National mental health report 2013

Indicator 19: Prevalence of mental illness among homeless populations

Page last updated: 2013

Key messages:

  • Routinely collected data from the former Supported Accommodation Assistance Program (SAAP) suggests that, in 2010-11, 11% of SAAP clients sought accommodation because of mental health problems, 9% did so because of substance use problems, and 7% did so because of comorbid mental health and substance use problems.
  • These figures are likely to underestimate the true prevalence of mental illness among homeless populations because they focus on clients whose referral to SAAP was associated with these problems. They do not take into account clients who may have underlying conditions that are not directly responsible for the referral.
  • From July 2011, the Special Homelessness Services (SHS) collection will enable more accurate estimates of mental illness among homeless populations to be calculated.
There is a substantial body of evidence that suggests that homeless people are more likely to experience mental illness than those whose accommodation needs are met. Mental illness featured prominently among stakeholder concerns during the consultation process leading up to the release in 2008 of The Road Home, the Australian Government White Paper on homelessness.63

Quantifying the prevalence of mental illness among homeless populations is difficult, and estimates have varied considerably. Australia's Welfare 2011, published by the Australian Institute of Health and Welfare (AIHW), reviewed the evidence and observed that while some studies estimated the prevalence of mental illness in the homeless population to be between 72% and 82%, others have found it to be between 12% and 44%. A key study cited by the AIHW, based on a review of approximately 4,300 case histories, found that 31% experienced a mental health problem. Of these, about half (47%) had a mental health problem prior to becoming homeless, and the remainder developed mental health problems following homelessness.64

For the purposes of this indicator, estimates are taken from data collected on clients of the former Supported Accommodation Assistance Program (SAA P), a cost-shared program funded by the Australian Government and state and territory governments and providing crisis accommodation and related support services to people who are homeless or at imminent risk of becoming homeless. Information on all SAAP clients was collected via a national minimum dataset, and included data on whether they sought assistance because of mental health problems, substance use problems or comorbid mental health and substance use problems.

Figure 63 shows the percentage of SAAP clients in each group from 2005-06 to 2010-11. In 2010- 11, 11% of SAAP's 142,500 clients were deemed to have sought assistance due to mental health issues. These included clients who were referred from a psychiatric unit, reported psychiatric illness and/or mental health issues as a reason for seeking assistance, were in a psychiatric institution before or after receiving assistance, and/or needed, were provided with or were referred on for support in the form of psychological or psychiatric services. An additional 9% were identified with problematic drug, alcohol and/or substance use as reasons for seeking assistance. A further 7% of clients were considered to have both mental health and substance use problems (comorbidity). The figures for mental health problems and comorbid mental health and substance use problems have remained fairly consistent over time, but those for substance use problems have dropped from 12% in 2005-06.

The difficulty with using routinely collected SAAP data is that it only provides part of the picture. It provides an indication of the percentage of clients whose referral to the program has been associated with the above problems, but does not take into account clients who may have underlying conditions that are not directly responsible for the referral. For this reason, a special census was conducted in June 2008 which aimed to gather more accurate data on the proportion of SAAP clients with complex needs. The results of this census confirmed that mental health problems are more prevalent among SAAP clients than the routinely collected data would suggest. The census found that 34% of the survey sample identified as having mental health issues. Of these, more than half (56%) had a known diagnosis of a mental illness and almost a third (31%) were identified as current users of specialist mental health services. The latter figure equates to about 10% of all SAAP clients.

Further evidence that the routinely collected SAAP data underestimates the true prevalence of mental illness among homeless populations comes from the National Survey of Mental Health and Wellbeing. This survey, conducted in 2007, found that over half (54%) of the people who had ever been homeless had a current mental illness, defined by their having a mood disorder, an anxiety disorder or a substance use disorder in the previous 12 months. This was almost three times the rate for those who had never been homeless.9,65

On July 2011, the SAAP data collection was replaced by the Special Homelessness Services (SHS) collection. SHS will provide better information about clients of homelessness assistance services, and is likely to enable more accurate estimates of mental illness among homeless populations to be calculated.

For now, it is reasonable to conclude that mental illness is a significant problem for many homeless people, and the two issues often occur together; mental illness may jeopardise people's chances of securing or retaining stable accommodation, and homelessness takes a toll on people's emotional wellbeing. As noted in the discussion of Indicator 4, governments have acknowledged the vital role that stable housing plays in promoting recovery from mental illness. Top of page

Figure 63: Supported Accommodation Assistance Program (SAAP) clients with mental health, substance use and comorbid problems, 2005-06 to 2010-11

Refer to the following table for a text equivalent of Figure 63: Supported Accommodation Assistance Program (SAAP) clients with mental health, substance use and comorbid problems, 2005-06 to 2010-11

Text version of figure 63

2005-062006-072007-082008-092009-102010-11
Mental health problems only
11.2
11.3
10.7
11.4
11.6
11.4
Substance abuse problems only
11.5
10.6
10.2
10.1
9.5
9.1
Comorbid mental health and
substance abuse problems
6.9
7.1
6.6
7.2
7.3
7.0