Abstract
Homelessness among adults receiving care in Australian public mental health services is common and clinically important. This study characterised homelessness across community and hospital settings among all publicly case managed adults in the Gold Coast region (Queensland, Australia) between January 2021 and December 2022, distinguishing primary homelessness (rough sleeping/public space), secondary homelessness (temporary or informal arrangements), and a hospital specific category, referred homelessness (loss of stable housing during admission).
This retrospective longitudinal observational study linked 15,135 routinely collected service contacts for 2047 adults across community care, acute inpatient care, and extended treatment settings. Homelessness type was analysed separately at key service timepoints (community, admission, discharge) using multinomial generalised structural equation models with an individual-level random effect to account for repeated observations. Models produced adjusted, setting specific estimates for demographic, diagnostic, functional, and life-skills covariates.
Overall, 33.22% of individuals experienced homelessness during the study period. Among those admitted to hospital, 41.75% had at least one admission while homeless, and 61.11% of those with a homeless admission also experienced a discharge to homelessness. In community care, homelessness was associated with substance use, violence related indicators, functional deficits, interpersonal difficulties, and self-care limitations. In hospital settings, homelessness at admission was strongly associated with homelessness at discharge, and discharge homelessness was associated with aggression, substance use, and occupational/activity impairment.
These findings provide a whole of service adjusted description of homelessness across community and inpatient mental health care in a high-risk case managed cohort. Across settings, homelessness aligned more consistently with behavioural, functional, and system factors than with diagnosis alone, supporting service responses that integrate housing, substance use, functional support, and discharge planning.
