Homelessness is one of Australia’s most pressing public health issues. Each night, more than 122,000 people, including families and children, lack a safe home. This lack of stable housing significantly impacts their physical, mental, and social well-being, creating a cycle of poor health outcomes and mortality risks.

Homelessness is a public health issue because housing instability can directly affect physical and mental health, access to healthcare and the ability to manage existing conditions. People experiencing homelessness may face barriers including cost, transport, appointment availability, lack of communication channels and difficulty safely storing medication. These challenges can contribute to delayed or fragmented care and greater reliance on acute health services. Australian evidence also identifies housing and homelessness as important social determinants of health, reinforcing the need for coordinated responses across healthcare, housing and community services.

For healthcare professionals, policymakers, and governments, addressing this crisis requires a closer examination of the barriers people experiencing homelessness face in accessing healthcare and the systemic changes needed to overcome them. Speaking with people experiencing (or at risk of) homelessness, and with the social services agencies that work with them, is critical.

We are grateful to have worked with people with lived experience and supporting agencies, funded. This two-part blog shares:

Part 1 – Findings from a regional health needs assessment of people experiencing, or at risk of, homelessness (funded by Eastern Melbourne PHN through the Australian Government).

Part 2 – Enhancing the capacity of primary health services to better understand and meet the health needs of these populations (a separate project).

This blog is Part 1. Grounded in the voices of the people we spoke with and supported by research, the Health Needs Assessment highlights gaps and possible solutions to improve health outcomes for those experiencing homelessness in urban settings outside the CBD.

Definitions and Extent of Homelessness

Our understanding of homelessness improved throughout the project. Homelessness isn’t a single experience; not does it necessarily happen in a particular type of place. It ranges from rough sleeping to couch surfing to living in temporary shelters or inadequate housing – and moving between these situations.

Each form brings unique challenges. For example:

• Rough Sleeping increases potential exposure to infectious diseases, violence, and severe weather.
• Temporary Shelters create overcrowded conditions, leading to stress and a lack of privacy.
• Housing Instability prevents individuals from following medical treatments, as they don’t have stable spaces for recovery or appropriate ways of storing many forms of medication.

In addition:

• One in five people experiencing homelessness is Aboriginal and/or Torres Strait Islander.
• One in seven are children aged under 12.
• People experiencing homelessness face higher rates of mental illness, poor oral and eye and foot health, and infectious diseases.
• In Victoria alone, 95,530 clients sought assistance from Specialist Homelessness Services in March 2024.

The most common forms of homelessness are experienced by people living in overcrowded or severely crowded dwellings (62.6% of people experiencing homelessness in Melbourne), people living in boarding houses (14.4%), people living in supported accommodation (12.6%) and people staying temporarily with other households (3.5%).

Housing stress – driven by rising costs and stagnant incomes – is the fastest-growing cause. Addressing it improves health outcomes and reduces healthcare burdens.

The Complex Barriers to Healthcare Access

People experiencing homelessness encounter multifaceted barriers to healthcare, many of which are deeply intertwined with their daily survival needs. From prioritising food, water, and shelter over medical concerns to grappling with housing instability and limited finances, healthcare often becomes inaccessible.

The Impact of Homelessness on Health

The impact of homelessness on health can extend across physical, mental and social wellbeing. Unstable housing can make it harder to maintain nutrition, sleep safely, manage chronic conditions, attend appointments and follow treatment plans. People experiencing homelessness also experience higher levels of some chronic health conditions, mental health concerns and other complex health needs. When healthcare is delayed or difficult to access, conditions may worsen before treatment is sought, increasing reliance on emergency and hospital services.

Key Factors Highlighted by Those with Lived Experience

Through consultation, people experiencing homelessness shared their struggles, painting a vivid picture of the challenges they face:

• Economic Hardship: “Scripts add up… I often choose between medication or meals.”
• Lack of Consistent Care: “I don’t have a GP.. When things get really bad, I just go to hospital.”
• Housing-Related Health Issues: “Living in a motel means I can’t keep my insulin at the right temperature.”
• Stigma and Judgment: “(in health settings) I hear voices, I talk to people, and I can get paranoid. People don’t like that, so they escort me out.”

Each story reinforces how homelessness negatively impacts health outcomes, creating a cycle where untreated conditions lead to emergencies and hospitalisations a costly and reactive approach for both individuals and the healthcare system.

Primary care services report wanting to provide more accessible care but struggle due to time constraints, limited resources, and difficulty providing holistic care due to fragmented care systems and transient populations.

(More on provider approaches are in Part 2 of this blog).

We recommended a series of recommendations focused on enhancing health providers’ ability to provide trauma-informed, non-stigmatising care; assisting providers to integrate housing supports with healthcare access; and consider funding “free” outreach health services to areas in which people experiencing homelessness are currently congregating.

Success Stories

Around Australia and internationally, innovative models of care for people experiencing homelessness have driven meaningful change:

• Mobile Medical Clinics: Deliver primary care directly to those unable to travel to traditional centres (e.g. “street doctors” or “street nurses” that provide care in place and link to other health services)
• Drop-In Centres: Provide safe spaces for vulnerable populations to access healthcare and social services seamlessly.
• Integrated Care Models: Programs that integrate various services such as healthcare, housing assistance, and social support, to address the interconnected needs of homeless individuals (e.g. community health, Aboriginal community controlled health services).
• Outreach Partnerships: Enable collaboration between healthcare professionals, homelessness services, and social workers to provide wraparound care.

Healthcare for People Experiencing Homelessness

Improving healthcare for people experiencing homelessness requires more than simply increasing the availability of appointments. Effective responses can include accessible primary care, outreach services, trauma-informed practice, medication support and stronger connections between health, housing and community services. Flexible models can help address practical barriers such as transport, cost, communication and continuity of care. Integrated approaches are particularly important because health needs and housing circumstances are closely connected.

A Call to Action

Improving health outcomes for people experiencing homelessness is both a moral duty and a step toward a healthier, more equitable society. The need for coordinated, integrated care is urgent, and solutions exist.

By fostering community-wide collaboration and championing funding for trauma-informed, holistic healthcare approaches, we can break cycles of poor health and homelessness. Together, we can ensure that every person has the dignity, support, and healthcare access they deserve.

Acknowledgements

We acknowledge the generous and invaluable sharing of knowledge from a diverse group of community organisations and healthcare professionals across the Eastern Melbourne catchment. Thank you for your tireless efforts to meet the needs of consumers and patients, and for giving your time toward the health needs assessment.

We also acknowledge the generous sharing of knowledge of those with lived experience, whom for privacy reasons cannot be named in this report. Your knowledge, experiences and voices have shaped this health needs assessment.

Conclusion

Addressing the health needs of people experiencing homelessness requires more than improving access to individual healthcare services. Housing instability, financial hardship, stigma, mental health concerns and fragmented services can all influence whether people receive timely and appropriate care. A coordinated response involving primary healthcare providers, community organisations, housing services and health-system partners can help address these interconnected barriers.

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