Street Health

 

Street Health.

Street Health is a service targeting the homeless people of Perth who are street present and not engaged with any social or medical services in our community. They are found in the parks, public gardens, doorways and pavements of the CBD, and are among the most disenfranchised and marginalised people in our society. Street present homeless have the worst health outcomes in our state with an average life expectancy of only 45 years.

Why?

 

The data is sobering. Street present homeless people live on the streets for an average of 5 years, and the length of homelessness is a key predictor of poor health outcomes. Approximately 40% identify as Aboriginal/TSI, well above the population average of 3.1% in WA.

The health of street present people is poor: 64% have a serious medical condition, 82% have a substance abuse issue and 78% have at least one mental health or cognitive issue while 47% have all three (medical, substance abuse, mental health/cognitive). 

Despite the high levels of morbidity, only around 25% access GP care. More often they wait until late in the course of their illness and present to emergency departments and require prolonged periods of hospitalisation.

The street present population is notoriously difficult to engage because of their high levels of traumatic life experience and previous negative experiences with health services which are not adapted or understanding of their specific needs.

 Opportunities to intervene early in the course of illness or injury are lost and by the time they reach hospital care, their conditions are serious and require extensive and expensive treatments. 

As observed at RPH, the street homeless cohort often accesses these services via the Emergency Department in a pattern of repeated crisis presentations with no continuity of care or early intervention.

How.

 

Since 2016, Homeless Healthcare (HHC) has provided a Street Health outreach service in the Perth CBD, consisting of a nurse from Homeless Healthcare working alongside case workers from local homelessness services.

In 2018, after the closure of the Fremantle Emergency Department, we also commenced a Street Health service in Fremantle.

The Perth Team work in collaboration with UnitingWA Street to Home key workers and liaise with City of Perth rangers and WAPOL. The Fremantle team is made up of Homeless Healthcare nurses and caseworkers and has a strong connection with the City of Fremantle rangers and WAPOL.

The Street Health service has relied solely on philanthropic funding until recently, and in order to start the Fremantle service, we reduced the number of days we were operating in the Perth CBD from 5 to three.

In April 2020, additional funding was provided by the WA Department of Health, enabling this service to be expanded to include a General Practitioner (GP) and to operate 8 hours a day, 4 days a week in Perth and 3 days a week in Fremantle.

Unfortunately this additional funding has ceased and the Perth team currently operate three days a week.

In 2021 we were the recipients of a $100,000 grant from Impact100 Fremantle which has enabled us to expand the Fremantle service again to three days a week.

42% of street present homeless identified as Aboriginal or Torres Strait Islander, well above the population average of 3.1% in WA.

Where.

 

The street team goes out on foot to see people on the streets and footpaths of inner-city Perth and Fremantle. This includes laneways, malls, and shop doorways.

The team also identifies “hot spots” in and around the central business districts and visits people in parks, camped out in tents or squatting on vacant properties.

The street present population is notoriously difficult to engage because of their high levels of traumatic life experience and previous negative experiences with health service.

What.

 

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

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.