Homelessness is a driver of poor health in Australia – so why not make housing part of healthcare?
The data is now overwhelming: a recent rental affordability index labelled every capital city in Australia 'critically unaffordable' for anyone on the minimum wage in 2024. One million low-income households already spend more than 30% of their earnings on shelter.
Housing stress is a potent driver of mental ill-health in Australia. Making housing part of healthcare sounds radical, but international evidence and pilot programs show it could improve health outcomes and almost pay for itself in lower hospital bills within a few years.
Other countries have run the experiment already. Finland's Housing First strategy gives people experiencing chronic homelessness a permanent apartment and wrap-around access to support, which has been successful in cutting rough sleeping for a decade.
Sign up for a weekly email featuring our best reads
Closer to home, New South Wales's Together Home program has housed more than 1,000 former rough sleepers. An evaluation last year found the use of emergency rooms by respondents decreased after being housed. It reported that the number of hospital admissions for respondents fell, while primary care visits rose. This is consistent with findings from previous studies and suggests that people had the stability to see a GP instead of waiting for a crisis.
These results echo a landmark trial in Canada, which saved the public purse for every dollar spent – and even more when high-need participants were counted.
We may spend $1,500 a night keeping someone in an emergency ward, but balk at $70 a night to keep them in a studio flat with a visiting support worker.
Here's a bold proposal: make secure housing a Medicare item.
Our health and housing systems sit in separate silos. The federal government funds Medicare, and states shoulder much of the social housing bill. A hospital can claim activity-based funding for a mental health admission, but not for preventing that admission with a rent subsidy.
Give GPs the option to refer eligible patients. Think of people cycling through the ED with anxiety or substance-use crises to a Housing First-type lease funded for two years, with tenancy support paid under Medicare.
Sign up to Five Great Reads
Each week our editors select five of the most interesting, entertaining and thoughtful reads published by Guardian Australia and our international colleagues. Sign up to receive it in your inbox every Saturday morning
after newsletter promotion
The National Housing and Homelessness Plan consultation report is on the minister's desk, so why not add a KPI: a 30% reduction in mental health hospitalisations linked to housing insecurity within five years? Report it in budget papers, line by line, just as we do with elective surgery wait times. When hospital admissions drop, the Treasury should return a slice of those avoided costs to the housing portfolio. Canada's model found that every dollar invested saved money in health and justice spending for people with complex needs.
Finland's Housing First units average about 15,000 Euros (about $26,000) a year each, including support. Roughly 38,000 Australians are stuck in what the Australian Institute of Health and Welfare calls persistent homelessness. Because that number is measured over two years, about 18,000–20,000 people enter chronic homelessness each year. Funding 10,000 Housing First places would cover around half the annual flow, a practical first step. The NSW's Together Home evaluation suggests emergency and inpatient savings alone could help foot the bill; factor in reduced policing, courts and ambulance use, and the program could get closer to net-positive within a parliamentary term.
Australia's Medicare levy exists because we once agreed no one should skip the doctor for fear of the bill. The same logic should apply to housing.
When a lack of secure shelter risks driving poor health outcomes, leading to increased health costs, refusing to fund evidence-based housing interventions makes little social or economic sense.
If the Albanese government is serious about 'getting bang for taxpayer buck', one answer is a stable address. If it can happen overseas, it's time to happens here.
*Nadia is a fictional amalgam to exemplify the representative demographic
Dr Ehsan Noroozinejad is a senior researcher on smart, affordable and resilient housing at the Urban Transformations Research Centre, Western Sydney University. He is the Global Challenge Lead at WSU on sustainable futures
Hashtags
Try Our AI Features
Explore what Daily8 AI can do for you:
Comments
No comments yet...
Related Articles
BBC News
3 minutes ago
- BBC News
Whitehaven plans for mental health hub at former bank
Plans have been submitted to create a 24/7 mental health hub in a former bank building, as part of an NHS pilot Community Trust Limited has applied for permission to turn the former Halifax branch on King Street, Whitehaven, into the Hope Haven comes after NHS England announced the pilot to expand mental health services in the area and bring different services under one roof."The hub will provide drop-in support, 1:1 consultations, group therapy and sessions focused on physical health, fitness, health promotion and shared learning," planning documents submitted to Cumberland Council said. Various organisations would work from the hub including Cumbria, Northumberland Tyne and Wear NHS Foundation Trust, mental health charities and organisations that can provide housing and employment Halifax branch shut in 2024 and although the building is not listed it sits within the Whitehaven town centre conservation documents said minimal alterations would be made to the outside of the building and any work would respect its "architectural character and historic value"."The proposed use seeks to revitalise the building, currently vacant and in a state of decline," they added. Follow BBC Cumbria on X, Facebook, Nextdoor and Instagram.
Daily Mail
3 hours ago
- Daily Mail
Huge '$25 cap' cost of living change to help millions of Aussies pay for an everyday staple
Australians will pay no more than $25 for selected medicines for the first time in more than 20 years under a proposal to be brought before parliament. It will be the second cap on medicines on the Pharmaceutical Benefits Scheme (PBS) introduced by the Albanese government in three years, after it cut the maximum price of PBS prescriptions from $42.50 to $30. 'The size of your bank balance shouldn't determine the quality of your health care,' Prime Minister Anthony Albanese said. 'My government will continue to deliver cost-of-living relief for all Australians.' PBS medicines would be capped at $7.70 for pensioners and concession card holders until 2030. The bill's introduction is largely a formality, with its passage through the lower house all but assured thanks to Labor's massive 94-seat majority in the 150-seat House of Representatives. The election promise is the Albanese government's next priority after it introduced childcare safety and HECS debt reduction legislation. Federal Labor has been talking up plans to strengthen the PBS amid concerns the scheme will be targeted as a bargaining chip in US trade negotiations to ward off threatened pharmaceutical tariffs. Albanese has repeatedly said the scheme was not up for negotiation. Australia eased its biosecurity restrictions on US beef imports last week, but the prime minister has denied the move was linked to US trade talks. He noted the decision followed a 10-year review of Australian biosecurity rules. Beyond new legislation, conflict in the Middle East will likely prompt fierce debate on the parliamentary floor after Albanese said Israel had breached international law by blocking the flow of food aid into Gaza. 'Quite clearly, it is a breach of international law to stop food being delivered, which was a decision that Israel made in March,' Albanese told ABC's Insiders on Sunday. He stopped short of saying Australia would join France in recognising a Palestinian state, but said his government would decide at 'an appropriate time'. 'Hamas can have no role in a future state,' he said. 'Hamas are a terrorist organisation who I find, their actions are abhorrent.' Opposition foreign affairs spokeswoman Michaelia Cash said Albanese failed to adequately condemn the role of the group in the ongoing conflict. The government is also likely to come under pressure regarding transparency when parliament resumes, after a Centre for Public Integrity probe revealed only a quarter of freedom of information request responses returned by the government in 2023-24 were un-redacted. By comparison, the Morrison government returned almost half of its FOI requests as complete documents in 2021/22.
Sky News
3 hours ago
- Sky News
'It destroyed my life': The drug addiction leaving users in chronic pain
Nicole will always remember the first time she took ketamine. It was the start of a night out and she didn't want to drink. So instead, she picked up the bag of white powder she found in her friend's car. It was a decision that had life-altering consequences. "I tried it and remember having it and just thinking, this is it," she recalls. "This is my saviour. This is my drug." Instead of rescuing her from her mental health struggles like she hoped it would, ketamine sent her into a spiral. Less than four years on, the 31-year-old mother of one from Southport is now living in a detox centre, separated from her son and living in chronic pain. 9:33 Nicole's journey from recreational use to a deep addiction that caused her severe bladder and kidney problems may be just one extreme case, but ketamine use is now at record levels. Experts believe this could cause a tidal wave of issues the country is not prepared for, placing severe pressure on the NHS, as well as addiction and mental health services. Currently a Class B drug, ketamine is used in clinical settings as an anaesthetic for people and animals. It is usually taken recreationally as a crushed powder, but also sometimes injected or swallowed - making people feel detached and dreamlike. Referred to as "ket" and "special k", it's easily available and costs around £30 a gram. Between 2023 and 2024, the number of children and young people who reported having a problem with the drug surpassed cocaine for the first time. The number of ketamine deaths in England and Wales also increased from seven in 2015 to 53 in 2023. 'I don't remember the last three years' I met Nicole at Birchwood, a residential drug and alcohol detox facility on the Wirral. In the week before I arrived, 14 out of 25 beds were taken by ketamine users. As we walk through the corridors, Birchwood manager Jo Moore tells me that in more than two decades of working in healthcare, she's never dealt with a challenge as big as the wave of people she's seeing addicted to ketamine, arriving with extreme and complex health issues. "They're all presenting with urinary incontinence, some can't even walk, they've lost their muscle tone, some are in wheelchairs, and the crippling pain they're going through is significant," she says. As well as running Birchwood, Jo speaks about the drug at conferences and holds a weekly video call, offering support for a growing group of parents whose children are addicted. I also met Callum, who describes himself simply as "just a lad from Cheshire ways". While speaking, he often pauses for thought, struck by how quickly his life has taken a turn since his addiction began three years ago. When his dad died following a struggle with alcoholism, Callum, who had been his carer, turned to ketamine. Until then, the 24-year-old had only taken the drug at festivals, but it quickly took over his life. "I was so out of it constantly," he says. "I don't remember the last three years properly because of just, you know, you've taken it the whole time." Daily use nearly cost Callum his life. He had multiple organ issues and weighed just six stone by the time Jo, who knew his family, told his mother that he needed to come to rehab. Callum's experience is a reminder of how hard it can be to break a dependency on ketamine. As an anaesthetic, it creates a vicious cycle. Users need it to help ease the pain it causes them. "It's only once you get off the ketamine you realise the pain that you've got and the problems that you've got," Callum tells me. "When you're on it, you know you've sort of got pains, but you don't think they're that bad. "People I know drank for 30, 40 years and my liver is worse than theirs, just from ketamine alone." 'Ketamine destroyed my life' Nicole also turned to ketamine because it felt like a way out. She'd had a difficult childhood, been in an abusive relationship as an adult and struggled with mental health issues her whole life. In a moment of blunt honesty, she tells me she does not regret taking ketamine. "If I didn't take ketamine in that period of time, I wouldn't be here," she says. "It was a coping mechanism for a while, before it destroyed my life." As her bladder and kidneys deteriorated, Nicole was taken to hospital several times, often treated by medics who could not understand the problems caused by heavy ketamine use. On one occasion, she was sent home with chlamydia tablets. On another, she had an invasive kidney procedure with no anaesthetic, because doctors were concerned about giving her pain relief due to her ketamine use. Becoming more animated, Nicole tells me: "To be in that situation where you need help, you don't know what's going on yourself, the only place you can go to is the hospital and not even they know what is going on with you. That is like a complete state of isolation, loneliness." Nicole now starts her days in severe agony. She says the chronic pain will last the rest of her life, and pauses at one point in conversation to tell me her bladder is spasming as we speak. Despite how difficult the last few years have been for them, Nicole and Callum both have hopes for their lives beyond Birchwood. In the months after I met him, Callum successfully completed his detox and rehab. He has also made good on a promise to "get his life back on track" by finding a full-time job. Things have been more difficult for Nicole, who is still in Birchwood and has been in and out of hospital for a range of bladder and kidney complications. She is still waiting to find out whether her bladder will be removed. Nicole has made it her mission to raise awareness, posting regularly on TikTok about her appointments and her day-to-day life. Her ultimate hope is to one day join Jo in delivering talks across the country about the drug and its dangers. Life-changing injuries within a year Away from Birchwood, the struggles of people like Callum and Nicole are also being felt in the NHS. Alison Downey is a consultant urologist at Pinderfields Hospital in West Yorkshire, where "ketamine bladder" has become an increasingly common phrase to describe the severe damage the drug can do. "We've seen an explosion in numbers over the past, particularly two to three years," she says. "Maybe about four or five years ago we would have one or two cases a month, we're now seeing eight or nine a month." Ms Downey says while urologists are continuing to learn about the drug's impact, there is one certainty: ketamine causes complex challenges for medics. "There's no other drug that does this amount of damage this quickly to your kidneys and your bladder," she says. "We obviously see patients who have drug addiction problems from heroin and cocaine in A&E or on the wards, but ketamine has this very specific, quick damage to the kidneys and bladder specifically that we just don't see in any other drug use." With balloons and a jug, Miss Downey explains the impact the drug can have on someone's bladder, reducing its capacity. "We know that the average (bladder) capacity of a person that's been using ketamine for a long amount of time is about 100ml, which is about the size of this balloon," she says. "If you compare that to a normal adult bladder, which holds about 500ml, so five of these balloons, you can see that the capacity is severely reduced. That can result in needing to go to the toilet every 15 to 20 minutes throughout the day or night." Framing the issues being seen on the frontline are the ongoing discussions around reclassification. Earlier this year, the government announced it would look into the possibility of making ketamine a Class A drug, which would carry greater penalties for making and selling it. Dr Caroline Copeland is a senior lecturer in pharmacology and toxicology at King's College London and also the director of the National Programme on Substance Use Mortality. For her, this debate is nuanced and needs to go beyond criminalisation. "I think that instead of necessarily focusing on the punitive measures, which is what comes with the reclassification, we need to be thinking more about how we can actually spend that time and money towards helping the people who are using ketamine and education programmes to stop people starting to use ketamine in the first place," she said. Dr Copeland also thinks reclassification needs to be a process that takes into account the wider context, because this is a drug that is commonplace and being used casually by many, without significant health consequences. She added: "Since ketamine was last reclassified from C to B, the landscape of its use has changed somewhat. "There's much more recreational use in a younger demographic. So we need to do a comprehensive assessment of its harms to determine whether it warrants escalating to being a Class A substance." However, for those whose lives have been changed by casual use spiralling into addiction, solutions are needed urgently. I can still remember Jo Moore's words as she walked me out of Birchwood on my first day of filming this story. She sees this as an issue that needs tackling, with a national framework to bring systems together. "We're really trying to fight, because we see the damage," she says. "I've looked after heroin addicts and after 20 years of them using heroin, they don't have anything related to the harm that we've got now for the ketamine users, only after a very short time. "And I think that's what's been so shocking about seeing these ketamine users come through. They can use ketamine for 10 months, two years, and have life-changing injuries. "That's why we're fighting for this. I think that we have all been very slow to react as a nation to these health concerns." Anyone feeling emotionally distressed or suicidal can call Samaritans for help on 116 123 or email jo@ in the UK. In the US, call the Samaritans branch in your area or 1 (800) 273-TALK.
