences.
  • Difficulties discussing their own mental health concerns, often due to stigma and shame in speaking about and accessing mental health services.
  • Cycling in and out of hospital due to emergency mental health situations.
  • Having multiple diagnosis of various mental health conditions and being unsure which is correct.
  • Having prescribed medications but experiencing difficulties obtaining medication or not taking their medication as prescribed.
  • Difficulties accessing mental health friendly GP’s, psychological therapies, and psychiatric support.
  • Services identifying a client as being mentally unwell, which is not acknowledged or recognised by the client.

Mental health support

Mental health support provided by Sonder’sToward Home Wellbeing service is primarily focused on ensuring each individual receives the right care, underpinned by trauma informed practice by:

  • Building and maintaining trust and rapport.
  • Acknowledging the mistrust that many clients have for the mental health system.
  • Understanding that many clients have a poor history and experience with mental health services.
  • Learning more about the client’s history and what they want to address.
  • Building an understanding that it is okay to talk about mental health.
  • Finding and linking the client with the most appropriate support, in line with the client’s goals
  • Ensuring clients can access support by providing advocacy, transportation and support to attend appointments.

For Aboriginal clients, other considerations for support include:

  • Considering Aboriginal-specific services.
  • Flexible service delivery, including location, time and frequency.
  • Consideration of cultural differences and how western view of mental health can impact on culture.
  • Utilising workers with lived experience, to help to reduce stigma around homelessness, addiction, domestic violence, and intergenerational trauma.
  • Understanding Aboriginal culture to help people feel trust in their worker.

Barriers to seeking support

Sonder’s Toward Home Wellbeing team currently has two Mental Health Practitioners, who have expertise in appropriate clinical intervention and overall wellbeing. Underpinning this is the Mental Health Practitioner’s understanding of the complexities surrounding homelessness and the difficulties in accessing mental health support, as well as being able to provide trauma-informed therapy in a non-judgemental way.

Our Mental Health Practitioners recognise that many people experiencing homelessness have had traumatic experiences with the mental health system, resulting in mistrust and fear of seeking support. Many people who would benefit from mental health support often refuse or may know what to say to avoid being involuntarily serviced, due to past experiences.

Mental Health Practitioners recognise the great stigma and shame that exists for many considering accessing mental health services. Many have reported poor histories with mental health services and a belief that they will be “locked up” if they are honest about their mental health concerns.

By providing skilful interventions, a non-judgemental stance, listening and working towards the client’s individual goals, clients can slowly come to realise that there is no shame in accessing mental health services and may begin to open up and become more willing to engage in conversations.

Many people requiring mental health support are often not stable enough to access clinical therapy. Those who are ready are often faced with lengthy waiting times to access psychological therapy, are unable to source a GP that they trust or are unable to pay gap fees.

Acnowledging this, mental health services in Toward Home are delivered with flexibility and on an outreach basis, where the individual is most comfortable. For some, this involves meeting with rough sleepers where they are staying or visiting clients in transitional housing, emergency motel accommodation and other community and public housing spaces. Whilst others may feel more comfortable meeting in a public space, recognising that this is often the first step for many people in seeking mental health support.

Many people experiencing homelessness do not have the capacity to begin to address their mental health concerns until they have secured housing. This is where the work of the Peer Practitioners in Toward Home shines – Peer Practitioners bring their own lived experience of homelessness and mental illness to assist people to navigate the housing and health system, understand the person’s goals and slowly introduce the concept of addressing mental health, where appropriate and when the client expresses an interest in doing so. This is particularly highlighted for people sleeping rough where mental health is often prevalent, but often not the most pressing issue. Peer Practitioners work on developing trust and rapport, until the individual is ready to start working on their mental health. For other people, they may have a desire to seek support for their mental health but may be facing difficulties due to take the step to do so due to feeling mistrust or fear towrads services. Peer Practitioners can provide advocacy to help people get the right support and assist with transport and attending appointments.

How can services best support mental health challenges?

In supporting individuals experiencing homelessness and mental health challenges, Sonder’s Toward Home Wellbeing team recommend the following considerations:

  • All support should be provided with a trauma-informed lens, recognising that many people experiencing homelessness often present with a number of traumas, that may or may not be known to the worker. As emotional dysregulation is to be expected, workers should have an understanding of how to best manage an emotional response, so as to not inadvertently retraumatise the person.
  • Ensure workers have adequate training and resources in assessing for safety. Including providing assessments for suicidal ideation and non-suicidal self-injury and understanding when to escalate to tertiary services.
  • Support must be highly individualised – a one size fits all treatment does not work for this client group, often due to their own past experiences with mental health services. This includes being flexible with where appointments take place and being prepared for clients to be unwilling to talk directly about their mental health.
  • Recognise when a client is ready to talk about their mental health and do not shy away from this conversation. Be realistic about what can and cannot be offered.
  • Understand the different mental health services available and assist people to navigate these, in order to get the best support possible.
  • Understand the link between physical and mental health – particularly for rough sleepers.  Individuals are much more likely to be open to discussing their mental health when they have a space to have a shower, wash clothing, have a meal and grab a drink. Workers also need to discuss nutrition to make sure that clients are eating regularly, advocating for food where needed.
  • For many people, when provided with housing, they lose their sense of social connectedness. Connecting people into their local community to obtain new social connections is key to supporting positive mental health and sustaining housing.
  • Be prepared to simply have a chat and find out more about what the person is experiencing and more importantly, what they do and do not want to do about it.

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.