The Role of Occupational Therapy in Working with the Homeless Population: An Assertive Outreach Approach

Article excerpt

The problem of homelessness has received increasing attention in recent years. The Queensland Health Homeless Initiative Plan 2006-2009 was set up to target those who are at risk of homelessness in addition to those who meet the adopted definition of homelessness (Queensland Health, 2007). There are three categories of homelessness. This includes people without conventional accommodation who are considered primary homeless since they may be living rough on the streets, sleeping in parks, squatting in derelict buildings, or using cars for temporary shelter. The secondary homeless are those who frequently move from one form of temporary shelter to another. For example, emergency accommodation such as, hostels for the homeless or night shelters, teenagers staying in youth refuges, women and children escaping from domestic violence by staying in women's refuges, people residing temporarily with other families because they have no accommodation of their own, and those using boarding houses on an occasional or intermittent basis. Finally, tertiary homeless are people who live in boarding houses on a medium to long-term basis (Chamberlain & MacKenzie, 1992). It was envisaged that the implementation of this plan would improve the health outcomes for people subject to homelessness by responding effectively and consistently to their identified health needs.

According to the Commonwealth of Australia (2008), every night around 105,000 people are homeless. The rate of rough sleepers per 100,000 people is highest in the Northern Territory (75 per 10,000), followed by Queensland (13 per 10,000), and Western Australia (12 per 10,000). On census night, the Australian Bureau of Statistics provides a snapshot of people who are experiencing homelessness by randomly counting rough sleepers and people in specialist homeless services. Of those, 56% were men and 44% were women. Interestingly, the difference increased to 60% men for people over the age of 35 years. More men sleep rough and live in boarding houses than women, and furthermore, family homelessness, that is women with dependent children, increased by 33% in the last five years (Commonwealth of Australia, 2008).

New Zealand lacks consistent data on the demographic profile of its homeless population making it difficult to identify the housing needs of the homeless and potentially homeless (Richards, 2009).

However, it is likely the demographic profile conforms to other western countries. According to Richards (2009), New Zealand is in a position to address the basic need for shelter of its people, regardless of age, gender, ethnic origin, religion or sexuality. At present, there is no single Government department that has a statutory responsibility for the homeless or for coordinating services. It has been found that homelessness has a low profile as a political issue (Richards, 2004).

There are many causes of homelessness. People who are at risk of homelessness tend to face many difficulties, for example, domestic and family violence, mental health problems, drug and alcohol addiction, and poverty. When faced with social pressure such as job loss, eviction, poor health, or relationship breakdown, people without support, skills, or personal resilience, or who have limited capacity due to their age or disability, may become homeless. With limited resources, it is likely these vulnerable people will remain homeless for a long period of time (Commonwealth of Australia, 2008).

Homelessness has a direct impact on health. Homeless people, particularly rough sleepers, have a higher rate of serious morbidity compared to the general population. They tend to experience a range of health problems including, infections, inflammatory skin conditions, skin infestations, respiratory illness, physical trauma, adverse effects of illicit drugs, and/or mental health issues (Wright & Tomkins, 2006). They are also responsible for a disproportionate use of judicial, social and health care resources. …