The Trauma and Homelessness Initiative was a collaborative project of four agencies that provide homelessness and mental health services in the community: Sacred Heart Mission, MIND Australia, Inner South Community Health and VincentCare Victoria.
The aim of the project was to achieve better outcomes for people who are long-term homeless and have experienced trauma.
The agencies commissioned the Australian Centre for Posttraumatic Mental Health (ACPMH), the University of Melbourne, to look at the nature between the relationships of traumatic events in people's lives and their state of homelessness.
What the Initiative was investigating
The key focus of the Trauma and Homelessness initiative was on people at risk of experiencing or currently experiencing long-term homelessness. These are people who cycle in and out of homelessness, or who constantly live with the threat of homelessness, often moving between the street, institutions and poor quality temporary housing.
People’s experiences of trauma in this study involved both Type I – these are traumatic events that occur as single events (such as motor vehicle accidents or natural disasters) and Type II - those events that are interpersonal, enduring and prolonged (e.g. child abuse).
The study was completed at four sites where services are provided by the four partnering agencies.
The Key Research Questions
The ACPMH developed a rigorous research methodology that involved a mixed methods approach i.e. both qualitative and quantitative research methods were used.
The research aimed to address the following key questions:
- What is the link between trauma and homelessness?
- What are the types of traumatic events experienced by people who have also experienced homelessness? What is the frequency that traumatic events were experienced? What is the prevalence of Type 1 and Type 11 Trauma? At what age did the traumatic event first occur?
- Does the experience of trauma contribute to homelessness, measured by the length of time that a person has experienced homelessness?
- What are the accompanying mental health issues people experiencing or art risk of homelessness present? What are the main presenting mental health issues such as PTSD, depression, substance use disorders?
- What are the levels of social support and community connectedness experienced by people who experience homelessness?
- What are the barriers to seeking help for issues related to trauma and mental health?
The first three phases of the research investigation included an extensive literature review and two qualitative studies with staff and clients of the four consortium agencies. The fourth and main phase involved rigorous quantitative methodology that included the random selection of participants and the use of well established and validated research scales to undertake the in-depth survey interviews with clients.
A total of 115 people were interviewed, making this research one of the largest Australian studies that has examined the relationships between trauma and homelessness.
Research Findings: Levels of Traumatic Experiences
The key findings from the research regarding the traumatic experiences of the participants confirmed:
- An extremely high level of reported exposure to traumatic events, with all 115 participants reporting at least one traumatic event in their lifetime. Type I trauma (single incident) trauma, was experienced by 98 per cent of participants.
- High levels of exposure to interpersonal violence (including sexual and physical assault) as well as natural disasters and life threatening accidents. Type II trauma (prolonged and repeated traumatic events) was directly experienced by 60 per cent of the participants
- Most participants were exposed to multiple traumatic events with over 97 per cent having experienced more than four traumatic events in their lifetime. This compares with a 4 per cent rate in the general community.
- 70 per cent of participants experienced at least one traumatic event before experiencing homelessness. The majority were exposed to trauma during their childhood.
- Trauma was often identified as a precipitant to becoming homeless, trauma exposure occurred after becoming homeless.
Mental health issues
A structured clinical interview process was used to identify the current and lifetime mental health issues of the participants.
The findings confirmed significant factors with implications for service delivery and structures:
- 88 per cent of the participants met criteria for a current mental mental health disorder, including : Posttraumatic Stress Disorder (73%), current depression (54%), alcohol abuse disorder (49%), alcohol dependence disorder (43%), substance abuse disorder(51%), substance dependence disorder(44%) and current psychotic disorder ( 33%). The overall prevalence of alcohol or substance abuse or dependence disorders was 69%.
- Participants reported high levels of symptoms associated with exposure to repeated and prolonged traumatic events such as emotional regulation difficulties, difficulty maintaining social relationships, risk taking and putting themselves in danger, suicidal ideation and having 'disassociative' experiences.
One significant assumption from this is the importance of an integrated service delivery model, incorporating mental health service interventions with housing support.
A further key assumption is that with this deepened understanding of the impact traumatic events have on people’s behaviours and overall life skills, such as the ability to maintain relationships, we can envision a service system that is more aware and cognizant of the real needs of people experiencing homelessness.
Social Support and Getting Help
The investigation established that participants experienced:
- High levels of social difficulties and social exclusion
- Low levels of social support and social connectedness.
- High levels of difficulties maintaining social relationships.
The research also identified social disadvantage as a fundamental component of the relationship between trauma and homelessness.
Of importance in the findings was that many participants had sought and received beneficial help for dealing with their experiences, but half also reported a time when they did not get professional help that they wanted for a mental health problem. Interestingly, one major reason was that people advised that they did not know how to get the help they needed at the time they wanted it. This is ‘low hanging’ fruit for services – ensuring clear and accessible information is available for our clients
Overall Key Findings of the Trauma Research Initiative
The key findings from the THI study show:
- Trauma drives homelessness: Traumatic events often occur as a precursor to becoming homeless. The research showed that, many people left home to avoid ongoing trauma in the form of assault, child abuse and other forms of interpersonal violence.
- Homelessness drives trauma exposure: being homeless is a risk for experiencing further trauma. In the study, the frequency of trauma exposure escalated when people lost their housing.
- Trauma drives social difficulties: it impacts on an individual’s sense of safety and connection with other people, especially when caused by a primary care giver.
- Trauma drives mental health problems: exposure to traumatic events in both childhood and adulthood are associated with mental health problems. The research showed that not only was the prevalence of mental health disorders high, but other mental health experiences were reported.
The research explained the cyclical interrelationship that exists between trauma exposure, long-term homelessness, mental health difficulties and social disadvantage.
Based on their research, ACPMH has produced a framework for trauma-informed practice together with a worker guidebook.
Please see the Publications section of our site to view the reports
Intellectual Property Rights
All intellectual property (including copyright) is owned or licensed by the controlling parties (Sacred Heart Mission, Inner South Community Health Services, MIND Australia, VincentCare Victoria and the Australian Centre for Post Traumatic Mental Health). The controlling parties grant the person or organisation (the user) who downloads or accesses the documents the non-exclusive right to use the material for staff development and practice improvement in a service delivery setting as well as education and training. The user acknowledges that all rights and title in the intellectual property in the materials (including copyright) vest absolutely in the controlling parties. On-selling, renting, sub-licensing or any commercial use of the material in whole or partial form, through any form of media is strictly prohibited without the written consent of the controlling parties.