Homelessness, mental health and mortality
September 18 2019
Content warning: this blog post features stories of people who have died by suicide. It might be triggering for some readers. If you need crisis support please call Lifeline 13 11 14.
Launch Housing’s submission to the Royal Commission into Victoria’s Mental Health System highlights the urgent need for housing to improve the mental healthcare of people experiencing homelessness.
As part of our submission we published a review of our client death register to highlight the need for stronger connections between mental health and housing services.
(Image via Unsplash)
The review found there were 45 known deaths of current or former clients between June 2018 and June 2019.
Not all deaths are directly attributable to mental health. But of the 45 people who died in this period, mental health was a contributing factor for many.
Thirty-seven people had a self-disclosed mental illness and 18 were in contact with mental health services at the time of their death.
Homelessness is a significant health inequality and is regarded as an important and modifiable predictor of mortality. Homelessness is also an independent risk factor for death and is more hazardous than being in ‘conventionally’ deprived socio-economic circumstances.
The following two case studies provide insight into the typical and tragic circumstances surrounding client deaths. To ensure anonymity, they represent a composite of the stories and experiences of a number of clients.
Maria* Took her own life at age 32, approximately one month after being discharged from a psychiatric inpatient unit.
‘Maria was deeply entrenched in the homelessness sector, with her first episode of homelessness occurring at age 18.
‘Maria’ was diagnosed with Bipolar disorder at age 17, and borderline personality disorder at age 20. Her experience of homelessness exposed her to significant trauma, and she was diagnosed with post-traumatic stress disorder (PTSD) at age 25.
‘Maria’ was a polysubstance user**, and had enormous trouble securing a dual diagnosis service. Maria cycled between alcohol and other drug services and the mental health sector, which highlighted the problem of ‘boundary’ disputes between the two sectors and about who had primary responsibility.
(Image via Unsplash)
Maria found it very difficult to maintain housing due to drug use and poor mental health, and cycled in and out of homelessness. She was evicted from crisis accommodation services, rooming houses and other emergency accommodation.
Maria was residing in public housing at the time of her death and received services from Launch Housing. ‘Maria’ had had four psychiatric admissions in the two years prior to her death and was on a Community Treatment Order***.
Her girlfriend advocated for her admission to a residential mental health service, however this did not eventuate.
Ultimately, Maria took her own life. It is likely that ‘Maria would have benefitted if the alcohol and drug sector, mental health and homelessness sectors were better able to coordinate service provision.
Ben* died at age 24, whilst residing at a residential mental health service.
Ben was diagnosed with schizophrenia at age 17, and depression at age 20.
His family experienced homelessness when Ben was 10, and he experienced significant trauma as a result.
His family was supported by a Launch Housing service at the time of his death. Ben was hospitalised as a psychiatric inpatient two months prior to his death and was discharged to a residential mental health service one month prior.
He was psychotic at the time of his death, but was not considered to be a danger to himself and was therefore held at the residential service.
On the day he died, Ben left the service, went for a walk, and was hit by a car.
* Not the actual name of the clients whose stories were used to inform these case studies.
** Polysubstance use is the abuse of two or more drugs that cause impairment or distress.
*** Community Treatment Order authorises the provision of a compulsory mental health treatment for a person where the treatment criteria applies.