Bringing mental health, family violence and housing support together

 

 

Traumatised women who determine, during the course of mental health support, that they cannot return to abusive relationships are at an elevated risk of homelessness upon discharge. This is because they are now in two categories of risk – being those escaping family violence and those leaving mental health services.    

Compounding the stress, this threat might need to be faced within weeks of them first seeking support from an agency with no specialist training in family violence or housing responses. 

In 2020, leading mental health provider Wellways Australia and McAuley Community Services for Women joined forces and conceived a role to try and address this challenge. 

The primary role of the partnership’s inaugural Family Violence and Homelessness Worker (the Worker), is to identify and transition eligible women from a short-term specialist mental health service to a service for women and children that specialises in family violence recovery and supported medium-term housing.  

Working alongside the Wellways team, the Worker  

• advocates for family violence victim-survivors in programs at four Wellways  Prevention and Recovery Care (PARC) centres,  

• builds capacity in the mental health team around family violence and housing issues, 
• works with mental health workers and program participants to develop individual support plans with goals to address family violence and homelessness, and 
• refers victim-survivors to safe, affordable, secure housing and relevant programs at McAuley House and other services where possible, while building support networks and longer-term housing options. 

An introduction to the partner services 

Wellways PARC centres provide sub-acute mental health services (a mix of clinical and psychosocial supports)  in a residential program. 

In a client-centred approach, Wellways recovery staff work with clinicians, creating recovery plans and transitioning participants to community support networks when they leave. Participants generally stay at a PARC for an average of 14 days. 

McAuley provides support for women and children experiencing homelessness and/or family violence, accepting referrals from across Victoria. Across McAuley’s services, women can access family violence and outreach support, health and employment programs, legal and financial advice, and trauma-informed supports for their children including tutoring programs and a children’s worker at court. 

As well as a 24-hour crisis response, McAuley runs a women’s refuge service, with stays of up to three months, as well as medium-term housing and support across the Western Metropolitan Region of Melbourne and Ballarat. The average stay across McAuley House is around nine months.   

In the 2020-2021 year, 44 per cent of the women supported by McAuley’s family violence services had been living in short-term or emergency accommodation, with little ability to improve that situation. Sixty four per cent of those supported by McAuley’s homelessness services had experienced family violence and 72 per cent of all women supported reported one or more mental health issues.  

Generally, McAuley clients can be dealing with a range of issues including homelessness, family violence, childhood trauma, episodic mental illness, sexual abuse and challenging social behaviours. 

Identifying the need:  

Presentations at Victorian homelessness services because of family violence represented 42 per cent of all clients in 2021, with mental health issues accounting for 40 per cent.  

Research over a longer period shows that 22 per cent of all those who experience physical violence while in stable housing fall into precarious housing the following year, while 75 per cent of victims of physical violence who were in precarious housing can find themselves still in that position in the same time frame.  

Why responding to homelessness is difficult in a mental health setting 

As with every mental health service, a condition of being accepted into the PARC program is that participants provide a residential address they can be discharged to. This is because the average time spent at PARC is two weeks.  

Despite this requirement, a risk of homelessness can still be revealed during the program. There are two main reasons for this. The first, we refer to as a ‘necessary untruth’ and the other, a ‘safe disclosure’.  

A ‘necessary untruth’ occurs when a participant knows that they can only access mental health help at PARC if they have a fixed address, so they provide one that is potentially unsafe to return to, or that they have no intention of using. Participants are not to blame for such misinformation and are understood to be doing what’s in their power to access a rationed, essential service.  

A ‘safe disclosure’ occurs when a participant has built up enough rapport with a  worker to disclose that their discharge address is unsafe for them. 

Commonly, the participant will then be referred to a homelessness Entry/Access Point that has a co-ordinating role in its region.  Each Access Point operates and delivers its services differently, making it hard to navigate. In our experience, it can be difficult to get a call back and delays are common. 

Where family violence has been revealed, a participant might also be referred to a specialist family violence service for support and/or crisis accommodation. 

This then can lead to women having to move multiple times as the family violence and homelessness systems respond to changes in safety, risk and availability of housing.  

Experiences of family violence can result in victim-survivors being five times more likely to have depression, post natal depression and suicidal thoughts, as well as be at risk of Post Traumatic Stress Disorder; it’s not hard to see how navigating multiple and shifting systems can be overwhelming. 

Indeed, those forced to seek help from the family violence and homeless systems speak of being confused and worn down by multiple moves, being given incorrect advice about eligibility for support, and drifting between both systems.

Removing barriers to prevent homelessness 

The Family Violence and Homelessness Worker role significantly reduces the risk that a victim-survivor who presents at PARC without a safe discharge address, could be turned away from mental health help because of it. 

Importantly, it also offers victim-survivors the opportunity to receive continuing support despite being considered ‘at low risk’ of further abuse. 

For example, through this role, a participant who had experienced homelessness was referred to McAuley because she did not want to return to an unsafe boarding house. A second participant was referred after she had been abandoned by her abusive husband when he left the country with their three children.   

But referrals for housing with ongoing support can only be made when places are available, and there is a critical need for safe housing upon discharge.  

How the mental health service has been enhanced 

While mental health support workers are experienced at picking up cues for abuse, some can feel like having a conversation with a participant without specialist family violence knowledge is like opening a ‘pandora’s box’.  

The role of the Family Violence and Homelessness Worker addresses this by building capacity within the team. For example, mental health support workers who ask for a secondary consult with the Worker because they suspect family violence, will be involved in that consult.  

Support workers are also able to take part in training. An online family violence education session has been delivered by Safe and Equal (formerly the Domestic Violence Resource Centre), and more training is planned. 

Being on site at PARC also enables the Family Violence and Homelessness Worker to share skills in reading external reports through a family violence lens, picking up for example, a woman who had presented numerous times to emergency departments with ‘panic attacks’ who had slipped through the cracks because the hospital had failed to identify family violence as the trigger.   

Family violence is now recorded on her discharge summary and can help to shape any future service response.  The participant also has a new understanding of her situation and is able to make decisions accordingly. It was really pleasing that after a family safety plan was drawn up, she was able to say: ‘I now realise that leaving is an option’. 

A survey of  Wellways staff at PARC showed 75 per cent had seen a difference in referrals, knowledge and conversations regarding family violence and homelessness over the first year of this appointment.  

Described benefits included availability for secondary consults, access to additional resources,  in-house knowledge of family violence and relevant referrals, timely support with housing needs, and providing PARC with an opportunity to work with people who might not otherwise be eligible because of homelessness. 

A similar role connecting a family violence and mental health service in Liverpool, NSW, attracted similar responses. An evaluation of that model concluded that it could ‘inform service delivery across the health system’.

Sally’s story – a case study of how the partnership is working 

Sally (not her real name) had experienced extreme trauma at the hands of her ex-husband at an earlier time and gave her discharge address to PARC as the home she now shared with her adult sons.   

During her stay, a PARC support worker began to suspect Sally was still experiencing abuse and referred her to the Family Violence and Homelessness Worker.  Being able to have a conversation with her in a safe space where trust had already been established, was hugely beneficial.   

It became apparent that Sally’s sons were repeating their father’s violence against each other.  When Sally acknowledged she didn’t want to live like that,  we were able to access McAuley services and move her into safe accommodation when her PARC stay ended. 

Not only was the anxiety of ‘what happens next’ removed from her thinking, but she was also able to access art and cooking activities as her identified coping mechanisms in her new surroundings. 

When it comes to family violence, momentum is everything and a change in circumstances and commitment to supports can occur very quickly. 

The Family Violence and Homelessness Worker role can significantly reduce the risk of homelessness for a victim-survivor who seeks mental health support. It also dramatically improves the chances that those surviving family violence can regain control of their lives so that stable housing becomes more achievable, more quickly, and more endurably.