The cycle between homelessness and healthcare barriers in Australia

Homelessness touches every aspect of life, including physical and mental health. And when these issues intersect, the harmful cycle can be tough to break.

For those without access to secure housing and support systems, staying healthy and managing existing conditions can become a serious challenge – which is why experiencing or facing homelessness brings a higher risk of poor health.

In turn, it may be harder to maintain employment, housing, and personal relationships, which are critical to breaking free from homelessness. At the same time, a lack of stability often exacerbates health problems, creating a downward spiral.

Here, we’ll explore the relationship between homelessness and healthcare, the obstacles people face in accessing medical support, and how a home can help. Keep reading to learn about this critical connection and what can be done to make a difference.

Consequences of homelessness on health

Living without a stable home takes a serious toll on both physical and mental health. Homelessness often exposes individuals to conditions that can trigger or worsen long-term health issues, creating challenges that are not only difficult to navigate but also challenging to treat effectively.

Mental health

Homelessness doesn’t just deprive people of shelter—it can profoundly impact their mental wellbeing. The relentless stress and trauma of not having a stable place to call home often manifest in anxiety, depression, and post-traumatic stress disorder (PTSD). Add to this the sting of societal stigma and discrimination, and the burden becomes even heavier.

For many, access to mental health care is out of reach, leaving conditions to worsen unchecked. This can spiral into devastating outcomes like substance use, social withdrawal, or even thoughts of self-harm.

Substance abuse often becomes a way to numb the pain, offering fleeting relief from the emotional strain of homelessness. But this temporary escape can lead to severe consequences—damaging physical health, deepening mental struggles, and creating an even harder road to recovery. 

Breaking this cycle requires more than compassion—it demands action, understanding, and accessible support systems.

Physical health

The harsh reality is that people experiencing homelessness are significantly more likely to suffer from chronic illnesses and premature death than the general population.

In Australia, severe overcrowding is the most common form of homelessness3, bringing its own set of health risks. Overcrowded spaces strain basic amenities like kitchens, bathrooms, and sewerage systems, creating a perfect storm for the rapid spread of diseases.

Without access to basic hygiene facilities like clean water, soap, and secure shelter, the risk of infectious diseases such as tuberculosis, hepatitis B and C, and HIV is heightened. Close quarters and unsanitary spaces further increase vulnerability to these infections, making prevention nearly impossible.

But the challenges don’t stop at infections. Chronic illnesses like heart disease, diabetes, and hypertension are more prevalent among people experiencing homelessness, driven by factors like malnutrition, stress, and limited physical activity. Without access to consistent medical care or nutritious food, managing these conditions becomes an uphill battle.

For those sleeping rough, daily survival—finding food, water, and a safe place to rest—becomes the top priority, leaving health concerns unaddressed until they escalate into emergencies. 

This reactive approach to healthcare is costly not just to an individual’s health, but to society as a whole. A 13-year study in Sydney revealed that hospital treatment for 2,140 homeless adults totalled over AU$548 million, with each person incurring a median cost of AU$81,481. Alarmingly, one in five individuals was readmitted within a month.

Meanwhile, the impact on life expectancy is stark: Australian studies suggest that people experiencing homelessness die, on average, 22 to 33 years earlier than people with stable homes. 

Much of this mortality gap stems from conditions that could be effectively treated with timely and appropriate healthcare. 

Barriers to healthcare when experiencing homelessness

Access to healthcare is a critical need for many people experiencing homelessness, yet significant obstacles stand in the way.

Physical barriers are among the most common challenges. Many individuals struggle to afford transport to appointments, lack a phone or mailing address for reminders, don’t have proof of identification like Medicare cards, and face difficulties securing their medications. For those in transient situations—whether rough sleeping, couch surfing, or staying in short-term accommodation—navigating a complex healthcare system is simply not an option. 

Statistics reveal the scale of this problem. In 2014, 13% of people who had experienced homelessness in the past decade reported encountering barriers to accessing healthcare, compared to just 4.4% of those who had not. Among those unable to access care, 40% cited cost as the primary issue, with long wait times and appointment shortages also being major hurdles.

Personal health challenges only compound these issues. Conditions like mental illness can make attending appointments or following treatment plans more difficult. As mentioned above, the stigma surrounding mental health care, along with feelings of judgment or stereotyping, can discourage individuals from seeking help altogether.

The good news? 

Some research highlights opportunities for intervention. 

A Scottish study revealed a rise in interactions with health services leading up to homelessness, particularly for mental health and substance use support, peaking around the time of first being assessed as homeless10. This underscores the potential for healthcare systems to identify at-risk individuals and provide early intervention to prevent homelessness.

That said, meeting the healthcare needs of people experiencing homelessness requires a tailored and holistic approach. Personalised treatment plans, access to essential medical care, secure housing, and robust social support are all vital in boosting health outcomes.

Sadly, these critical services are often underfunded and stretched beyond capacity, leaving many vulnerable individuals without the care they desperately need. 

Addressing these gaps demands greater societal commitment, funding, and compassion to ensure no one is left behind.

Healthcare services for people experiencing homelessness

When it comes to healthcare for people experiencing homelessness, meeting them where they are—literally and figuratively—can make all the difference. Tailored solutions are key to overcoming the barriers that prevent access to essential care.

For example, mobile outreach services are one lifeline, bringing critical healthcare directly to those sleeping rough. From immunisations and podiatry to wound care, infection treatment, and diagnostic services, these programs ensure that care reaches those who need it most, right where they are.

Meanwhile, drop-in centres and fixed-site clinics act as safe havens, providing much more than medical assistance. Here, individuals can access showers, warm meals, winter clothing, and even emergency supplies like thermally insulated swags. These services offer a moment of respite, a sense of humanity, and tangible support in an otherwise challenging existence.

Wondering how to help or where to turn for support?

Below, we’ve compiled a list of healthcare services dedicated to supporting people experiencing homelessness across New South Wales, Queensland, and Victoria.

 New South Wales

• St. Vincent’s Homeless Health Services
• Street Side Medics
• Health On The Streets

 Queensland

• Homeless Health Outreach
• Health and counselling services

Victoria

• Cohealth
• Alfred Health

How a stable home can help

To truly address the health challenges faced by people experiencing homelessness, we need housing solutions that are integrated with comprehensive support services, including preventive care for physical and mental health conditions.

Continuity of care becomes nearly impossible when someone is sleeping rough or has no fixed address. Basic tasks like filling prescriptions, taking medications consistently, or attending follow-up appointments become monumental challenges. A stable home provides the stability needed to prioritise and maintain healthcare.

Globally, research shows that secure housing following a period of homelessness delivers tangible health benefits:

• Fewer hospital admissions
• Less spread of infectious diseases
• Improved mental health outcomes
• Better overall wellbeing11.

A safe, permanent place to call home doesn’t just change lives—it saves them. Housing combined with accessible support services is the key to breaking the cycle of homelessness and giving each person the opportunity to thrive.

References

1. Fitzpatrick S, Bramley G and Johnsen S (2013) ‘Pathways into Multiple Exclusion Homelessness in Seven UK Cities’, Urban Studies, 50(1), 148-168, https://doi.org/10.1177/0042098012452329 
2. Morrison D S (2009) ‘Homelessness as an independent risk factor for mortality: results from a retrospective cohort study- external site opens in new window’, International Journal of Epidemiology, 38(3): 877–883, https://doi.org/10.1093/ije/dyp160. 
3. ABS (2023) Estimating Homelessness: Census
4. Buckle C, Gurran N, Phibbs P, Harris P, Lea T and Shrivastava R (2020) Marginal housing during COVID-19, AHURI. 
5. Huang C, Foster H, Paudyal V, Ward M and Lowrie R (2022). ‘A systematic review of the nutritional status of adults experiencing homelessness’ Public Health, 208: 59-67, https://doi.org/10.1016/j.puhe.2022.04.013 
6. Wise C and Phillips K (2013) ‘Hearing the silent voices: narratives of health care and homelessness’, Issues in Mental Health Nursing, 34(5):359–67, https://doi.org/10.3109/01612840.2012.757402 
7. Knaus C (2024) ‘Homeless Australians are dying at age 44 on average in hidden crisis’, The Guardian, accessed 20 January 2025.
8. Aldridge RW, Menezes D, Lewer D, Comes M, Evans H, Blackburn RM et al. (2019) ‘Causes of death among homeless people: a population-based cross-sectional study of linked hospitalisation and mortality data in England’ Wellcome Open Research 4:49, https://doi.org/10.12688/wellcomeopenres.15151.1 
9. ABS (Australian Bureau of Statistics) (2015) General Social Survey: summary results, Australia, 2014. ABS website, accessed 8 January 2025.
10. Waugh A, Clarke A, Knowles J and Rowley D 2018. Health and homelessness in Scotland Edinburgh: The Scottish Government.

Carnemolla P and Skinner V (2021) ‘Outcomes Associated with Providing Secure, Stable, and Permanent Housing for People Who Have Been Homeless: An International Scoping Review’, Journal of Planning Literature, 36(4): 508-525, https://doi.org/10.1177/08854122211012911