Meeting the Needs of Women Experiencing Chronic Homelessness

Arts

Social Sciences

Social Policy Research Centre

Meeting the Needs of Women Experiencing Chronic Homelessness

Prepared for: The Mercy Foundation Jane Bullen February 2017

Research Team Dr Jane Bullen, Research Associate, qualitative researcher Dr kylie valentine, adviser For further information kylie valentine, [email protected] Acknowledgements We thank the 10 women who participated in qualitative interviews about their experiences of service provision while homeless. We also thank the two homelessness service provider partners, B Miles Women’s Foundation and the Haymarket Foundation. Finally, we thank the Mercy Foundation for providing funding to conduct this research.

Social Policy Research Centre UNSW Sydney NSW 2052 Australia T +61 (2) 9385 7800 F +61 (2) 9385 7838 E [email protected] W www.sprc.unsw.edu.au © UNSW Sydney 2017 The Social Policy Research Centre is based in Arts & Social Sciences at UNSW Sydney. This report is an output of the ‘Meeting the needs of women experiencing chronic homelessness’ research project, funded by the Mercy Foundation. Suggested citation Bullen, J. (2017). Meeting the needs of women experiencing chronic homelessness (SPRC Report 01/17). Sydney: Social Policy Research Centre, UNSW Sydney. http://doi.org/10.4225/53/58d06e0ceb7f3

Contents 1

Executive summary

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2 Introduction

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3 Method

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3.1 Literature review

6

3.2 Qualitative interviews

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3.3 Workshop with service provider partners

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3.4 Limitations

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4 Findings

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4.1 Demographic information

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4.2 ‘Self-managed’ or ‘Hidden’ homelessness

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4.3 Initial contact with services

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4.4 Housing and support

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4.5 Outreach and drop in services

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4.6 Housing Access

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5 Conclusion

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Appendix A Interview Topic Guide - Meeting the needs of women experiencing chronic homelessness 22 Appendix B Literature review: Meeting the needs of women experiencing chronic homelessness 23 References 33

Social Policy Research Centre 2017 Meeting the Needs of Women Experiencing Chronic Homelessness

I

Glossary Chronic homelessness

Chronic homelessness is defined for the purpose of this research as an episode of homelessness lasting six months or more or having experienced multiple episodes of homelessness over a 12-month period or more.


II

Executive Summary

This research project was funded by the Mercy Foundation, and involved a partnership between the researchers and two homelessness service providers, the Haymarket Foundation and B Miles Women’s Foundation to: • identify gender-responsive service strategies for responding to women experiencing chronic homelessness • assess the effectiveness of these strategies • identify and develop plans for implementation and monitoring of improved service responses for women experiencing chronic homelessness. The context of the research is the recent targeting of new homelessness services in Australia to people experiencing chronic homelessness. The overall aim is to reduce women’s chronic homelessness, by: • assisting the partner service/s to reflect on, and improve their responses to women experiencing chronic homelessness • producing a resource that can be used by other services to improve their responses to women experiencing chronic homelessness. We hope that such improved responses will contribute to reducing women’s chronic homelessness. Methodology for the research comprised a literature review, qualitative interviews with 10 women who were or had previously experienced chronic homelessness1 and a workshop with the two service provider partners. This report provides a general resource about service responses to women experiencing chronic homelessness. In addition, it is intended that a follow up meeting will be held with expert service providers and a more specific resource for services working with women experiencing chronic homelessness will be developed. Research about chronic homelessness has paid little attention to issues of gender because chronic homelessness is associated strongly with older men with problematic alcohol use. However it is recognised that as a result of economic and social changes, from the late twentieth century, other groups experiencing homelessness emerged, including women. It is also recognised that while women who experience chronic homelessness are very diverse, their experiences occur in the context of women’s overall economic and social disadvantage. The 10 women interviewed for this research ranged in age between 26 and 59 years, with both the average and median age being 43 years. The shortest period of homelessness 1

For this research, chronic homelessness is defined as having been homeless for 6 months or longer or having experienced multiple episodes of homelessness over a 12 month period or more.


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Executive Summary

reported was just over 6 months and the longest, experienced by two women, was 10 years. Eight of the 10 women had been homeless for more than a year. The average length of homelessness was 4.0 years and the median was 4.3 years. The sample size for the study was small, but revealed a diversity of experiences and needs. Most of the women interviewed experienced an initial period of housing instability or homelessness during which they did not approach services but tried to cope as best they could on their own. These experiences are consistent with descriptions in literature of women’s chronic homelessness as ‘hidden’ or ‘self-managed’. Women reflected that their experiences of homelessness could have been shorter if a number of changes were made, aimed at helping them recognise their situation as it unfolded, and to become aware that help was available. Initial contact with services such as police, hospitals, ambulance and Housing NSW were mixed, with some instances where these services responded appropriately and others where the response was inadequate. These experiences differ markedly from the way people experiencing chronic homelessness are frequently portrayed in research, policy and the media, as high users of emergency and homelessness services, and indicate the need for gendered responses. All of the women interviewed had used crisis accommodation, and most had also used transitional accommodation. None had lived in a Housing First model. Interviewees highlighted the importance of feeling ‘at home’, welcome and safe in accommodation. Some interviewees noted that they appreciated services that had minimal rules and a harm reduction approach. Some of the women said that it was important for them to stay in women only services while others were comfortable staying in accommodation where both men and women were on site, as long as it was supervised. However all the women emphasised the importance of safety and security in accommodation, and some women shared experiences of violence and intimidation that had occurred in homelessness and other services such as psychiatric wards of hospitals. Interviewees also emphasised the importance of staff members being helpful, trained, knowledgeable, supportive, consistent and non-judgmental. Interviewees appreciated the help that services provided with finding housing, and helping sort out other problems. Women were also asked about the relative benefits of accessing permanent housing early, through a Housing First model. There were varied responses to this, with some women valuing Housing First and others, particularly women who had been hospitalised, stating they preferred a transitional period in a group supportive environment prior to moving to separate permanent housing. Some of the women interviewed had used outreach and drop in services, while others had never used them. Overall those who had used them found them helpful. Lack of access to housing affected women not only in seeking permanent housing but also throughout their experiences of using homelessness services, because the tight accommodation situation led to them having to wait at each step – crisis, transitional and permanent housing. Surprisingly some of the women experiencing chronic homelessness interviewed had been assessed as ineligible for priority social housing and were seeking private rental in a share house or boarding house, despite the issues with security and safety


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Executive Summary

involved in living in these arrangements with people who they did not know or choose to live with. The findings from this research support other research that indicates that women experiencing chronic homelessness require responsive and flexible support that is available as long as needed, safe accommodation, other relevant services and permanent housing. It cannot be assumed that responses that work best for men also work best for women. However women experiencing chronic homelessness are a very diverse group and a choice of service models that will meet the needs of different women is needed. Smaller-scale specialist services are more appropriate than larger, generalist services.


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1 Introduction

The research focuses on women who experience chronic homelessness (defined for the purposes of this project as an episode of homelessness lasting six months or longer or multiple episodes of homelessness over a 12 month period or more). Since 2008 a range of new services has been established nationally that are targeted to people experiencing chronic homelessness, such as Street to Home and Common Ground projects2. While some services for people experiencing chronic homelessness have been evaluated there is a lack of specific information about how well current services are meeting the needs of women experiencing chronic homelessness, and whether some service types or strategies are more appropriate to women or lead to better outcomes. Research indicates that there are differences in the situations and needs of men and women experiencing chronic homelessness, and that homelessness service responses do not always meet the needs of women (Petersen and Parsell 2014, Watson 2000, Golden 1990). This project involved a partnership between the Mercy Foundation, the researchers and two homelessness service providers, the Haymarket Foundation and B Miles Women’s Foundation, to: • identify gender-responsive service strategies for responding to women experiencing chronic homelessness • assess the effectiveness of these strategies • identify and develop plans for implementation and monitoring of improved service responses for women experiencing chronic homelessness. The overall aim of the Mercy Foundation’s grants program is to end homelessness and the program prioritises women’s chronic homelessness. This research contributes to that aim by adding to the evidence base of the needs and choices of women experiencing chronic homelessness. The service provider partners for the project were: • The Haymarket Foundation exists to support homeless and disadvantaged people in inner Sydney to maximise their potential and identify pathways to safer, healthier and more fulfilling lives. The Foundation provides support to people who live with mental illness and alcohol and other drug issues, and provides referral to treatment, as well as a safe place to live. The Haymarket Foundation is involved with a number of service responses assisting people experiencing chronic homelessness with complex issues, including the Haymarket Foundation Clinic, the Haymarket Centre accommodation, the 2 Street to Home provides support to people who are sleeping rough or experiencing chronic homelessness to move

into long term housing. Common Ground provides permanent housing with on-site support, for formerly homeless and low income people in one bedroom or studio apartments within an apartment building.


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1 Introduction

Inner City Integrated Services Project and Sydney Common Ground. • B Miles Women’s Foundation is a Specialist Homelessness Service (SHS) that operates within the City of Sydney Local Government Area. B Miles Women’s Foundation supports women living with a mental illness who are experiencing homelessness, or are at risk of homelessness, including women experiencing chronic homelessness. The primary objectives of B Miles Women’s Foundation are to resolve and prevent homelessness by providing flexible service delivery comprised of (1) crisis accommodation, (2) transitional housing, and (3) outreach support. B Miles works in collaboration with mainstream services and housing providers using an integrated, client-centred approach that is tailored in intensity and duration based on the particular circumstances of each client, their experiences and choices. Programs assist women to stabilise their circumstances, to build their capacity to maintain or progress to longer-term living arrangements, and to sustain mental health stability. The project aimed to: • assist the partner service/s to reflect on, and improve their responses to women experiencing chronic homelessness • produce a resource that can be used by other services to improve their responses to women experiencing chronic homelessness. We hope that such improved responses will contribute to reducing women’s chronic homelessness. This report provides a general resource about service responses to women experiencing chronic homelessness. In addition, it is intended that a follow up meeting will be held with expert service providers and a more specific resource for services working with women experiencing chronic homelessness will be developed.


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3 Method

The research study aimed to provide information to homelessness services about what is helpful for women who become homeless, so that services improve the help they provide, and the time women stay homeless is reduced. The methodology for the research comprised a literature review, qualitative interviews with 10 women who were or had previously had experiences of chronic homelessness and a workshop with the two service provider partners.

3.1 Literature review A brief literature review was conducted to identify key challenges faced by women experiencing chronic homelessness and best practice in responding to their needs, to enable benchmarking/comparison with what’s happening on the ground. We searched the relevant academic databases, including MEDLINE, PsycINFO (for psychology), CINAHL Plus (nursing), Proquest, Women’s Studies international (EBSCO), Scopus and the Social Sciences Citation Index (for Sociology and economic disciplines). We also searched policy and grey literature, to ensure that emergent and practice literature was included. Search terms included ‘women’, ‘homeless*’, ‘chronic* homeless*’ and ‘long-term homeless*’. The literature review is at Appendix B.

3.2 Qualitative interviews Interviews were conducted with 10 women who are or were previously experiencing chronic homelessness in order to gain their suggestions for good practice and improving service provision. Chronic homelessness is defined for the purpose of this research as an episode of homelessness lasting six months or more or having experienced multiple episodes of homelessness over a 12-month period or more. The two partner services for the research (The Haymarket Foundation and B Miles Women’s Foundation) assisted in recruiting interviewees by inviting potential interviewees to participate in the research. If the invited interviewee gave initial consent to the trusted person, their contact details were passed to the researchers to arrange the interview and gain full consent to participate. This ‘arms’ length’ process, using a trusted person, is ethically sound as it aims to avoid real or perceived coercion by the researchers. Interviewees received a $50 gift voucher as reimbursement for their time participating in interviews. Interviewees had had contact with a number of services including police, hospitals, ambulance and Housing NSW. They had also used a range of accommodation and support services, as well as drop in, outreach and other services. Interviewees were asked about their experiences of service provision. The discussion guide


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3 Method

was informed by the literature and is at Appendix A.

3.3 Workshop with service provider partners A workshop was held with the two service provider partners, B Miles Women’s Foundation and the Haymarket Foundation at the end of the project. Several members of staff from each of the partner services attended. The purpose of the workshop was to report findings from the literature and client interviews to service providers, provide an opportunity for service providers to reflect on how these findings relate to their service practices and validate the findings.

3.4 Limitations The sample size for the study was small, but revealed a diversity of experiences and needs. The interviewees provided information from their experiences, which can assist to shed light on how they experienced service delivery on the ground. However it is important to recognise that some women experiencing chronic homelessness are less likely to participate in interviews, for example women who have spent many years in a psychiatric hospital (Novak, Brown, & Gallant, 1999). During the fieldwork, some women who had initially been available for interview did not attend the interview. It is likely that women with the most complex needs were those less likely to participate.


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4 Findings

The purpose of the interviews conducted for this research was to ask women about their experiences of using services when they were homeless (see Appendix B), in order to contribute to understanding about what is helpful for women who become homeless, so that services improve the help they provide. In turn, this knowledge may lead to improvements in services, which reduce the incidence of chronic homelessness among women. Therefore the interviews did not specifically seek details of other issues such as what precipitated their homelessness, or what other life problems or challenges they had experienced. However information that the women shared during interviews suggested that, consistent with the literature, many had experienced one or more of the following: disadvantage, poverty, childhood deprivation and trauma, involvement with the child protection system and being fostered, domestic and other violence, mental health problems and drug and alcohol problems.

4.1 Demographic information The demographic details that were sought were restricted to those necessary to confirm that the women met the criteria for the research: that they were aged 18 years or over and that their experiences were consistent with the definition of chronic homelessness used for this project, which was that they were homeless for more than six months or more than once over a 12 month period or more. The ten women interviewed for this research ranged in age between 26 and 59 years, with both the average and median age being 43 years. The mature age of the women highlights housing issues for this group, particularly during periods when they are unable to work (Petersen & Parsell, 2014). The shortest period of homelessness reported was just over six months and the longest, experienced by two women, was ten years. Eight of the ten women had been homeless for more than a year. The average length of homelessness was 4.0 years and the median was 4.3 years. Some of these periods of homelessness comprised more than one episode.

4.2 ‘Self-managed’ or ‘Hidden’ homelessness The experiences of the women interviewed were marked by a delay in receiving assistance, despite in some cases protracted homelessness. This ‘self-managed’ (Robinson & Searby, 2005) or ‘hidden’ (Mayock, Sheridan, & Parker, 2015) nature of women’s long term or chronic homelessness is also described in literature. Most of the women interviewed experienced an initial period of housing instability or homelessness during which they did not approach services but tried to cope as best they


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4 Findings

could on their own. Over periods ranging up to seven years, the women couch surfed or slept rough outdoors or in a car. Because the interviews focussed on women’s experiences of services the interviewer did not specifically ask about their experiences of homelessness on their own, but it was clear that at least for some, this period was difficult and insecure. Some women were not aware of what services existed or who to approach; some felt they were managing adequately at the time or believed that if they were not sleeping on the street they were not homeless; some were reluctant to accept they were homeless because of stigma; and some were concerned that the place where they might be sent would be an institution. While this interviewee did not state the type of institution that she was concerned about, it may be that she was referring to a psychiatric institution. Women’s comments about these initial experiences included: I had no idea there was refuges. So I just used to stay at my friends’ houses and just couch surf for a while until I found a place that I could stay but ... I was always renting with someone. So if we had a blue I was up shit creek because they were on the lease, I wasn’t. [Int 10] I’ve always been really shy and a different character, I just wanted to survive by myself. [Int 6] I was living on the beach and just had my suitcase, and just myself. [Int 7] I lived in my car for three years, and I lived in my car quite happily for about two of them. Whether I was in denial or not I don’t know … I wasn’t even trying to access housing, because I was like I’ve got a house, I’ve got my car. [Int 1] I’ve been homeless – I mean I’ve had my family to go to. I class that still as sort of being homeless because I don’t have a place of my own. So I will say I’ve probably been homeless for about five years ... I was in rehab, I went to hospital ... [Were you in contact with any other services at all?] No, I didn’t know about anyone. [Int 5] Link2home, I was a bit distrustful of it, partly because a police officer had handed it to me … Then I was just concerned that Link2home, I would end up in an institution. [Int 1] I’ll tell you why I didn’t know [about services that could help] and didn’t look [for services]. Essentially when I was first diagnosed and right up until 2013, I was staying above the water. I would have an episode, I would go back to work, I would have an apartment, and my life was back to normal. I had a major episode and I couldn’t work, and I couldn’t support myself. I couldn’t even think about how to help myself ... I didn’t know how to help myself. It was also a stigma for being homeless. I said to myself, “I cannot be homeless. How could I be homeless? I’ll just get out of here, and I’ll go back to work, and things will be back to normal.” Things don’t happen overnight like that. [Int 4] These experiences are consistent with the findings of other research, which suggests that women who become homeless often avoid services and adopt strategies (such as staying with family and friends, gaining shelter through sexual relationships and rough sleeping in concealed locations) to hide their homelessness and manage it themselves (Klodawsky,


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4 Findings

2009; Mayock et al., 2015; Robinson & Searby, 2005). Interestingly these women’s experiences differ from other literature about people experiencing chronic homelessness, which suggests that they are very high users of emergency and homelessness services (Culhane, Metraux, & Hadley, 2002; Larimer et al., 2009). While a number of the women reported mental health problems and had used psychiatric services, and some had used other services, they did not report the type of intensive use of multiple psychiatric services or other emergency services over their period of homelessness characterised by ‘Million Dollar Murray’ (Gladwell, 2006) and other literature in this area. Indeed one woman reported couch surfing for seven years without being in contact with services. This illustrates a different pathway and a challenge in responding to the initial period of many women’s chronic homelessness. The women who had experienced rough sleeping reported various strategies to keep safe, such as staying awake at night, sleeping on the roofs of bus shelters, staying on main roads rather than side streets and staying in a commercial car park that closed at night: If I couldn’t find any place where I thought I could be safe I didn’t stay there. There were quite a few times when I just walked all night long trying to find a place. I watched when the general population went to sleep, and only then would I stay behind a bush that was near a road or somewhere else that provided a good shelter and go to sleep there. Also my sleep was really funny. Every noise I would wake up ... It entered my thoughts many times that’s its dangerous because you can get bashed, raped, your throat could be slashed while you’re sleeping and you wouldn’t even know and you wake up as a corpse. [Int 3] One woman reported difficulty finding help with emergency accommodation online while sleeping rough: When I had phone credit I was looking for things online and I found like the food vans and stuff, so I was able to go and get food sometimes from the food vans. But in terms of locating women’s refuges and things like that, they didn’t really come up. I found them very difficult to find. So just visibility on the web. [Int 1] In addition to this message about the need to increase visibility of how to access crisis accommodation on the web, interviewees had these messages for policymakers and services: The first sort of point of call to homeless people is generally going to be the police, even if they just want to kick your butt and move you on, and it would be very helpful if they carried some of the pamphlets they’ve got downstairs. [Int 1] Reaching out. It is something that is quite apparent. People living in the street don’t have the means, they don’t have the background necessary to go out there and fight for themselves. People doing it tough is completely different circumstances. I think they need more support in reaching out for help, and identifying their needs. [Int 4] Looking back, women reflected that their experiences of homelessness may have been shorter if a number of changes were made, aimed at helping them recognise their situation as it unfolded, and to become aware that help was available. Better online information would


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4 Findings

assist some women. The interviewees recommended a more proactive response in general, to actively make contact with and help women who were homeless.

4.3 Initial contact with services When women did make contact with services they had mixed experiences. Some women who had avoided contact with services were located by police. In general women found the police had been helpful. For example one woman had found the police ‘sympathetic’ and said they had called the ambulance to take her to hospital in order for her to gain assistance. Another woman said that police had been helpful when she was walking on the side of a highway in providing a lift into a rural town but had not provided any information on accommodation. Some women reported that they had been hospitalised as a result of mental health problems. Some of these women were already homeless when this occurred and some had been in private rental or social housing and became homeless because they were evicted while they were hospitalised because they could not pay the rent. Women who became homeless while in hospital did not experience a period without assistance that other women experienced, although one woman interviewed had stayed for an extended period in a hospital rehabilitation centre because she did not have anywhere else to go. Some women had found that hospital staff were helpful and responded appropriately to their needs, and had not discharged them until they had other accommodation. One woman did however report being taken to hospital for assistance with mental health problems and being discharged late at night without somewhere to sleep. One woman reported an experience with an ambulance staff member saying ‘Oh, this is a waste of time. Someone could be having a heart attack.’ [Int 1] Some women said that they did not know who to contact and sought the advice of family or friends. Some women also said that the only place they knew of to seek assistance was Housing NSW. Departmental staff members were generally helpful and provided the telephone number for the homelessness information and referral telephone service (now Link2home). In some cases they arranged for women to stay in hotel or crisis accommodation, although in some cases they did not refer to crisis accommodation. Housing NSW is able to assist people who are homeless with hotel accommodation for a period of 28 days. While hotel accommodation provided immediate shelter, one woman who had had no knowledge of services other than Housing NSW explained that she didn’t receive any help or support to find permanent housing while she was at the hotel: So in some ways I didn’t find that really helpful because it’s really hard to find a place in 28 days and you know, when 28 days is up, it’s like where do I go from here? [Int 10] Another woman said that the hotel where she was placed was ‘full of cockroaches and the kitchen was disgustingly dirty’ [Int 2], and that she had felt afraid there: There was a room down the corridor from where I was with a lot of men in one room and they had the door open, and they were playing music and drinking. I don’t know I just didn’t feel safe… Everything was very dirty, and having to beg for a drinking cup.


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That gives you a really good idea that something is not quite right. [Int 2] While early responders such as police and health staff were in many cases helpful, a more consistent response of recognising women’s needs, providing information and assistance and not discharging women into homelessness would have helped more women. The system of providing hotel accommodation with little or no support provides a band-aid but not assistance to resolve the ongoing situation. In addition some women reported unsafe and inadequate services, suggesting arrangements may need to be reviewed. Greater availability of housing and support service provision would minimise the need to use this option.

4.4 Housing and support Most of the women interviewed had stayed in both crisis and transitional or medium term accommodation. Crisis accommodation may be from one night to three months, although a number of women reported staying longer because of a lack of other accommodation to move to: Some people in that refuge stayed like over six, seven months. It happens in a lot of refuges because like the demand of housing and like it’s really hard to get into. [Int 10] Transitional accommodation varies between three and 18 months, although again, some women reported staying longer while waiting for permanent housing to become available. All of the women had used crisis accommodation, and some had used it more than once. Most had also used transitional accommodation. Crisis accommodation services accommodate varying numbers of people on one site, in shared or single rooms. Some have dormitory-style accommodation. They usually have staff on site 24 hours. Transitional accommodation usually does not have staff on site, and may be in shared houses or separate units, sometimes on one site. Most of the points raised by women were consistent across the two types of accommodation. ‘Housing First’ is an approach that assists homeless people by providing immediate access to long term independent housing with voluntary linked support services, without requiring sobriety or treatment. Long term housing models offering voluntary support (also known as supportive housing) that are accessed by Housing First include ‘scatter site’ models that operate using apartments throughout the community as well as single site models that house and support formerly homeless people in apartments in the same building (Parsell, Petersen, & Moutou, 2015). In Sydney a number of scatter-site Housing First projects have been established, as well as one project, Common Ground, that houses formerly homeless and low-income people in one bedroom or studio apartments within one building. The women were asked their view on Housing First. None had used Housing First services.

4.4.1 Atmosphere and targeting Consistent with literature (Adkins, Barrett, Jerome, Heffernan, & Minnery, 2003), some women highlighted the importance of feeling ‘at home’ in the accommodation. Interviewees highlighted areas such as provision of meals in crisis accommodation, a welcoming attitude


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4 Findings

from staff and a clean environment. Interviewees did not want services to be like institutions. They wanted them to be safe but not have unnecessary rules. Interviewees appreciated services that were not overcrowded and services where someone was there overnight if the accommodation was shared: Essentially I needed a warm bed and a secure place to stay. Also, something to eat. Essentially you come out [of hospital], and you go into a place where... I found that I went into a place where I felt safe, where I felt welcome. Where there was a hot meal in the evening, a home-cooked meal. There were faces looking at me without judgement. Smiling and trying to help me navigate my transition from hospital… I wasn’t judged. [Int 4] If you stay out for two nights, someone’s like, “Well where have you been?” That’s kind of like comforting, you know, because I was very isolated [Int 1] Observing other residents, and the way that they were being helped, just gave me this feeling that the organisation really cares about you. [Int 4] The good thing is that they’re there overnight. [Int 7] It was small so it felt homely ... I don’t know, it was more open and there was an actual kitchen where we could go in and if we wanted to cook ourselves, we could. [Int 8] You are given individual attention. You are supported on a one-on-one basis. You know what? It is that feeling of being closer to home. [Int 4] Some interviewees appreciated services that had minimal rules and a harm minimisation approach. They criticised services that had too many rules or searched women who stayed there. On the other hand some interviewees were surprised when they stayed at services where drug users or people with a criminal history stayed. In particular women were not comfortable in services where the needs of different people staying there conflicted and were not well managed by staff. One woman who had both mental health and drug and alcohol problems reported she had previously had difficulty finding a service that would accept her: I felt like I didn’t qualify for a lot of things. If I had mental illness and because I’ve been to rehab, it almost felt like sometimes it was them saying, “Actually you need to go and deal with that first or you need to deal with the mental illness first before we can look at your thing.” That hasn’t been said in my face but that’s what it felt like when I was trying to find housing. [Int 8] Many women mentioned not wanting to go to crisis accommodation that was rough or unsafe. Some women were very comfortable staying in mixed gender services: ‘I never felt unsafe’ [Int 10]. Others strongly preferred women only services. Oh, I didn’t feel safe. I was sort of put in a room and bunked next this girl. There was a girl, two girls in one room and I was sort of slotted next to them, there’s men hanging around in the kitchen, and you didn’t know what was wrong with them. So I didn’t get a good feeling there, I left there and that’s when I went homeless [rough sleeping]. I just got this awful feeling, and I thought I’m getting out of here and I just packed my stuff


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and left. I don’t believe in mixed, I think that’s not good for someone. Because women have issues, and men have issues, so I think the mixed is a bit of a problem… you don’t know some of those people could have domestic violence … I’ve got this thing about being safe. [Int 7] I couldn’t have gone anywhere where there were men. I’ve had – I’ve been raped a couple of times, three – four times in my life. A couple of them were quite nasty ones so, yes, I would have found that very hard. You come out of hospital, you’re vulnerable, they’re getting your meds right. [Int 9] Some other women were concerned about any service that seemed unsafe: I also have PTSD from child abuse, child sexual abuse, then I also suffered severe anxiety as well and you just needed that environment of calmness and being with... I guess if someone’s drug affected or suffering a psychosis, that just makes things worse … I used to walk around to some of the other homeless [services] and I just couldn’t imagine myself there. Just being at the front of them. I would look at those people and they would actually really scare me. Just because, yeah, I was very highlevel with anxiety. [Including the homeless women as well as the men?] Yeah. It just seemed chaotic... It wasn’t chaotic at all but in my mind I read it as chaos. [Int 8] Another woman noted that some services, especially where accommodation is shared, were not secure. This interviewee said she had learnt a lot of valuable lessons: Just like never trust anyone you know, always keep your eye on your things. Like they may pretend to be your friends but you know, I had a lot of things stolen there and just like always be aware that you know, people who are on drugs, they’re not themselves. You can’t blame them for how they act and that’s my input. I never felt threatened [Int 10] One woman expressed concern about cohabiting with men because she was concerned that if she was unwell she might start a sexual relationship that she later regretted: When you think about someone like me with bipolar, if I got manic, which means I could jump anything that walks [laughs] and like now, you know, in mixed services that doesn’t help. [Int 8] Some women commented specifically on transitional accommodation that was shared or on one site. Two women who had lived in unsupervised shared houses expressed concerns about safety and security living with others: [One woman] would meet people in the street and brings them, men, women, anybody … you see her yelling and slamming doors and bringing people and using drugs. [Int 2] I was housed with three other women who had mental health issues. There were no staff. We were living independently. It was a nightmare. It was the worst thing that happened to me. I couldn’t wait to get out of there. Also, the issue of cleanliness using the bathroom, the kitchen, and mental health has different impacts on different people. You have no control over what another person would do. There was one woman who was violent … She trashed the house. [Int 4]


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4 Findings

A lot of the women who were domestic violence or had been – horrific pasts with rape and things like that, they found it very difficult. There was one woman in particular who happened to live next to me. [She was drinking and drugging] and bringing men home and basically selling her body for sex pretty much. [Int 8] Some women who moved to separate transitional accommodation reported initially finding it difficult to adapt to living alone. One women spoke about how she received support from the service ‘to take it slower and take some time for to recover’ [Int 4], and to have additional support. Then even in the medium-term [accommodation], having that support with my case worker was so important because from the three months in the hostel there was always someone there all the time. Whereas moving into a place by myself, I walk into my place and I was like, “Oh my God.” … the case worker was really important in terms of me getting back into society. I think if I didn’t have her and that slow graduation from full-on support to less and less support, I don’t know if I would have made it through to where I am now because I could hardly get out of the house… My case worker would come in I think it was once a week and that slowly moved to once a fortnight and then it moved to once a month. By the time I think it moved to once month I had started being able to do part-time work. [Int 8]

4.4.2 Staff and service skills and attitudes Interviewees appreciated staff members being helpful, trained, knowledgeable, supportive and consistent. They appreciated when services responded to the individual person, understood if they were anxious or upset, gave individual attention, and were kind and respectful. They also appreciated when staff members understood problems and challenges that people faced and were non-judgemental and able to defuse and manage situations where people’s mental health or other issues caused them to behave in problematic ways. … the staff here are really well trained in interpersonal relationships, how to communicate with people … and they’re all very different people, but they will all deal with things the same … Then I love that everyone knows the rules, people don’t break the rules, because there’s only a few rules and they’re reasonable rules. So yeah, everyone kind of just falls in line [Int 1] I wasn’t judged … I was never made to feel like I had overstayed my stay, and I was never made feel like I have to rush for things to happen. They said, “we’re here to support you.” I felt that throughout the cycle of me actually being in the situation that I was, I didn’t have to ask for it, it was given … It’s the way that you’re being treated, the way that you’re being supported … Having the ability to see through it, and accommodate my needs. For example, my need of not being able to stay on my own. [Int 4]

4.4.3 Help provided Interviewees appreciated services that gave proactive help, such as assisting women to find housing, helping with appointments, including for some women, helping them to remember


15

4 Findings

appointments, and helping women sort out legal, financial, health and other problems. One interviewee spoke about one service providing ‘a whole package and it wasn’t just about therapy. It was also about learning to live by yourself again and the support that’s given through that’ [Int 8]. Where services had good connections with other services that women needed, this was appreciated: They had all the connections there. So, if you’re dealing with mental health sometimes it’s just hard to just get out of bed never mind anything else, so that was the good thing everything was there, the connections, the doctors … the services, you didn’t have to think about it, it was there and it was offered to you. I had a lot of financial things I had to sort out, they helped me sort all that out, which was huge… you got your own case manager [Int 7] I found my caseworker really helpful. Helped me get over a lot of hurdles and when I first got there, I was mainly just staying at home because I was appreciating my privacy but then after a while, I kept saying I really need to get out, and she showed me a flyer of what was going on … She took time to make sure that my housing was in, just make sure always on top of things, have a plan, you know, get me to get some confidence in myself to do like, go to TAFE, do something and just not being a lazy person just to sit at home all day… Just like kind of pushed me a little bit but in a good way but not too pushy ... [Int 10] One woman with mental health issues was not receiving income support payments from Centrelink and reported that one service had limited her stay to one night: They just said oh are you on Centrelink and at that time there’d been a gap with Centrelink and I said “no I have to go back to Centrelink to…”, and they said oh you can only stay one night, because I wasn’t on Centrelink, because that’s how they get paid. [Int 7] Women were also asked about the relative benefits of accessing permanent accommodation early, in a Housing First model. None of the women had experienced Housing First, although one reported knowing other formerly homeless people who were housed through Housing First. There were varied responses to the question about Housing First, with some women valuing Housing First and others, particularly women who had been hospitalised, stating they preferred a transitional period in a group supportive environment prior to moving to separate permanent housing: I would say that [Housing First] wouldn’t have worked for me, because social contact was important for me. That ability to go and knock on the door and say, “Look I need to chat. I need to discuss something.” The sheer need for company, and just being around people. Looking at the normalcy of life, the actual way things are done…That human factor of, actually being around people and being supported and being guided. It’s something that cannot be replaced. If it’s by housing a person, it’s only one layer of support that you provide. Support that you provide them, on an emotional basis, is a whole different story. [Int 4] I would live on my own… It would have been all right, I would have been all right, I would have been settled down. [Int 5]


16

4 Findings

Common Ground is brilliant. I would go there. There’s no two ways about it. [Int 6] I think if you can get the permanent housing it stops all the upheaval, because when you have to move and move that can be quite you know lifting everything up, and if you can’t cope or quite cope with that sort of thing. It’d be lovely if that would happen. [Int 7] I don’t think it would have been good for me straight after hospital, to be by myself. I needed constant prompts, whether that was making sure I’d gone to all my appointments for the day or just sitting outside with other people. Because I’m a natural introvert and when I’m not well it’s even more. I push myself to do the opposite and be around people whereas for some people that might be the best thing for their recovery, to be by themselves and they heal better. I think that for me that would have been all too consuming, having my own space because I was trying to get out of it at the time. [Laughs] [Int 8] Yes [Housing First would have suited my needs] and I was very lucky when I was in [crisis accommodation], they gave me my own room. So I didn’t have to share with anybody else, there was so many problems with other people sharing in there but I was so lucky I had for the whole time… [Int 9] I’d rather what I had at [service] which was someone coming over and see me from time to time. I did not like at [another service], staff being there all the time. [Int 10] The responses that women have given about their experiences of and views about housing and support highlight that their periods of homelessness were also periods of particular vulnerability, and the importance of safety and security (Murray, 2009). They also underscore the diversity of experiences, responses and needs of women who become homeless (Nunan & Johns, 1996) and indicate a need for individual services to assess and respond to women’s needs; a range of services that will meet the diversity of women’s needs and situations; and sufficient services to respond to these different needs, so that women are not referred to services that are inappropriate.

4.5 Outreach and drop in services Some of the women interviewed had used outreach and drop in services, while others had never used them. Women who had used these services had used them in different ways. One woman had used services extensively for food, showers and clothing, as well as the injecting room, while sleeping rough in the city. Some other women had not used outreach or drop in until they were accommodated in crisis or transitional accommodation. These women were referred by service staff, and used these services for emergency relief, food and activities such as fitness, creative activities and looking for work. Women expressed a variety of responses to the services that had used, and whether they were helpful. Overall women had found these services useful. Some were critical of particular services where they felt unsafe or uncomfortable, or where the assistance available did not match what they needed. Several interviewees had found the homelessness services hub approach, where a range of services was brought together in one place, to be helpful.


17

4 Findings

And the hub, like there’s a service hub that they run. Like they don’t run it here but I know about it from this place and where all the services you want are together in one place, so if you have problems with your ID so that you can’t even access any other services and stuff like that. [Int 1] ... you can have a free lunch, their food’s beautiful there and you get free clothes … [Is that kind of service useful?] Absolutely, especially if you’ve got no knickers. I mean they threw out all my clothes [when I was evicted]. I had nothing when I walked in apart from what people had given me when I was in hospital, it was just ridiculous [Int 9] It’s really cool. I used to go there when I was looking for work and the lady there was really helpful like helping me with a cover letter because I’m not the world’s greatest speller and writer. I’m more of a person that can do things than write things down. But yeah, it was really helpful. I went there, I did some drawing, did some painting and they had like a gym. I’ve gone to the gym there. [Int 10]

4.6 Housing Access The best option available for women experiencing chronic homelessness to access ongoing housing is social housing (Housing NSW or community housing), whether through the priority housing list or, occasionally through Housing First projects. The challenges in accessing social housing are illustrated by the fact that several of the women interviewed, despite experiencing chronic homelessness, were currently or previously assessed as not being eligible for priority housing. These women were planning to seek private rental in a share house or boarding house, although they were aware that these arrangements that involved living with people who they did not know or choose to live with were less secure and safe (Murray, 2009). On the other hand most single person private rental is unaffordable for lowincome people, particularly in urban areas. Some women were also still in the process of applying for priority and were not aware what they might be eligible for: So I’d probably look at a house share. I mean, God I would love it if I got priority housing, and I probably should because I am literally homeless, but I don’t know if I meet other criteria. I’m not even a hundred percent sure what the criteria are. But like I don’t have any dependants, any child dependants or anything like that, so I might not get it ... But I wonder, I’d better find this out. If I go into a boarding house, does that then take me off the priority housing list. [Int 1] I’m not eligible for priority housing, I’m looking for some affordable private rental, that’s very hard to find [Int 2] Two women interviewed had become homeless because they became mentally ill and were hospitalised. Their accounts raise issues about the circumstances in which people with mental illness can be evicted and the need for alternatives to prevent them becoming homeless (and in one case having lost her possessions) at a time when they are most vulnerable. One woman was evicted from a Community Housing Provider (CHP) because her rent was in arrears and her property damaged while she was hospitalised: The reason why I left the [CHP] was that my place was broken into while I was in


18

4 Findings

hospital and there was a lot of damage done and all my stuff was stolen and all sorts of things and they tried to blame me for it. So they tried to send me a bill for back rent and all this cost to fix things that they’d never fixed anyway and then whatever else had happened that I never saw and it was almost a court case of me suing them for wrongful eviction. So they agreed to write off the debt which wasn’t my debt anyway and then put me back on the Housing register. [Int 9] One woman who had lost her private rental housing because she lost her employment when she was hospitalised, notes that her situation of recurring mental illness made private rental problematic: Until you can go back into full-time employment, you’re prevented from finding affordable [private rental] accommodation because you can’t afford it on Centrelink [Int 4]. This woman had accessed housing with a two year fixed lease through Housing NSW. This was soon to be reviewed and the review outcome was a source of anxiety, because she was concerned that if she had to return to private rental, she might again become unwell, lose her employment and be homeless again. She valued that the homelessness service that she had used was going to assist her with the review: ... I’m in housing [Housing NSW] just January last year. My tenancy is up until January 2017. I’m in the process of it being reviewed. That happens six months prior to the end of the tenancy. I’ll have to make a case explaining why I need to stay where I am, and the reason why I need housing and how important it is for me … I consulted with them, and I said, “Would you help me to put a case forward if I need to.” They said that they would be willing to help me [Int 4] One woman described administrative difficulties and delays in applying for social housing. She received help from the service that had been providing medium term accommodation: I’m in housing commission at the moment. I think the whole Department of Housing needs to be looked at for one. It’s just like a long drawn out piece of string. Well my paperwork got lost, it was a whole lot of internal, and I said to them [the homelessness service] “I can’t deal with that, you’ll have to ring up.” [Int 9] It is important to note, however, that housing access affected women not only in seeking permanent housing but also throughout their experiences of using homelessness services. They spoke of waiting to access crisis services, waiting in crisis services longer than the stated time that accommodation was offered, waiting to access transitional services, and similarly waiting to access social housing. As one woman reflected, her chronic homelessness would not have been so long if this had been different: I would have liked housing earlier, I would have been settled [Int 5]


19

5 Conclusion

This research aimed to identify gender-responsive strategies for responding to the needs of women experiencing chronic homelessness. The context for the research is the recent targeting of new services to people experiencing chronic homelessness, and the lack of attention generally given in research and policy about chronic homelessness to the issue of gender because chronic homelessness is associated strongly with men. The experiences of many of the ten women interviewed were characterised by a period during which they did not have contact with services, but instead tried to cope as best they could on their own. This delay in receiving assistance lasted up to seven years, with women couch surfing or sleeping rough outdoors or in a car. These experiences are consistent with descriptions in literature of the ‘hidden’ or ‘self-managed’ nature of many women’s homelessness. While the focus of interviews was on use of services, nevertheless it was clear that at least for some women, this period was difficult and insecure. These experiences differ markedly from the image of chronic homelessness that is frequently conveyed in research, the media and policy, which suggests people experiencing chronic homelessness are very high users of homelessness and emergency services. A number of the women interviewed reported mental health problems and had used psychiatric services, and some had also used other services, but they did not report intensive use of multiple services. This illustrates a different pathway and a challenge in responding to the initial period of many women’s chronic homelessness. It also signals the need for differing responses to women’s chronic homelessness. Women interviewed highlighted the need for accommodation and support responses where they felt ‘at home’ and welcome but were not subject to intrusive or arbitrary rules; and where staff members were supportive and non-judgmental. Women were not comfortable in services that were dirty, overcrowded or where the needs of different people staying there conflicted or were not well managed by staff. However the women interviewed were also diverse, and had different preferences in relation to the service model. Some women preferred women only services, while others were comfortable in mixed services. While none of the interviewees had experienced a Housing First model, some were of the view that a Housing First approach would suit them, while others preferred a transitional period in a group supportive environment prior to moving to separate permanent housing. These findings suggest not only that there is a need for individual services to assess and respond to women’s needs; but also a need for a range of services that will meet the diversity of women’s needs and situations; and sufficient services to respond to these different needs, so that women are not referred to services that were inappropriate. These should include women only and Housing First options, as well as timely access to suitable Social Policy Research Centre 2017 Meeting the Needs of Women Experiencing Chronic Homelessness

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5 Conclusion

permanent housing following transitional options. Responsive, safe, smaller scale services that offer flexible length of support and accommodation with a secure transition to permanent housing are appropriate for supporting women experiencing chronic homelessness. Specialisation in target group enables women to receive well-focussed support and assist in providing a supportive environment. Large generalist services are unlikely to meet the needs of women experiencing the most chronic homelessness. Inflexible length of accommodation and support lead to women’s time of assistance being terminated before their situation is resolved, leading to a return to homelessness. One interviewee summed these needs up: I think Sydney as a city just really needs to look at services for women, vulnerable women. Whether it’s domestic violence or drug addiction or mental health or all three, which is quite common. [Int 7] Similarly, a choice of appropriate options for long-term housing and support are required. This is consistent with the diversity of women’s needs and principles of consumer choice. Currently women’s access to long term housing is restricted in a number of ways. Two women interviewed reported being not ineligible for priority housing. Two women had been evicted from social housing when they were psychiatrically unwell and in hospital. One woman who had lost her private rental housing because of mental illness had been granted a short term social housing lease only and was anxious about having her tenancy reviewed, in case she had to return to private rental and the risk of homelessness if she again became unwell. Women reported that the tight accommodation situation led to waits for crisis, transitional and permanent housing, and so impacted on every step in their experiences of chronic homelessness and their attempts to seek a pathway out of homelessness. Processes are needed to address these types of issues and support housing stability for women experiencing chronic homelessness.


21

Appendix A

Interview Topic Guide: Meeting the needs of women experiencing chronic homelessness 1. How long and on how many occasions were you/have you been homeless or in unstable housing? What is your age? (confirm participant meets study criteria). 2. What is your current living situation and is that temporary or permanent housing? 3. How did you come to live there/be referred there? 4. Where were you living previously? 5. Over this time, how many different services have you been in contact with about getting help about not having somewhere to live? 6. What kind of help did each of these different services provide? For each, what was useful/not useful? 7. Thinking back over that time, what type of help did you need from services? What help that you did receive was most useful to you in getting and keeping housing, or dealing with other problems that would have helped you get or keep housing? Was there help that you did not receive that would have been useful to you? Prompts: • Information and support from workers • Getting permanent housing • Getting temporary accommodation • Type of temporary accommodation • Safety and security • Support with any other issues or problems 8. What suggestions do you have for improving the help you received? 9. Do you think that services you used were able to meet the needs of women who were using those services? Did some types of services meet your needs as a woman better than others? 10. Do you have suggestions for making the help services give more relevant for women? 11. If you could change one thing about the type of help that you have received, what would you change? 12. Is there anything else you would like to say about helping women who are experiencing homelessness or unstable housing? Social Policy Research Centre 2017 Meeting the Needs of Women Experiencing Chronic Homelessness

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Appendix B

Literature review: Meeting the needs of women experiencing chronic homelessness Homelessness and housing problems among women are not new (Golden, 1990). However the later decades of the twentieth century saw an expansion in the population recognised as homeless, to include not only those older ‘skid row’ alcoholic men predominantly presenting as homeless, but also other groups affected by economic and social forces including an increase in individual risk resulting from economic and social changes including labour market deregulation and changes in household composition and relationships (Adkins et al., 2003; Robinson & Searby, 2005). These groups, known as the ‘new homeless’ included women, children and young people, families, older people and people with disability including mental illness (Adkins et al., 2003). These groups were affected by factors including domestic and family violence and abuse; labour and housing market changes; changes in social provision including public housing and long term institutional care; and the increasing feminisation of poverty (Adkins et al., 2003). While chronic homelessness has traditionally been associated with ‘skid row’ men, women too can become homeless for extended periods (Adkins et al., 2003). However there is a lack of recognition and research specifically about women’s chronic homelessness and responses to this problem (Mayock et al., 2015).

Definitions of chronic homelessness It is widely agreed that adults experiencing chronic homelessness form a small but significant subgroup of the homeless population (Caton, Wilkins et al. 2007). There is no single agreed definition of ‘chronic homelessness’, with the term being variously used in international literature to refer to longer-term homelessness. For example, the US government adopted the following definition of chronic homelessness in 2003: ‘an unaccompanied homeless individual with a disabling condition who has either been continuously homeless for a year or more OR has had at least four (4) episodes of homelessness in the past three (3) years’ (U.S. Office of the Federal Register National Archives and Records Administration, 2003, quoted in Zlotnick, Tam, & Bradley, 2010, p. 471). Klodawsky, writing in Canada, quotes another definition: “A chronically homeless person is one who has spent 60 or more cumulative nights in the past year in an emergency shelter and has reached the point where he or she lacks the physical or mental health, skills and/or income to access and/or maintain housing” (Homelessness Community Capacity Building Steering Committee, 2008, quoted in Klodawsky, 2009, p. 592). Bridgman, another Canadian researcher describes people who experience chronic homelessness as those who ‘live rough on the streets or cycle through fleeting periods of being housed’ (Bridgman, 2002, p. 51) or ‘live on the streets for many years’ (Bridgman, 2002, p. 76). Social Policy Research Centre 2017 Meeting the Needs of Women Experiencing Chronic Homelessness

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Appendix B

In Australia Chamberlain and Johnson described chronic homelessness as homelessness lasting six months or more (Early Intervention: A Research Paper Prepared for the Victorian Homelessness Strategy, 2000, quoted in Casey, 2002, p. 78) while Gordon refers to ‘individuals with complex needs who have been homeless for over 12 months’ (Gordon, 2008, p. 5). The Australian government’s 2008 White Paper on homelessness describes people who experience chronic homelessness in the following terms: For ... a small minority, homelessness is part of a chaotic and uncertain life of poverty and disadvantage. These people tend to cycle in and out of homelessness and when they do find housing, it tends to be short term (Department of Families, 2008, p. xi) There are also differences in definitions of chronic homelessness among women. US researchers Brown and Zeifert (Brown & Ziefert, 1990) distinguish between three groups of homeless women: women who experience chronic homelessness without a permanent home for at least year; episodically homeless women who move between living on the street, using shelters, staying with family and friends and short periods of living independently; and situationally homeless women who lack shelter as a result of an acute crisis, and who are usually homeless for the first time. They suggest that distinguishing between these groups better informs service provision. Brown and Zeifert describe women who experience chronic homelessness as having ‘a routinized existence that barely meets their basic needs’ (1990, p. 8), as well as having a low or no income and obstacles to searching for low cost housing, such as substance abuse, mental illness and volatility. This group is described as ‘suspicious, withdrawn and generally unconnected to the service network’ (Brown & Ziefert, 1990, p. 8). Brown and Zeifert describe episodically homeless women as having long term unresolved crises and as being unprepared to live independently, due to problems such as substance abuse, mental illness and volatility, also experienced by women who experience chronic homelessness. Long-term homeless women are also described as alternating time spent in shelters, with family and friends, on the street and in brief periods of living independently. Casey (2002) uses a variation of Brown and Zeifert’s descriptions based on urban Australian experience to describe the experiences of women who become homeless. Casey uses the term chronic homelessness to refer to those women ‘who have been homeless since they were children and had little or no significant experiences of home as adults’ (2002, p. 81); and the term long-term homelessness to refer to women who had at some stage lived independently in private rental accommodation but became homeless after a series of critical events. Women in the long-term homeless group had experienced long periods of homelessness often including rough sleeping before they contacted services, or had experienced lengthy psychiatric admissions. Consistent with Ziefert and Brown’s approach, Casey uses the term situational homelessness to describe those who become homeless in response to a particular crisis, for example someone whose mental illness led to them losing income and their accommodation. The Mercy Foundation which is a non-government organisation that focuses on homelessness as a social justice issue and has funded this research project defines chronic homelessness as: ‘an episode of homelessness lasting 6 months or longer or multiple episodes of homelessness over a 12 month period or more’ (Mercy Foundation, 2016). The


24

Appendix B

Mercy Foundation definition is used for the purposes of this research project.

Existing Australian quantitative data on women’s chronic homelessness Australian data collections about homelessness provide little information on length of homelessness. The Australian Institute of Health and Welfare (Australian Institute of Health and Welfare, 2016b) has produced a table showing the number of support periods per client of homelessness services. This data may provide an indication of chronic or long-term homelessness. The table shows that in 2014/15, 6.7% of all clients had 3 support periods (10, 566 women and 6,631 men), 3.0% had 4 support periods (4,626 women and 2,939 men), 1.4% had 5 support periods (2,293 women and 1,408 men) and 2.3% of clients had 6 or more support periods (3,506 women and 2,496 men). US estimates are that around 11% of the US homeless population experience chronic homelessness (Culhane & Metraux, 2008). Depending on how we interpret this data, it could be consistent with the estimate of a similar percentage of service users being chronically homeless to that in the US. Although this data reflects only those homelessness experiences where people use services, it does suggest that large numbers of women do experience long-term homelessness. Research into homelessness among older people found that 30 percent of a sample of homeless older people who had experienced ongoing housing disruption throughout their lives were women (Petersen, Parsell, Phillips, & White, 2014, p. 64), and approximately half of older women who are homeless have had ongoing housing disruption during their lives or have had a transient housing history (Petersen et al., 2014, p. 42). The AIHW also counts both the number of people who received assistance from homelessness services, as well as the number of requests for where people are not offered any assistance. In 2014/15 nearly 59% of clients of homelessness services were female, and two in three of all people unable to be assisted were female (Australian Institute of Health and Welfare, 2016a). The Journeys Home longitudinal dataset also provides some information about the length of homelessness. Using this dataset, researchers suggest that, while women are likely to exit homelessness sooner than men if the homelessness involves staying with friends and family, in a boarding house or in emergency accommodation. However women are less likely than men to exit homelessness when it is narrowly defined as rough sleeping (Cobb-Clark, Herault, Scutella, & Tseng, 2014). This is consistent with qualitative research that suggests that overall, those women who sleep rough may be a more high needs and vulnerable group who face even more challenges in addressing their situation than men who sleep rough (Robinson & Searby, 2005). Chronic or persistent homelessness that started when the person was a teenager is linked to rough sleeping, although people who are homeless for short periods also sleep rough (Chamberlain & Johnson, 2015). However the experience of sleeping rough becomes more common the longer people are homeless. One study, for example, found that nearly two-thirds (62 per cent) of those who had been homeless for over a year had slept rough, and that proportion reduced for people who had been homeless for shorter periods (Chamberlain, Johnson, & Theobald, 2007). This trend occurs because people’s options for alternative temporary accommodation decline over time, which in turn makes it more difficult


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Appendix B

to maintain a ‘normal’ lifestyle and increases social exclusion. Only 2 per cent of people who are homeless sleep rough all the time, and about half have slept rough at some time (Chamberlain 2007). The 2011 Census found that approximately 6 per cent of homeless people were sleeping rough in improvised dwellings, tents or sleeping out on a given night, 14% were in supported accommodation; 19% were staying temporarily with other households, 22% were staying in boarding houses and 35% were in severely crowded dwellings3 (Australian Bureau of Statistics, 2012). The Census also that 44% of all homeless people counted were women, and thirty-two per cent of those identified as sleeping rough on Census day were women (Australian Bureau of Statistics, 2012, pp. 5,7).

Needs and experiences of women experiencing chronic homelessness Economic disadvantage and a lack of access to affordable housing are central causes of homelessness (Casey, 2002). Chronic homelessness is experienced more frequently by people with a history of disadvantage, including poverty and long term unemployment; psychiatric and other disability in the context of deinstitutionalisation and a lack of services; substance abuse; other health problems, including post traumatic stress disorder; adverse events including domestic violence and other experiences of victimisation; and childhood deprivation and trauma, including having been under the care of child protection systems (Caton, Wilkins, & Anderson, 2007; Department of Families, 2008; Watson, 2000). This disadvantage is often conceptualised in terms of complex need or multiple exclusion homelessness, and is also understood in the context of an increasing individualisation of risk related to economic and social changes including deregulation and the winding back of welfare provision (Beck, 1992; Casey, 2002; Darab & Hartman, 2013). There is also a recognition that homelessness definitions and policies ‘exist on a gendered terrain in which women’s housing needs and experiences remain marginalised’ (Watson, 2000, p. 159) and that specific, gendered factors contribute to women’s homelessness and their experiences of homelessness. However studies of homelessness have generally given little attention to the issue of gender because chronic homelessness is associated strongly with single men (Mayock et al., 2015). Indeed, the dominant profile of chronic homelessness is described as: … high and complex needs males who sleep rough and/or live in emergency hostel accommodation for prolonged periods, have entrenched substance use problems, low educational attainment and serious mental health problems’ (Mayock et al., 2015, p. 878). Women who experience homelessness and the precipitating factors for their homelessness are very diverse (Nunan & Johns, 1996). However the economic and social disadvantage of women who become homeless occurs in the context of women’s poverty and overall economic inequality including gender discrimination, the gender pay gap and women’s poor position in the housing market; the low level of income support; the impact on women of domestic and other violence against women, sexual assault and child sexual assault; 3

People who are usual residents of dwellings which needed four or more extra bedrooms to accommodate them adequately


26

Appendix B

and the limited nature of women’s traditional roles (Adkins et al., 2003; Darab & Hartman, 2013; McFerran, 2010; Novak et al., 1999; Robinson & Searby, 2005; Sharam, 2008). One study of homeless women at a homeless day centre found that for many of the women, home was a place to be feared rather than a refuge and that avoiding abuse was a common reason for their past residential instability (Tomas & Dittmar, 1995). Many homeless women are mothers, but if homelessness persists their children will generally no longer be living with them, an additional source of trauma (Caton et al., 2007; Zlotnick et al., 2010). Women experiencing chronic homelessness are impacted not only by a lack of housing but the impact of having experienced stress throughout their lives (Brown & Ziefert, 1990). A lack of timely service responses may also contribute to chronic homelessness (Robinson & Searby, 2005). Women who become homeless often adopt strategies that hide their homelessness, and may be less visible to the public than men (Klodawsky, 2006; Mayock et al., 2015; Robinson & Searby, 2005). Strategies include staying with family and friends, gaining shelter by having sexual relationships with men and rough sleeping in concealed locations in order to maximize safety (Mayock et al., 2015; Novak et al., 1999). Women who experience chronic homelessness are also less visible because they are not accompanied by children (Mayock et al., 2015). Stigma and shame associated with women’s homelessness encourage women to conceal their homelessness (Mayock et al., 2015). These differences mean that the homeless pathways of women who are longer-term homeless are not well understood. Women who are homeless alone have been referred to as ‘the self-managed homeless’ (Robinson & Searby, 2005, p. 16) because they often manage their situation by themselves and avoid presenting at services until they have no other option. This strategy has the effect of prolonging their homelessness and increasing its impact. This impact includes the likelihood of experiencing violence and intimidation while homeless (Murray, 2009), adverse effects on physical and mental health including the effects of additional trauma (Gelberg, Browner, Lejano, & Arangua, 2004; Novak et al., 1999), and increased isolation (Mayock et al., 2015). The experience of homelessness is traumatic in itself. This means that by the time women do seek assistance, they are likely to be in more chronic crisis, to be more unwell, facing greater challenges and to have been homeless for longer than would otherwise be the case (Robinson & Searby, 2005).

Recent approaches to chronic homelessness and service use Internationally, a number of models of housing with support exist for people who have been experiencing chronic homelessness or have complex needs, and a combination of housing and support is viewed as best practice for ending chronic homelessness (Caton et al., 2007; Rog, 2004). These models include both transitional and permanent models of housing and support, as well as variations within these models (Caton et al., 2007). Recent approaches have criticised the role of temporary and transitional housing for people who are experiencing chronic homelessness, on the grounds of consumer preference, effectiveness and cost (Culhane et al., 2002; Tsemberis & Asmussen, 1999). Permanent housing models, and in particular ‘housing first’ models, aim to remove barriers to housing for the most vulnerable homeless people (Gulcur, Stefancic, Shinn, Tsemberis, & Fischer,


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Appendix B

2003). ‘Housing First’ is an approach which rejects the assumptions of the transitional or ‘continuum of care’ approach that has been widely used internationally, that involved moving people through a linear series of time limited residential services conditional on the client’s acceptance of treatment and abstinence from drugs and alcohol (Johnsen & Teixeira, 2010). Instead, Housing First assists homeless people by providing immediate access to long-term independent housing with tailored, flexible support services, but without requiring sobriety or treatment. Housing First models include ‘scatter site’ models that operate using apartments throughout the community as well as ‘communal’ models that house formerly homeless people in apartments or rooms in the same building (Parsell et al., 2015). International research indicates that people in programs that provide ‘housing first’ have better outcomes than those in transitional programs (Gulcur et al., 2003). In particular, some research suggests that transitional services do not resolve the problems of the long-term homeless, who have often received accommodation and support from these services but remain homeless (Gulcur et al., 2003). However some Australian research notes that in general Australian ‘transitional’ homelessness programs have not adopted a linear continuum model where access to housing was conditional on abstinence or treatment, adopted an approach focussed on ‘choice, harm minimisation and long-term intensive support’ (Johnson, 2012). Instead, it was the growing lack of affordable and accessible housing in Australia rather than conditions imposed by service providers that led to people circulating through services while remaining homeless (Johnson, 2012). People experiencing chronic homelessness have been characterised as high users of services such as homeless shelters, hospital emergency departments, drug and alcohol services and jails, and some recent research has focussed on whether Housing First could offset the costs incurred by this disproportionate use (Culhane et al., 2002; Larimer et al., 2009). The case of ‘Million Dollar Murray’, a chronically homeless inebriate whose use of services had been estimated to cost a million dollars use illustrates these concerns (Gladwell, 2006). However Klodawsky (2009)argues that an approach based on cost alone risks overlooking the role of issues that are particularly important in women’s chronic homelessness, such as childhood sexual abuse. Other services suggested as key responses for people who are experiencing chronic homelessness are outreach services that may provide food, blankets and clothes, accommodation support and assessment, assistance to find housing, legal and welfare advice, hygiene and medical support, including drug and alcohol, counselling, transport and relationship building (Caton et al., 2007; Phillips, Parsell, Searge, & Memmot, 2011). Discharge planning is aimed at ensuring that people are not discharged into homelessness from services and institutions such as hospitals, statutory care, juvenile justice, prisons and treatment facilities (Caton et al., 2007; Department of Families, 2008). In addition to identifying good practice service models, literature suggests that what is needed is a paradigm shift away from traditional conditional approaches; clear goals and changes in attitude; and arrangements that involve a broader community responsibility for addressing chronic homelessness are needed (Burt et al., 2004). For example, Burt et


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Appendix B

al. suggest that the goal should be to end chronic street homelessness and that primary responsibility for homelessness programs be shifted to mainstream public agencies rather than remaining with charitable or religious groups. Burt et al support both housing first models where people can move directly to permanent housing units with support services and transitional versions of housing first so people bypass emergency shelters, combined with a harm reduction or low demand approach with a requirement only to meet lease conditions but not to participate in treatment or activities. Some Australian literature

Responding to the needs of women experiencing chronic homelessness Service Approach Literature on services for women experiencing chronic homelessness emphasises the overall approach that services take in service provision. Women’s longer-term homelessness is characterized by ‘a complex pattern of movement through precarious housing and ‘hidden’ homelessness’ (Mayock et al., 2015, p. 893) that is structured by the options available to them and their awareness of these options. When women who have been experiencing chronic crisis and homelessness approach services, they are likely to need intensive and long term support, rather than just crisis or short term accommodation (Robinson & Searby, 2005). Flexibility and innovative approaches are required to respond to the needs of different women (Bridgman, 2002; Novak et al., 1999; Watson, 2000). There is a need for approaches to respond to the issues that have produced women’s homelessness, including lifetime disadvantage and poverty, the effects of violence and abuse, and health challenges including mental health and drug and alcohol problems (Novak et al., 1999). Women in this situation need more than accommodation. Support and relationships are key: services need to support women’s own strengths to deal with the situations they face; and offer genuinely supportive relationships with staff (Casey, 2002). Support from friends and extended family where this is possible is also important. Services need to have an approach that emphasises caring and affiliation which are important in addressing the sense of alienation that can result from long term abuse and homelessness (Brown & Ziefert, 1990). The process of engaging with women experiencing chronic homelessness may be slow and services need to be able to take the time to do this rather than being pressured to move clients on, an approach that contributes to clients cycling through different services without resolution of their situation (Robinson & Searby, 2005). Research also indicates that feeling ‘at home’ in both accommodation and drop in services is important to women experiencing chronic homelessness. This involves ‘material and ontological security’ (Adkins et al., 2003, p. ii), including safety, security, protection, stability and an environment free from surveillance. Intrusive approaches, degrading rules and sanctions may exclude women, in particular those with the highest needs (Bridgman, 2002). Accommodation should be low demand (Bridgman, 2002). Home-like services including access to food, washing and other supports are important, as is a location that is familiar (Adkins et al., 2003; Robinson & Searby, 2005). In Australia homeless women who are not accompanied by children are grouped in a


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Appendix B

‘generalist’ service sector which was traditionally focussed on services for homeless men (Robinson & Searby, 2005). Accommodation which is shared with men (with whom who the woman has not chosen to live) has been criticised in literature as being unsafe and inappropriate due to safety concerns (Murray, 2009; Novak et al., 1999), and women-only residential, transitional and rooming house accommodation is seen as most successful in addressing homelessness (Robinson & Searby, 2005). Small-scale specialist, women-only services are suggested to meet the needs of women experiencing chronic homelessness rather than large-scale least-cost generic services which may be avoided by many women (Casey, 2002). Some women also preferred sex-segregated rooming houses (Bridgman, 2002). In a small US study of the preferences of women experiencing chronic homelessness women some women preferred mixed accommodation and some preferred all women accommodation, but having adequate security of person and possessions was high priority for almost all the women, who had had experiences of harassment, assault and theft (Goering, Paduchak, & Durbin, 1990). This study also found that living situations which are ‘normal’ and independent but that also offer support are preferred by most women, although a minority preferred meals and psychosocial support to be provided (Goering et al., 1990). Women in this study did not wish to be housed with others who had different needs including mental illness and alcohol and drug problems, or who were involved in criminal activities. The preference for ‘normal’ housing is also the case for people who are homeless or have mental health problems more generally (Hogan & Carling, 1992; Tsemberis & Asmussen, 1999).

Service types Prevention: An Australian study (Casey, 2002) –based on an analysis qualitative interviews with eleven single women aged 25-45 years without children in their care about their pathways into and out of homelessness suggested that providing social supports and health and welfare services before women become homeless is a preventive measure. Supports could include counselling, mental health services, specialist drug services, education, employment and training services as well as housing related support including emergency financial relief to assist women to keep their housing. Similarly, Canadian research nominates one-on-one support, residential treatment programs for women with dual diagnosis, harm reduction facilities such as needle exchanges and injecting rooms, and low demand, high support permanent housing facilities (Novak et al., 1999). Discharge planning is needed so that vulnerable women are not discharged from institutions to crisis accommodation but instead are provided with follow-up care including options for permanent housing with support (Novak et al., 1999) Outreach, drop in and other services: Drop in centres and food banks are valued by homeless women for their services such as material assistance, food, hot showers, clothing, information and referral, medical services and computer access and in particular if the staff were helpful (Novak et al., 1999). Outreach services can connect women experiencing chronic homelessness with services including connecting those sleeping rough with appropriate small scale specialised well staffed


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Appendix B

accommodation (Novak et al., 1999). Generalist services with which women experiencing chronic homelessness come into contact could also contribute to improving assistance by providing better and more timely information and referral (Casey, 2002). These services include Centrelink, general practitioners, psychiatric in-patient services, goals, police, needle exchange services and crisis services.

Housing and Support Models Literature on housing and support models for women experiencing chronic homelessness recommends values a greater flexibility in models than is suggested in the general literature on chronic homelessness. For example, Klodawsky (2009) argues that the distinction between transitional and Housing first models is less important than the broader policy framework and the specific details of policies and programs. She supports the Housing First critique of transitional models that use a patronising approach of rewards and punishments, but argues that there is value in more nuanced transitional approaches that have policies of no eviction and harm reduction, and that provide opportunities for support, healing and connection with others (Klodawsky, 2009). Several studies report on models that had transitional aspects but were also unlimited stay and low demand. Bridgman (2002) describes a high support, unlimited stay, low demand safe haven model that is neither transitional nor Housing first but includes aspects of both. Similarly, Casey reports that women in her Australian study were of the view that: The most successful housing and support model, based on feedback from the interviewed women, was an integrated women-only service that included residential, transitional and rooming house accommodation and support services. In addition, women also accessed drug and alcohol, mental health and counselling services. There was a strong emphasis on referral to employment and training programs, support for education and/or other lifestyle activities (Casey, 2002, p. 86). One study (Rich & Clark, 2005) found gender differences in outcomes for homeless single men and women with severe mental illness from a Housing First-like program and a specialised time limited case management program that included outreach, counselling and assistance with finding housing and services. The male respondents in the Housing Firstlike program had significantly greater reductions in homelessness than those in the case management program. On the other hand, while women in both programs had reduced homelessness, those in the case management program achieved greater housing stability over time. The authors conclude that the differences were related to women who had greater support through case management spending less time in psychiatric hospitals. While further research may assist a better understanding of these results, they do support the suggestion that services for people experiencing chronic homelessness need to better understand and address gender differences (Tolomiczenko & Goering, 2001). At the same time, it is important to note that studies such as that conducted by Rich and Clark do not suggest that all the women had the same outcome. Women experiencing chronic homelessness are diverse and it would be surprising if one model were best


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Appendix B

for all. Other research (Mayock et al., 2015) recommends Housing First in autonomous, independent housing with targeted supports as the best approach to longer term homelessness (Mayock et al., 2015). Novak’s recommendation for a choice of long-term housing and support options that meet the needs and preferences of different women and assist them to maintain their housing and wellbeing is consistent with the ethos of consumer choice and with the diversity of women’s needs.

Housing access Finally, there is a consensus in research that investment to improve the affordability and availability of housing would resolve homelessness for many people and relieve pressure on homelessness services which are currently forced to ration service provision resulting in women experiencing chronic homelessness being turned away or circulating between services (Casey, 2002; Klodawsky, 2009; Robinson & Searby, 2005). Similarly, adequate income to meet high housing costs would also assist women to secure housing (Casey, 2002). Housing First and other permanent housing models have a particular significance because policies for affordable housing are characterised as ‘wicked’ problems in need of innovative solutions, and these models are indeed viewed as innovative solutions (Klodawsky, 2009). Improvements in access to affordable housing could open up space for a range of responses to chronic homelessness among women and more generally.


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References

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