Foundations for change - Homelessness in NSW - 28 Oct 2016

Foundations for change

Homelessness in NSW

Submission to Family and Community Services

October 2016

Mental Health Commission of NSW

Note about language

The term consumer is used interchangeably with terms such as ‘person with a lived experience of mental illness’ and ‘person who experiences mental illness’. The term consumer is used by those in Australia who have advocated for the human rights and citizenship of people who live with mental illness, and is therefore strongly associated with this movement. The word consumer also powerfully endorses the principles of choice and autonomy for people with mental health issues, who are active participants in their own care and support.

Organisations providing recovery oriented and trauma-informed services to people affected by mental/emotional distress are encouraged to adopt the Recovery Oriented Language Guide developed by the Mental Health Coordinating Council, which has been applied here.

The Mental Health Commission of NSW

The Mental Health Commission of NSW is an independent statutory agency responsible for monitoring, reviewing and improving the mental health system and the mental health and wellbeing of the people of NSW. It works with Government and the community to secure better mental health and wellbeing for everyone, to prevent mental illness and to ensure the availability of appropriate supports in or close to home when people are unwell or at risk of becoming unwell.

In all its work, the Commission is guided by the lived experience of people with mental illness and their families and carers. The Commission promotes policies and practices that recognise the autonomy of people who experience mental illness and supports their recovery, emphasising their personal and social needs and preferences as well as broader health.

The Commission works in three main ways:

Advocating, educating and advising about positive change to mental health policy, practice and systems to support better responses to people who experience mental illness, and their families and carers.

Partnering with community-managed organisations, academic institutions, professional groups or government agencies to support the development of better approaches to the provision of mental health services and improved community wellbeing, and promote their wide adoption.

Monitoring and reviewing the current system of mental health supports and progress towards achieving the Actions in Living Well, and providing this information to the community and the mental health sector in ways that encourage positive change.

Mental Health Commission of NSW

Foundations for change: Homelessness in NSW Submission | October 2016 3

Living Well: A Strategic Plan for Mental Health in NSW 2014-2024

On 15 December 2014, the NSW Government adopted Living Well: A Strategic Plan for Mental Health in NSW 2014-2024, developed by the NSW Mental Health Commission following an unprecedented program of consultation and engagement with Government, non-government agencies, mental health professionals and the community, in which more than 2000 people participated. In accepting Living Well, and all the 141 Actions it contains, the Government has set a ground-breaking new direction for the provision of services and supports to people in NSW who experience mental illness. This is modelled on proven principles of recovery and person-centred care, which emphasise choice and autonomy and consider the personal and social dimensions of mental illness alongside its impact on people’s health. For this reason, the Plan takes a whole-of-Government perspective, including housing, education, employment assistance, the justice system and family support among the spectrum of services that people may require when they experience mental illness. Living Well also firmly embeds an acknowledgement that good mental health is not only a matter for individuals, and that early support for children, families and communities can create strong foundations for positive mental health and resilience across the whole of life.

Mental Health Commission of NSW

Foundations for change: Homelessness in NSW Submission | October 2016 4

Introduction

The Mental Health Commission of NSW was established in July 2012 by the Mental Health Commission Act 2012. The Act provide that public sector agencies are to have regard to the principles set out in section 11 of the Act in the exercise of their functions, namely:

(a) people who have a mental illness, wherever they live, should have access to the best possible mental health care and support, (b) people who have a mental illness and their families and carers should be treated with respect and dignity, (c) the primary objective of the mental health system should be to support people who have a mental illness to participate fully in community life and lead meaningful lives, (d) the promotion of good mental health and the effective provision of mental health services are the shared responsibility of the government and non-government sectors, (e) an effective mental health system requires:

(i) a co-ordinated and integrated approach across all levels of government and the non-government sector, including in the areas of health, housing, employment, education and justice, and (ii) communication and collaboration between people who have a mental illness and their families and carers, providers of mental health services and the whole community.

Section 16 of the Act further provides that:

(1) It is the duty of the Commission and public sector agencies that provide mental health services or are involved in dealing with people who have a mental illness to work co-operatively in the exercise of their respective functions

Homelessness is a systemic issue that affects people who have a mental illness. Homelessness and mental illness co-occur with, precipitate and exacerbate each other. In both homelessness and mental illness, identifying the initial signals and intervening early can prevent things from getting worse. Identification can be challenging, as it is often agencies and services not traditionally focused on homelessness or mental health to which people first present their symptoms. Mainstream services need to be aware of the warning signs and risk factors for both conditions, and know how to make appropriate referrals. Sectors and systems should know how to respond whenever a person reaches out for help, whether for their homelessness or their mental health. Services should recognise that seeking support may be difficult, and may not happen again. In practice, this may require service providers to plan how to assist those whom they cannot support directly to obtain the right information and care and to help people to navigate those pathways. The following answers are in response to questions posed by the NSW Department of Family and Community Services discussion paper, Foundations for Change – Homelessness in NSW.

Mental Health Commission of NSW

Foundations for change: Homelessness in NSW Submission | October 2016 5

1. How can government and non-government agencies build on previous NSW homelessness initiatives and plans to create a robust strategy to prevent and reduce homelessness in NSW? The strategy should respond to the actions relating to homelessness and housing that were adopted by the NSW Government in Living Well, as numbered below. 6.4.1 Build on the success of the Housing Accommodation and Support Initiative

(HASI) by increasing the number of packages and expanding the model to include new cohorts. Develop a model to support people who experience mental illness to maintain their tenancies, such as through the provision of lower-intensity HASI-style packages.

6.4.2 Improve referral pathways to state and Commonwealth-funded housing,

homelessness and mental health services. This will require district implementation and coordinating committees to work with specialist homelessness services to develop a better understanding of the mental health system.

6.4.3 Investigate mechanisms that assist people with mental illness to access the

private rental market. This will require working with business and community-managed organisations, and consideration of economic disadvantage and discrimination in the private rental market.

6.4.4 Develop and implement therapeutic models for public, community and

Aboriginal housing where a substantial number of tenants experience mental illness. This will require consideration of the physical environment -the local community environment and support structures the relationship between housing staff and tenants.

6.4.5 Use cross-agency data to identify issues and provide support to people with

mental health and housing needs. This will require improved cross-sector, interagency information collection, and sharing. The data collected must identify: people with a mental illness who are homeless public housing, Aboriginal housing and boarding house tenants with a mental illness people with a mental illness using crisis accommodation services the housing status of people leaving mental health care facilities and people with a mental illness leaving corrective service facilities.

2. What are the key outcomes the homelessness system should deliver and what

outcomes can it influence?

The homelessness system should seek to: Reduce levels of homelessness across all cohorts. Reduce levels of repeat homelessness across all cohorts. Reduce stigma associated with accessing homelessness services. Increase client satisfaction with homelessness prevention services. Increase security of tenure for vulnerable families and individuals.

Mental Health Commission of NSW

Foundations for change: Homelessness in NSW Submission | October 2016 6

Improve the lived experience of those with a mental illness and keep people well in the community.

Remove the inappropriate use of temporary accommodation by introducing clear service standards around appropriate use, safety and length of stay.

Improve mental health and wellbeing.

The homelessness system may have a positive impact on the following Living Well i indicators:

Increase the proportion of the community that reports positive mental health and

wellbeing. Decrease the rate of psychological distress in the community. Reduce the proportion of people with a mental illness experiencing discrimination

and stigma. Increase the rate of community participation among people with a mental illness. Increase the proportion of consumers with a positive experience of service delivery. Decrease the rate of suicide and suicidal behaviour. Decrease the rate of involuntary treatment orders (inpatient and community)

issued (e.g., by providing support services to people in their homes to prevent homelessness and mental illness)

3. What role can the corporate sector, philanthropists and other people in the

community play to help reduce homelessness? Social Impact Bonds, contracts containing a commitment to pay for improved social outcomes, provide a mechanism for rewarding innovation and can improve accountability and transparency of expenditureii. However, although they may enable service delivery to target specific challenges and provide a clear outcomes measurement, it is critically important to ensure stakeholders are unable to game the systemiii.

4. Are there circumstances where it is more difficult to link people to a suitable

housing option? What are the barriers?

In 2012, mental health consumers and carers reported that accessing affordable housing was a major problem in NSWiv. Many consumers on low incomes reported living in unstable and marginal housing such as boarding houses, backpacker accommodation, crisis accommodation, pubs and other forms of temporary housing. People also reported that obtaining public housing was difficult because of long waiting lists and the burden on individuals to “continually prove their needs and advocate for their ‘case’”v. People with complex needs arising from coexisting conditions such as drug and alcohol issues, intellectual and physical disability and physical health face additional challenges in gaining access to suitable housing. Mental illness and housing issues each contribute to the other – homelessness both exacerbates and is exacerbated by mental health problemsvi. Mental illness, drug and alcohol issues, unavailability of affordable accommodation, poor access to services and social isolation are reported

Mental Health Commission of NSW

Foundations for change: Homelessness in NSW Submission | October 2016 7

as key factors contributing to people entering unsuitable/unstable housing in rural areasvii. Complex service systems can be difficult to navigate. This is a challenge experienced by consumers, caregivers and their families. They may require additional support to navigate and access the system successfully. All Government agencies and community-managed organisations that serve the public should know the proportion of their clients who have a mental illness, and how those people are affected by the ways in which services are delivered. Difficult encounters with service providers can at times be traumatic for people who live with mental illness and, as a result, they may avoid further interactions and risk not getting the support they need. The physical environment in which these interactions occur can also be a significant barrier.

A commitment to Mental Health First Aid Training could improve the service offered by front-line staff could make services more accessible and easier to navigate for consumers and carers.

5. In addition to increasing housing supply, what actions are needed to improve access

to housing for people experiencing homelessness and how can the access system for social housing be more responsive to their needs? The following actions could improve access to housing for people experiencing homelessness:

Using local homelessness data and data gathered from homelessness strategies and reviews to inform housing access at a local levelviii

targeting of regions and communities with the greatest and most entrenched mental health and social disadvantage, and address how inequalities cluster in geographic areasix

ensuring that the development and evaluation of policies, services and programs include meaningful participation of people with a lived experience of mental illness and people that care for them

6. What different supports or tenancy management approaches could help keep

people at risk of homelessness in their homes? The following tenancy management approaches could help keep people at risk of homelessness in their homesx: Identify clients at risk of tenancy failure and vulnerable client archetypes using

existing data and target support at sign up or periods of identified risk. Identify homelessness risk events using existing data (e.g. rent arrears at Christmas)

and plan a client centred, seamless system around these data points. Implement an automated alert system to housing staff to provide targeted pre-emptive support and information when risk events are triggered.

Mental Health Commission of NSW

Foundations for change: Homelessness in NSW Submission | October 2016 8

Develop specialist homelessness prevention skills within a range of service delivery settings.

Establish clear service standards, performance indicators and targets for homelessness prevention services.

Measure and report on both the extent and effectiveness of homelessness prevention activities.

Ensure staffing structures and job descriptions are consistent with the new prevention focused, strategically guided approach to homelessness.

Ensure home visits by a Housing Officers/Support Workers/Out of Home Care are utilised to identify and prevent homelessness.

7. What needs to change to get greater private sector involvement in delivering social

and affordable homes?

New ‘off-the-plan’ private sector housing building contracts could ensure the developer builds a percentage of social housing properties.

8. How can the strategy help engage the corporate sector and philanthropists with the

issue of homelessness and better link their expertise and funds to help reduce it?

See the answer to question 9.

9. How can the strategy help services, the corporate sector and philanthropists work together to make a difference?

Services, the corporate sector and philanthropists could engage in a co-design process with people who have experienced homelessness or at risk of homelessness to review the existing evidence and identify the wider systemic challenges that contribute to homelessness and the risk of homelessness (including gaps in service provision). Together, they could pilot, evaluate and implement different services models and approaches.

10. How can exit planning and pathways into housing be better connected? Interview procedures could be established across a range of settings within mainstream services to focus initial attention on preventing homelessness. These interviews could seek to provide support and advice at different transition points, for example, pending discharge from prison, rehabilitation, hospital etc. The interview process should not act as a barrier to prevent or discourage people who are homeless from seeking help.

11. How can people at risk of homelessness be better engaged in their exit plans?

Smooth transition to social housing should be part of dedicated resettlement programme, undertaken in partnership with Community Managed Organisations.

Mental Health Commission of NSW

Foundations for change: Homelessness in NSW Submission | October 2016 9

12. How can employment initiatives be linked with other initiatives to support housing and homelessness outcomes?

Living Well action 3.5.5 requires all government agencies or community managed mental health organisations proving services to people with a mental illness to respond to the individual aspirations of clients to access education, training and employment. This is especially important in terms of the positive impact that employment can have on a person’s ability to maintain a tenancy. The Y-Central model in Gosford has proved to be a successful example. It offers a free, one-stop shop for young people aged 12-25 years of age centred on early intervention for mental health and emotional wellbeing and assesses and refers to appropriate services. These include headspace, specialist mental health, drug and alcohol services, vocational and educational, employment, accommodation and primary health.

13. Where are there opportunities to improve how employment, training and education services help prevent homelessness?

Homelessness services could employ people with a lived experience of mental illness; they have an expertise that is incredibly valuable. Employing people with lived experience in peer worker roles to support others brings a tremendous range of benefits. Peer Workers should be employed in all workforces that deliver services to client groups with a significant number of people who experience mental illness. The Peer Work Hub was created in response to the recommendations outlined in Living Well as an online resource for organisations wanting to develop and grow their peer workforce. A commitment to Mental Health First Aid Training could improve the service offered by front-line staff could make services more accessible and easier to navigate for consumers and carers.

14. How can the strategy encourage and support people working in the mainstream

system to find solutions for people at risk of homelessness?

See the answer to question 22. 15. What are the barriers limiting services from working with people to get them the

support they say they need? Targeting mental health training to housing maintenance workers and front desk staff may overcome the barrier of consumers gaining early access to services, these roles typically engage with people more frequently. Partnerships between Specialist Homelessness Services, schools, domestic violence services and mainstream services may increase awareness and enable the identification of issues earlier.

Mental Health Commission of NSW

Foundations for change: Homelessness in NSW Submission | October 2016 10

16. Where are local services and stakeholders implementing a collaborative approach to prevention and early intervention that is making a difference?

Northern Sydney District has implemented Ready for Life Ready for Success (RFLRFS) an evidence based, early intervention and prevention approach to actively promote concepts of equity, self-responsibility and reciprocity both amongst agency partners and directly with the community. The key aim of RFLRFS was to re-purpose the existing local service delivery system and transition from a programmatic to person centred and relationship based approaches including: A focus on common outcomes, meaning the long-term changes that services and

other activities achieve collectively and in aggregate. Co-design and Co-production to make services more effective and bring in new

resources, by working in partnership with the people using their services Promotion of social and shared value by placing social, educational, environmental

and economic outcomes at the centre. 17. Would a system wide definition of homelessness, prevention, early intervention and

crisis responses help drive more collaborative approaches? A universally agreed definition of homelessness could be linked to eligibility to access minimum support. It would also enable strategic partners to plan around a common set of principles. The definition could include the graduated steps between housing stability and homelessness. In response, an intervention framework could map out the function of mainstream and specialised interventions for different cohorts at defined risk events.

In addition to a system definition of homelessness, services should respond to households (groups of people living together) and individuals who consider themselves homeless and those who have reason to believe they are at risk of homelessness. Using a self-defined categorisation of homelessness and risk of homelessness can enable services to be person centered, maximise appropriate referrals, and remove barriers to access.

18. What are the barriers to collaboration between sectors and how can they be

addressed?

Lack of Mental health literacy in mainstream services can act as a barrier to collaboration between services. It is essential that suitable, basic training in mental health literacy is available and promoted to all public sector employees who provide services directly to the public (such as nurses and counter staff of public services), or whose work involves making decisions related to people’s welfare, such as human services assessment officers and members of the judiciary).

The structure of services means people with an intellectual disability and mental illness are falling between the gaps in services, with neither the health nor disability systems taking full responsibility. They do not have the appropriate skills to address

Mental Health Commission of NSW

Foundations for change: Homelessness in NSW Submission | October 2016 11

the complexity presented by people with intellectual disability and mental illness. There is also a lack of training, leading to a lack of confidence on the part of mental health professionals and poorly developed interagency service models.

Without collaboration, mental health systems can be fragmented, complex and uncertain. We need to reduce uncertainty, increase cross-organisational learning and improve decision-making for the benefit of consumers and carers. Collaborative approaches to training and planning should seek to integrate services, reduce service duplication and ensure the system is easy to navigate. Ideally, consumers should be able to access a range of supports they require across different service providers through a continuum of complementary care, irrespective of funding source. By working collaboratively, services can provide person-centred seamless care, regardless of whether an individual is accessing Commonwealth or State funded services. This approach is critical to improving the lives of those who experience mental illness.

19. Where has coordinated effort been used to prevent homelessness? What worked

and what didn’t? Mainstream assistance programs should coordinate their efforts to effectively serve people who may be at risk of homelessness. This mainstream assistance approach ensures responsibility does not get referred on at a later date, thus delaying the point of intervention, increasing costs and reducing success ratesxi. Good prevention programs should strive to target people who have the highest risk of becoming homeless but who also have a good chance of remaining housed if they receive assistance.”xii The Housing and Support Initiative which is a collaboration between Housing NSW, NSW Health, and the community managed sector has successfully supported people who experience mental illness in stable housing. The emergence of Health Justice Partnerships which are local collaborations between Legal Aid, Family and Community Services, and Health NSW have also reported case studies where individuals have been supported to maintain their tenancies.

20. How can the NSW Government and mainstream agencies make their services available to people experiencing homelessness in ways that are accessible, dignified for the individual, and provided in a way that it is not re-traumatising to the person?

A key message of Living Well is to ensure that trauma informed care and practice is understood by services that work with people with a mental illness. Many people with a mental illness have experienced childhood trauma or been subject to traumatic experiences many that relate to systems that are meant to help not harm them. The homelessness service system should seek to understand trauma and respond appropriately. Services should seek to focus on ensuring services do not re-traumatise

Mental Health Commission of NSW

Foundations for change: Homelessness in NSW Submission | October 2016 12

or blame people for their efforts to manage their traumatic reactions but understand a person’s behaviour in the context of their life experiences and attempts to cope.xiii

A range of techniques could shed useful light on service quality and equity including the concept of mystery shopping, where researchers pose as service clients to record and assess the nature of the help provided. Another approach is peer reviews where other services systematically inspect one another’s services to identify strengths and weaknesses (Scottish Housing Best Value Network, 2005).xiv

21. What examples are there of effective local referral processes which engage a broad

range of sectors and mainstream services? Service NSW is a NSW government initiative delivering improved one-stop services for government customers. Service NSW delivers more than 800 transactions, including driver licences, birth certificates, Seniors Cards and Fair Trading licences through one digital service, one phone number and a network of one-stop shops.

22. How can referrals between other sectors and systems, such as primary health networks, be improved? Services should strengthen their responsiveness to people who experience risk and vulnerability and their families and carers through a ‘no wrong door’ approach. For all services, this involves a new determination to support those seeking assistance to find the right entry point for the services they need, even if not provided by that agency itself.

23. What data being collected by agencies could be shared to improve responses to

homelessness? The Client Information Management System (CIMs) captures personal and health data from clients receiving support from Specialist Homelessness Services (SHS) in NSW. The Client Consent, Information Sharing and Referral Protocol sets out the circumstances in which client data may be shared between government and non-governmental organisations. The Australian Institute of Health and Welfare makes the following data available, which could be used to improve responses to homelessness:

National Drug Strategy Household Survey (NDSHS), which is, conducted every three

years, yields detailed information on alcohol, tobacco, and other drug use within

Australia, as well as community attitudes to drug use. Both legal and illegal drugs

are covered.

Alcohol and Other Drug Treatment Services (AODTS) provides information on the

services provided by alcohol and other drug treatment agencies in Australia.

Mental Health Commission of NSW

Foundations for change: Homelessness in NSW Submission | October 2016 13

National Opioid Pharmacotherapy Statistics Annual Data (NOPSAD) collection

contains information on treatment services provided to people dependent on

opioid drugs such as heroin.

Housing assistance in Australia 2016 data provides up-to-date information relating to government-funded provision of social housing, rent assistance, home purchase assistance and support services to help households maintain their tenancies.

24. Is there any scope for reconfiguring services based on this data? The NSW Data Analytics Centre which facilitates data sharing between agencies to inform more efficient, strategic, whole-of-government evidence based decision-making may enable the leveraging of internal and external partnerships so that the right capabilities, tools and technologies can be applied.xv

25. Where are the opportunities to better identify and respond to the warning signs that young people are at risk of homelessness?

The opportunities to better identify and respond to the warning signs that young people are at risk of homelessness include:

ensuring those at risk get the right assistance as soon as they need it giving young people information about services available and how to access themxvi identifying family breakdown as a risk point and an opportunity to better respond

to the warning signs of homelessness for young people ensuring staff involved at the initial stages of contact with the young person have

the appropriate expertise and level of responsibility to determine the potential suitability of mediation as an option for young people

ensuring there are established screening procedures and protocols for removing the young person from the threat or actual experience of abuse, where this is requiredxvii

26. How can the strategy strengthen services to ensure young people are engaged in the

services they access and that services are tailored to the needs of children and young people? Tailored services to children and young people should seek to examine:

the risk factors affecting children, young people and their families at different life

stages and how these risks are responded to within the present systemxviii how the existing system could be better aligned to eliminate gaps opportunities for better coordination of services and service innovation in practice how the interaction between mainstream and targeted services could be improved opportunities presented by other reform activity a second tier response to Children at Risk of Significant Harm to address need that

does not meet the keep them safe threshold but may require cross-sector coordination and provision of support

Mental Health Commission of NSW

Foundations for change: Homelessness in NSW Submission | October 2016 14

27. How can services better work together and engage young people at risk of homelessness to keep them in education, training or employment? Schools, Out of Home Care and Specialist Homelessness Services could share information relating to children at risk of homelessness.

28. How can services engage with young people to help them into appropriate housing?

Through data analysis, seek to identify collaborative opportunities to target service provision to where young people face risks such as low participation and attainment in education, poor physical and mental health, welfare dependency, drug and alcohol use and involvement with the criminal justice system.

29. How can we build on Staying Home Leaving Violence and Start Safely, to address the

risk of homelessness for people experiencing domestic and family violence, including supporting women and children to remain in their home?

Support for the people who experience domestic and family violence should be considered within a strategic and coordinated multi-agency approach. This could be organised at the local level and involve key agencies such as the police, housing, education, health, domestic violence programs, and the courts. Households who have left their homes due to domestic and family violence often need to be supported in making a transition towards independence in a safe and planned way. Access to ongoing outreach or resettlement support, once they move on to more independent or settled housing, can play an important role in tenancy sustainment and preventing repeat homelessness, as well as helping to prevent people from returning to violent relationshipsxix. Staying Put, an initiative in Northern England (http://www.stayingput.uk.net/) which has a range of programs specifically designed to assist and support women stay in their homes, where it is assessed as safe to do so.

30. How can the Safer Pathways rollout be used to ensure early intervention for people

at risk of homelessness?

The Safer Pathways should seek to ensure

people at risk have access to information about services available people at risk are identified early, and opportunities are created to better

respond to warning signs staff involved at the initial stages of contact with the person at risk have the

appropriate expertise and level of responsibility to determine the potential suitability of different safety, legal and support options

there are established screening procedures and protocols for removing people at risk from the threat or actual experience of abuse, where this is requiredxx

a trauma informed response is used in service delivery

Mental Health Commission of NSW

Foundations for change: Homelessness in NSW Submission | October 2016 15

31. How can existing services better identify and support Aboriginal people at risk of

homelessness? Aboriginal participation, design, implementation and evaluation of NSW Government policies and initiatives should be strengthened to improve the mental health and social and emotional wellbeing of Aboriginal people (including the risk of homelessness). Aboriginal communities should be empowered to develop ground-up approaches, owned and promoted by the communities, including by Aboriginal people with a lived experience of mental illness. Mechanisms by which non-Aboriginal organisations can access expert, practical advice from Aboriginal people on strategies to improve the cultural appropriateness of their services should be established.

32. How can service systems improve how they engage with Aboriginal people to deliver culturally competent, holistic responses when they are at risk or experiencing homelessness?

Aboriginal homelessness is commonly about the insecurity of tenure, often due to overcrowding. This is a part of the Aboriginal experience in relation to concepts of home, and freedom to roam and stay in different placesxxi. More effort needs to be put into understanding, addressing and allowing overcrowding - as part of the cultural phenomenon rather than as a breach of tenancy – leading to eviction/homelessnessxxii.

Government programs must be co-designed, implemented and managed in partnerships with Aboriginal people and communities. It should not be assumed one person or group speaks for others; all Aboriginal people should be able to have their say. Effective and meaningful partnerships with Aboriginal communities must be a priority for leaders in government- and community-managed agencies. Investment in these partnerships must be reflected in agency planning and visible in the actions of agency leaders and their staff. Efforts to support Aboriginal mental health and social and emotional wellbeing must be grounded in respect for Aboriginal self-determinationxxiii.

33. Where are the opportunities to identify and support older women earlier who may be vulnerable and at risk of homelessness? Older women at risk of homelessness could be identified earlier by providing support and building continuity through social and professional networks around the following risk events: loss of ability to live independently because of limited mobility, chronic pain,

frailty or other mental or physical problems experience of events such as bereavement, a drop in socioeconomic status with

retirement, or a disability Isolation, loss of independence, loneliness and psychological distress

Mental Health Commission of NSW

Foundations for change: Homelessness in NSW Submission | October 2016 16

34. How can the aged care system help to divert people from homelessness?

See the answer to questions 39 and 40. 35. What are the barriers to housing and support providers working together to support

a Housing First approach for people sleeping rough? The central goal of the Housing First approach should be clarified. The goal of housing stability is easier to achieve in the short term, while the goal of recovery is likely to take longer and require specialist skills and resources. The programme must also be clear about its target group, especially with regard to clients experiencing comorbid issues. The existing data on Housing First and addiction is ‘mixed and unsettled’xxiv

36. What scope is there for new investment models to fund housing and support models

for people who are sleeping rough?

Australian Housing Supply Bonds, issued by a specialised financial intermediary, could be channelled towards ensuring affordable rental housing and meeting homelessness outcomesxxv. In addition, a high profile singular homelessness trust could be established to invite philanthropic donations to address homelessness.

37. Where are the opportunities to identify people who are sleeping rough and

intervene earlier to stop the problem becoming chronic?

Mental and physical heath, drug and alcohol issues can be treated together successfully, this could form part of a homelessness preventative approach. Research shows that programs that address multiple risky behaviours at the same time are more effective than those that respond separately and sequentially to different issues in a person’s lifexxvi.

38. What needs to change to stop people living with mental illness from becoming

homeless because of the episodic nature of their illness? Mental health consumers must have a sense of ownership and belonging, a sanctuary of safety and security in their community. They must have safe, stable, affordable housing and should be supported to maintain it. People with mental illness have a right to live in safety and with stability, and to choose where they want to live, with whom, and the amount of support they require. The rights of people who experience mental illness must be recognised and responded to accordingly. The right of a person who experiences mental illness to live, as much as possible, in the community is recognised within NSWxxvii xxviii and internationallyxxix. Implicit in this is the importance of consumer preference and choice. There is also a particular need to re-focus resources from temporary crisis accommodation services to delivering effective prevention and early intervention

Mental Health Commission of NSW

Foundations for change: Homelessness in NSW Submission | October 2016 17

strategies. Addressing mental health issues and housing needs before they escalate into crises may generate cost efficiencies for government and improvements in quality of life for many people with mental illness. Where people do experience periods of acute mental illness, there needs to be appropriate services to support them maintain their tenancies.

39. How can the mental health system better keep people at risk of homelessness engaged with their support?

The mental health system should be part of an integrated care approach, which involves the provision of seamless, effective and efficient care that responds to all of a person’s health needs, across physical and mental health, in partnership with the individual, their careers and family. It means developing a system of care and support that is based on the needs of the individual, provides the right care in the right place at the right time, and makes sure funds go to the most effective way of delivering health care for the people of NSW. Achieving truly integrated care that supports the mental and physical health and wellbeing of the people of NSW may require changes to a wide range of systems. A number of factors contribute to the provision of good integrated care for people with mental health needs, including: information-sharing systems shared protocols joint funding and commissioning co-located services multidisciplinary teams liaison services care navigators research reduction of stigma There are major social and structural influences on health and wellbeing, such as education, unemployment, housing, poverty and discrimination. As such, a range of sectors beyond ‘health’ is central to the success of integrated care, including income support services, education, employment and housing supports.

40. How can housing, health and disability support services work together to ensure

that the risk of homelessness for people with disability is minimised by identifying problems and intervening early? Housing, health and disability support services need to collaborate effectively around the care needs of people with disability. They must place a greater emphasis on intervening early and providing support that helps people remain in their communities and avoid hospitalisation or homelessness.

Mental Health Commission of NSW

Foundations for change: Homelessness in NSW Submission | October 2016 18

41. How can mainstream housing providers and the NDIS work together to ensure that housing providers have access to services, information and support that will promote the maintenance of successful tenancies in both the public and private housing sectors?

The National Disability Insurance Scheme (NDIS) should meet its independent living and community participation objectives, and ensure availability of appropriately designed housing close to participants support networks. Family and Community Services (FACS) and Community Managed Organisations (CMO)s should keep a watching brief on how the NDIS evolves over the coming decade, as NDIS is likely to provide opportunities to align services and support. Service providers may wish to create a community of practice in relation to local implementation of NDIS for the purpose of sharing knowledge and expertise. This may help to promote the maintenance of successful tenancies of people receiving individualised packages in both the public and private housing sectors.

42. What exit planning strategies and support partners need to be involved to stop

people leaving prisons into homelessness? Exit and entry planning strategies should emphasise continuity of care and the importance of close collaboration between external agencies to: Enable the delivery of services and programs for those inmates likely to be

released to the community after a relatively short stay. Ensure a continuum of care that facilitates treatment engagement, limits repeated

contacts and improves wellbeing. Take into account the needs of the local inmate population, noting the particular

needs of Aboriginal and female inmates. Ensure that treatment for mental illness is integrated with interventions aimed at

reducing criminal behaviour, such as social skills and vocational training. Assist prisoners to find new post release accommodation and by providing post-

release support. Provide prison based homelessness prevention projects make contact with

incoming prisoners as part of their initial ‘induction’ into the establishment concerned .

Provide information and advice to those entering the system who lack awareness of the potential options that exist to save their existing tenancies.

42. 43. Are there linguistic or cultural barriers to accessing services, which could help

prevent homelessness? Government and other relevant agencies need to be better informed about cultural barriers to accessing services, this can be addressed by: looking for ways to make, LGBTI, multilingual, culturally skilled staff more readily

available in areas with smaller populations

Mental Health Commission of NSW

Foundations for change: Homelessness in NSW Submission | October 2016 19

capitalising on the language skills and cultural knowledge of their workforce ensuring that the needs of LGBTI communities are considered in planning and that

policies, tools, and resources are inclusive of LGBTI communities ensuring services providers, employers, and other organisations are aware of the

availability of LGBTI cultural awareness and inclusion training and that staff receive training

improving research, population surveys and routine data collections by including appropriate gender and sexuality indicators

44. What systemic changes would prevent Veterans and their families from becoming homeless, particularly during the transition from military to civilian life? FACS could provide homelessness and housing referral information to General Practitioners (GPs) to improve the suite of resources following an Australian Defence Force Post Discharge GP Health Assessment.

45. Where are the opportunities to identify and intervene earlier with veterans at risk of homelessness? All former serving members of the Australian Defence Force (ADF) can access a

comprehensive health assessment from their GP. This assessment is available to all

former serving members of either the permanent or reserve forces. A key objective is

to help GPs identify and diagnose the early onset of physical and/or mental health

problems among former serving ADF members. In supporting this, the Department of

Veteran Affairs has funded the development of a specifically designed screening tool.

This screening test could be used a starting point to identify the risk of homelessness

and the various referral options available.

Mental Health Commission of NSW

Foundations for change: Homelessness in NSW Submission | October 2016 20

i Mental Health Commission of NSW (2016). Living Well: A Strategic Plan For Mental Health: Sydney, Mental Health Commission of NSW, State of New South Wales ii NSW Treasury, FAQs, Social Benefit Bonds Trial in NSW http://www.treasury.nsw.gov.au/site_plan/social_benefit_bonds/social_benefit_bonds_trial_in_nsw_FAQs#faq3 iii Payment by Results and homelessness – Sitra- Payment by Results and homelessness - Sitra. (2016). Sitra.org. Retrieved 26 September 2016, from http://www.sitra.org/news/payment-by-results-and-homelessness/ iv NSW Consumer Advisory Group Mental Health Inc. (2012). Border to Border: Visions of hope: A report to the NSW Mental Health Commission. Sydney, NSW Consumer Advisory Group Mental Health Inc. v NSW Consumer Advisory Group Mental Health Inc. (2012). Border to Border: Visions of hope: A report to the NSW Mental Health Commission. Sydney, NSW Consumer Advisory Group Mental Health Inc. vi Morrell-Bellair et al., (2000) as cited in Jones, R., Reupert, A., Sutton, K., & Maybery, D. (2014). The interplay of rural issues, mental illness, substance use and housing problems. Journal of Mental Health, 23(6), 317-322 viiThe interplay of rural issues, mental illness, substance use and housing problems: Journal of Mental Health: Vol 23, No 6. (2016). Journal

Of Mental Health. Retrieved from http://www.tandfonline.com/doi/abs/10.3109/09638237.2014.951476 viii H, Pawson. G, Netto and C, Jones (2006) Homelessness Prevention – a guide to good practice, School of the Built Environment, Heriot-Watt University Department for Communities and Local Government: London ix Mental Health Commission of NSW (2016). Living Well: A Strategic Plan For Mental Health: Sydney, mental health commission of NSW, State of New South Wales x Homelessness Prevention: Creating Programs that Work Homelessness Prevention: Creating Programs that Work. (2016). Endhomelessness.org. Retrieved 26 September 2016, from http://www.endhomelessness.org/library/entry/homelessness-prevention-creating-programs-that-work xi Homelessness Prevention: Creating Programs that Work Homelessness Prevention: Creating Programs that Work. (2016). Endhomelessness.org. Retrieved 26 September 2016, from http://www.endhomelessness.org/library/entry/homelessness-prevention-creating-programs-that-work xii Homelessness Prevention: Creating Programs that Work Homelessness Prevention: Creating Programs that Work. (2016). Endhomelessness.org. Retrieved 26 September 2016, from

http://www.endhomelessness.org/library/entry/homelessness-prevention-creating-programs-that-work xiii Trauma informed Care and Practice | Dr Cathy Kezelman AM. (2015).Cathykezelman.com. Retrieved 6 October 2016, from

http://cathykezelman.com/category/trauma-informed-care-and-practice/ xiv Housing & Welfare Reform Scotland (2016). Welfarereformscotland.co.uk. Retrieved 6 October 2016, from http://www.welfarereformscotland.co.uk/ xv NSW Data Analytics Centre | Department of Finance, Services and Innovation. (2016). Finance.nsw.gov.au. Retrieved 20 October 2016,

from https://www.finance.nsw.gov.au/nsw-data-analytics-centre xvi Council to Homeless Persons | Youth homelessness, Council to Homeless Persons | Youth homelessness. (2016). Chp.org.au. Retrieved

28 September 2016, from http://chp.org.au/homelessness/youth-homelessness/

xvii H, Pawson. G, Netto and C, Jones (2006) Homelessness Prevention – a guide to good practice, School of the Built Environment, Heriot-Watt University Department for Communities and Local Government: London xviii Council to Homeless Persons | Youth homelessness Council to Homeless Persons | Youth homelessness. (2016). Chp.org.au. Retrieved 28 September 2016, from http://chp.org.au/homelessness/youth-homelessness/ xix The Homelessness Prevention – A guide To Good Practice (2006) xx H, Pawson. G, Netto and C, Jones (2006) Homelessness Prevention – a guide to good practice, School of the Built Environment, Heriot-Watt University Department for Communities and Local Government: London xxi Jul 16, 2014 - Australian Institute of Health and Welfare 2014. Housing circumstances of Indigenous households: tenure and overcrowding. Cat. no. IHW 132. xxii Mental Health Commission of NSW (2016). Living Well: A Strategic Plan For Mental Health: Sydney, mental health commission of NSW, State of New South Wales xxiii Mental Health Commission of NSW (2016). Living Well: A Strategic Plan For Mental Health: Sydney, mental health commission of NSW, State of New South Wales xxiv Kertesz, S., Crouch, K., Milby, J., Cusimano, R. & Schumacher, J. (2009) Housing First for homeless persons with active addiction: Are we overreaching?. The Milbank Quarterly, 87(2), 495–534 xxv Yates, J. (2012). Housing Supply Bonds—a suitable instrument to channel investment towards affordable housing in

Australia?. 188, (1834-7223). Retrieved from https://www.ahuri.edu.au/research/final-reports/188 xxviMental health - Drug Prevention & Alcohol Facts – Drug Info. (2016).Druginfo.adf.org.au. Retrieved 20 October 2016, from

http://www.druginfo.adf.org.au/topics/mental-health xxvii Mental Health Act 2007 (NSW). s68 (c) xxviii United Nations (2006). Convention on the rights of persons with disabilities and optional protocol. Geneva, United Nations. xxix United Nations (1991). The protection of persons with mental illness and improvement of mental health care: Principle 3. Geneva,

United Nations.