Young people experiencing homelessness often miss out on support because there’s no plan or specialist support associated with their mental health and substance use warns Melbourne City Mission’s Molly OShaughnessy.
The specialist homelessness system acts as a safety net when other service systems – child protection, education, health, disability, and mental health, housing, and justice services – fail to meet the needs of our most vulnerable citizens. Right now it’s clear every time you open the paper or walk down a city street that this safety net is close to breaking point, strained under the weight of unprecedented levels of street-based homelessness.
While much of the media’s recent coverage has focused on older rough sleepers, over the past three years Melbourne City Mission, through its CBD-based youth homelessness access point Frontyard, has seen unprecedented growth in another sector of the rough sleeping population: people under the age of 25.
For the majority of this group, the specialist homelessness system can provide a pathway out of immediate homelessness. Most young people attending Frontyard will not need to return, and for those that do, most will only return on another one or two occasions. However, there is a small but significant number of young people who are caught in a cycle of recurrent homelessness, and return to services again and again, sometimes over months or years. This group is notable not only because of their use of services, but also for the complexity of their need.
While each journey is unique, the common factor for these young people facing homelessness is a history of abuse, trauma and self-harm. Most have grown up in out-of-home care and many have extremely high levels of engagement with the youth justice system.
Most have co-occurring substance abuse, cognitive impairment, and often other disabilities.
More than 80 per cent report a mental health diagnosis and, significantly, 90 per cent report problematic substance abuse. It is, however, worth noting that the level of substance abuse may be under-reported – experienced frontline staff at our youth refuges suggest that, for this particular group of young people, problematic substance use sits at closer to 100 per cent.
We currently estimate that 50 to 75 young people with these characteristics are experiencing homeless in Melbourne at any one time, and are ricocheting through the health and justice systems, as well as the homelessness system. We know that unless they receive the right assistance – a new kind of support – they are on a trajectory towards a lifetime of chronic and enduring homelessness.
So what is “the right kind of support”?
As Victoria’s largest funded youth homelessness provider, we know that the majority of the 6,117 young people who are homeless on any given night will require a short-term, very specific intervention, such as family mediation and counselling, to resolve their homelessness. Others will require a package of supports over a longer timeframe, for example, housing information and referral and some support to maintain that tenancy.
However, for street-attached young people who have lost faith in ‘the system’, are disinclined to engage with specialist homelessness services, and who exhibit extremely challenging behaviour when they do engage, a new disruptive approach is needed.
In our experience, a young person who is rough sleeping while also dealing with mental health or addiction issues – for example – is unlikely to be readily accepted into any service, due to complications in the assessment process and difficulties encountered in determining that young person’s ‘primary cause’ point. Young people in this situation will often not only miss out on mental health and AOD support, but miss out on a refuge bed also, because there is no plan or specialist support associated with their mental health and substance use and the facility is concerned that they will not be able to manage the risk. For many of these young people, the system is once again letting them down, offering a place on a waitlist, but no certainty of support.
Young people in this transient and often highly traumatised group are in need of immediate assistance. Being placed on a waitlist is as good as services saying no. Unable to access services, these young people experience further rejection, and use phrases such as “kicked out” and “they don’t want me back” to describe their experience of services. They may end up in rooming house or adult services, or disengage entirely; categorised as having “failed to engage” or displaying “chaotic” behaviour.
We need to ensure that these young people, particularly those with more complex needs, do not disengage. We know that young people who disengage from services often find themselves in dangerous situations likely to increase their trauma and reduce their capacity to exit homelessness.
While the success of a new approach requires assertive outreach, more intensive interventions and longer periods of support than the system is currently designed (and funded) to provide, one of the most critical requirements is our ability to forge flexible and effective service pathways and partnerships across sectors, but importantly across homelessness and alcohol and other drug (AOD) services.
While each journey is unique, the common factor for young people facing homelessness is a history of abuse, trauma and self-harm.
The treatment models used by youth AOD services provide many good practice examples for homelessness services. In particular, the precedent set by street and assertive outreach programs in the drug and alcohol sector provide an extremely useful model for services working with rough sleepers. Additionally, the way that Victorian AOD primary health services prioritise the principle of accessibility above other areas of service design in order to work with the most marginalised clients also offers a valuable model to draw from. Although not always specifically youth focussed, these programs have proved available and easy to access for even those people usually reluctant to seek help from services.
It is imperative that we, as a sector, start considering the needs of those groups of people who are at risk of or who have disengaged from services.
In a time when demand exceeds supply and resources are not always available, and when the needs of the young people are more and more complex, and require more of our attention to manage, our challenge is to turn our attention also to those that we do not see.
Melbourne City Mission is currently engaging in cross-system collaboration, to develop a new disruptive model that will operate out of Frontyard. This new model will include street and community outreach and digital engagement. A centrepiece will be a 24-bed refuge from which new ‘boundary spanning’ therapeutic interventions will be provided to support young people to address trauma and other complex needs, and integration with other community supports.
This is an edited extract of Molly OShaughnessy’s presentation to the 2017 VAADA Conference: Complexity, Collaboration, Consumers and Care.
Melbourne City Mission’s Frontyard Youth Services provides integrated services to address the physical, social and emotional needs of young people aged between 12 and 25 years who spend time in Melbourne’s CBD.