Street Health
Why Street Health is needed
Homelessness is a health crisis. People sleeping rough experience some of the poorest health outcomes in our community. Without a safe place to sleep, store medication, shower, rest, eat well or recover from illness, health problems can deteriorate quickly. Treatable conditions often become urgent, people are more likely to present to hospital in crisis, and recovery is almost impossible while someone remains on the street.
National evidence shows that people with a history of homelessness service support die decades earlier than other Australians. People with a history of rough sleeping die younger again. These deaths are not inevitable — they are the result of poverty, trauma, exclusion from healthcare and the lack of safe housing.
Street Health: healthcare where people are
Street Health is Homeless Healthcare’s assertive outreach service for people who are sleeping rough or experiencing street-present homelessness. Our nurses, caseworkers and peer support workers provide compassionate, trauma-informed primary healthcare in the places people are already living, gathering or seeking support — including streets, parks, public spaces, drop-in centres and community service locations.
Our model is persistent, proactive and consistent. We do not wait for people to come to a clinic or ask for help at the right time. We return regularly, build trust over time, follow up health concerns, and keep offering care even when someone is hard to reach, moves locations, or has had poor experiences with services in the past.
What Street Health provides
Primary healthcare assessment, treatment and follow-up
Support with chronic disease, wounds, infections, pain and medication management
Mental health and alcohol and other drug support within a trauma-informed model of care
Health education, harm reduction and practical support to reduce preventable harm
Connection to GPs, hospitals, mental health services, alcohol and other drug services, housing support and community services
Continuity of care for people who may move between street, crisis accommodation, hospital, respite and housing
Where Street Health operates
Homeless Healthcare has delivered Street Health outreach in the Perth CBD since 2016. The service expanded to Fremantle in 2018 following the closure of the Fremantle Emergency Department, recognising the need for accessible, local healthcare for people experiencing homelessness in the area.
Street Health now also provides services in the Kwinana and Rockingham area four days a week in partnership with St Pat’s. This expansion strengthens access to healthcare for people experiencing homelessness and rough sleeping across Perth’s south metropolitan corridor, where outreach, housing support and health responses need to work closely together.
Working in partnership
Street Health works alongside homelessness services, outreach teams, local governments, hospitals and community partners to make sure people are not left to navigate complex systems alone. In Perth, the team works with local outreach and street-present services. In Fremantle, the team has strong links with local homelessness, ranger and community services. In Kwinana and Rockingham, the service is delivered in partnership with St Pat’s, supporting a coordinated health and homelessness response in the south metropolitan region.
Our approach
Street Health is based on trust, consistency and dignity. Our teams understand that many people sleeping rough have experienced repeated trauma and exclusion. We take the time to build relationships, listen to what matters to each person, and provide practical healthcare that responds to immediate needs while helping people reconnect with longer-term support.
Our goal is not only to treat illness, but to prevent health crises, reduce avoidable hospital presentations, support safer transitions between services, and improve the chance that people can recover and stay well when housing becomes available.
The Hub: As homelessness becomes more complex and persistent, coordinated primary healthcare is essential. The Hub helps people access care early, stabilise health issues, manage chronic conditions and stay connected while they move between street, crisis, temporary and more stable housing settings.
Respite Centre: People experiencing homelessness are often discharged from hospital without a safe place to recover. Medical respite provides the time, care and stability needed to heal, reduce avoidable readmissions and support people to reconnect with housing, health and community services.
Understanding the Complex Health Needs of People Sleeping Rough.
People experiencing long-term homelessness often face multiple, intersecting health challenges:
64% have a serious medical condition.
82% experience substance dependence, often as a way to cope with past trauma.
78% have at least one mental health or cognitive condition, such as PTSD, depression, or acquired brain injury.
47% experience all three conditions simultaneously.
Despite these high rates of illness, only about 25% access GP care, often because traditional healthcare services are not designed to meet their needs. Instead, many delay seeking help until their conditions become critical, leading to avoidable suffering and emergency hospitalisations.
42% of street present homeless identified as Aboriginal or Torres Strait Islander, well above the population average of 3.1% in WA.
The Support Street Health provides.
Finding & building rapport with people not engaged in homeless services
This has included people who:
Have had past distressing experiences in health system
Are new to homelessness (including since COVID-19)
Are reluctant to engage with homelessness or other health services
Struggle to communicate their needs (e.g. due to trauma, psychosis, brain injury)
Mental Health and AOD support
Gently building trust and unobtrusively assessing mental health &/or AOD issues
Informal counselling for people experiencing situation crisis and anxiety
Referrals to mental health/AOD services, and follow up to help people navigate this
Mental health treatment (e.g. monthly depot injections for psychosis)
On the spot primary care
Wound assessment and dressings
Diagnosis &/or treatment for asthma & respiratory conditions, infections, diabetes, Flu and now COVID vaccinations
Checking with people how they are managing with existing conditions (e.g. epilepsy, emphysema, high blood pressure)
Antenatal /pregnancy care
Strengthening continuity of connections to other services
Input to case management for complex needs clients of health or homelessness services
Linking people to relevant services and supporting this with follow up (e.g. WANDAS, Derbarl Yerrigan, alcohol and drug or mental health services)
Locating people that other health services are concerned about (e.g. people who have self-discharged from RPH)
Arranging GP follow-up via Homeless Healthcare clinics
Case Study: Shane
Shane is a 20 year old young man, sleeping rough since a relationship breakdown 18 months ago. Diagnosed with Type I Diabetes 3 months ago. After a 3 day admission to hospital, Shane is discharged with some education that is not really clear to him, 2 different types of Insulin to administer, a glucometre with limited test strips and a follow up appointment for 1 week.
Being homeless he has no fridge to keep his Insulin in; a diet that is limited to Soup Vans and drop in centres; often high in sugar and carbohydrates; and a diagnosis that is extremely difficult to come to terms with for any young person. When we met Shane he was fortunate enough to be staying at Tom Fisher House for 2 nights. He had run out of one of his insulin’s, had no test strips and very little knowledge of his disease – and no intention of doing anything about his situation, it all appeared too daunting. His blood sugar level (BSL) was 30 (normal range 4-6). We were able to provide immediate education, in small doses, set up an appointment for the next morning at the RUAH centre where Shane was given scripts for Insulin, strips and introduced to the Street to Home (S2H) programme co-ordinator.
We see Shane on a weekly basis now and as of last week he has been put into Foundation Housing in Fremantle.
Case Study: Chris
Background
Chris is in his late forties and has been homeless for nearly a decade. In 2014, he scored 10 on the VI-SPDAT survey and reported having comorbidities of mental health and AOD issues. During 2017, Chris had multiple ED presentations relating to a cyst on his hip that was repeatedly infected over a two-month period. Chris initially approached Street Health who transported him to RPH for abscess draining and dressing. He returned to ED on four occasions for dressing changes in the days following the initial drainage at the hospital. The average ED visit in a Perth public hospital is costed at $765, equating to an estimated cost of $3,060 for dressing changes in the ED setting.
Role of HHC
He subsequently saw the Street Health nurses nine times over the next month to have his abscess wound dressed. As observed by Dr Amanda Stafford of the RPH Homeless Team, “It has taken 6 weeks of dressings by Street Health and the wound has now completely healed”. Having his wound re-dressed by Street Health cost substantially less, with an average consult with the Street Health team costing $37 (compared with the cost of $765 for an ED presentation). Hence, nine visits with the Street Health nurse for his dressing changes totalled only $333, compared with a cost of $6,885 to the health system if he had presented at ED on these nine occasions.
Impact.
During the first 18 months of operation, Street Health was able to engage the majority of the street present population in the Perth CBD. The high levels of acceptance within the group facilitates engagement with the more reclusive individuals. In the 12 months 2015-2016, Street Health has carried out 929 consultations in 427 rough sleeping individuals. During the 2017/2018 period, 18% of Street Health patients decreased their number of hospital days and 62% showed no change in their number of hospital days, indicating that they did not become sicker and spend more of their time in hospital, despite the health risks associated with sleeping rough.
The presence of an Assertive Outreach worker on Street Health rounds brings expertise in community services for rehousing and support to public places to start the process of engaging rough sleepers in coming off the street and into accommodation to address the social determinants of health. The coupling of health and community services means that Street Health is able to make a real impact on the lives of rough sleepers, recognising that both issues need to be addressed simultaneously. Thanks to Street Health, many homeless people who are street present are now regularly attending general practice and are being rehoused and supported by programs such as Street to Home and the 50 Lives 50 Homes collaboration.
