Homelessness amongst Aboriginal and Torres Strait Islander peoples

Homelessness amongst Aboriginal and Torres Strait Islander peoples with complex disablement. Roberts I , Townsend C. , White P. , Cullen J. , Pevitt S. , Mc Comb K . 1 2, 3, 4 5 2, 3 1 1 Anglicare National Conference Stronger Together: Our Mission in the Marketplace 17 -20 September 2017 Sydney (1) Anglicare North Queensland Ltd; (2) Synapse; (3) Griffith University; (4) James Cook University; (5) Queensland Department of Communities, Child Safety and Disability Services, Specialist Disability Services Assessment and Outreach Team

NEUROCOGNITIVE DISABILITY (NCD) Any type of brain damage or neurological disruption occurring (after birth) causing partial or functional disability or psychosocial maladjustment. • Accidents • Stroke • Lack of oxygen • Trauma • Vascular disease • Alzheimer's disease • Infection • FASD • Korsakoff's psychosis Impairments may be temporary or permanent.

CAIRNS COMMUNITY CONSULTATIONS 2014 • High rates of suspected NCD and co-morbidity, including mental illness • Services identified a lack in the capacity to assess NCD’s • Expressed need for culturally appropriate assessment and service provision • Homelessness and camp dwelling = housing and/or policing issue 3

THE GUDDI PROJECT 13 month study, commenced Nov 2014 Partners: Anglicare; Queensland Department of Communities, Child Safety and Disability Services; UQ; JCU; Synapse Investigate the extent and experience of NCD and complex disablement amongst Aboriginal and Torres Strait Islander peoples. To develop a culturally safe methodology and assessment tool that: • Enables identification of NCD and co-morbid conditions • Facilitates inclusion in the NDIS • Establishes an evidence base to inform NDIS policy and practice

THE GUDDI PROJECT Participants: Homeless people who use the Quigley Street Night Shelter, Anglicare Cairns. 1. Point prevalence study 2. Culturally appropriate assessments: Neurocognitive Medical Functional 3. Qualitative interviews Yarning 4. Community consultation 5

THE GUDDI PROTOCOL 1. 2. 3. 4. 5. 6. 7. Here and Now Aboriginal Assessment (HANAA) Kimberley Indigenous Cognitive Assessment Scale (KICA) WHODAS - 36/12 Drugs and Alcohol - CARE Depression - KICA Psychosis - First National MH Survey Post-traumatic stress

METHODOLOGY YARNING Past Present Future 7

THE GUDDI PREVALENCE STUDY 30 Sept 2015 Recruited Clinical Assessment Qualitative data collection Total 80 Female Male 60 28 Indigenous 15 Indigenous 40 5 Non 12 Non. Indigenous 12 Indigenous 11 Indigenous 5 Non. Indigenous 12 Non. Indigenous 8

RESULTS NCD MENTAL HEALTH SOCIAL HEALTH WHO-DAS Overall level High levels Depression Social Skills deficits of disability Acute Pneumonia High levels of head injury High levels Posttraumatic stress Hypertension High levels Neurocognitive Disability High levels thoughts of self-harm Lack of educational qualifications Ischaemic heart disease TB Poorly controlled Diabetes High use of Emergency Department

BASIC STATISTICS ON ALL GUDDI SITES TOTAL = 162 (EXCLUDING GUDDI PARTICIPANTS UNDER 18) Quigley Street Research context Point prevalence study Guddi Trials No. of participants 60 48. 3% 40 N/A 30% N/A N/A Incidence of head injury Rates of Depression Rates of PTSD Rates of Psychosis Winda Mara Townsville (Happy Valley) Banya Nyargu Health Week 39 46. 2% 8 75% 12 50% 51. 3% 64. 1% 20. 5% 0% 37. 5% 25% 50% 33. 3% 58. 3% Ongoing Health Week data collection

COLLECTIVE INTERGENERATIONAL TRAUMA AND LOSS RESULTS Homeless Aboriginal and Torres Strait Islander People with Complex Disablement in Cairns STRESSFUL EVENTS MAINSTREAM EXCLUSION LOSS Drugs & Alcohol Trauma Sexual abuse Physical abuse Domestic violence Crime Accidents Family Dislocation from land & culture Separation & loss TRANSIENCE, CYCLICAL HOMELESSNESS High levels of complex disability POVERTY High levels of acute & chronic illness and contact with emergency depts LACK OF UNDERSTANDING ABOUT DISABILITY Financial Educational Employment Skills Training The Guddi Homeless Project, Cairns Queensland 2015 - 16. This project has the blessing of Traditional Elders. STRUCTURAL VIOLENCE

IMPLICATIONS FOR HOUSING AND HOMELESS SERVICES LONG TERM HOMELESSNESS Lack of knowledge re living & managing houses & homes PRISON HOME Engagement ; Trust Social Exclusion Disempowerment TRAUMA Childhood /Adulthood DENIED SUICIDALITY Limited education, work experience, exacerbated by imprisonment, D&A COMPLEX DISABLEMENT Memory Choice Control Unstable; S/T; DV; Crime & Alcohol; Escape into homelessness UNEMPLOYMENT DYSFUNCTIONAL VIOLENT RELATIONSHIPS 12

IMPLICATIONS • Recognising the impact of acute and chronic illness combined with NCD and mental illness on capacity to engage with services and systems • Recognising the ‘biological’ impact of NCD on capacity to access services and systems • Recognising the impact of NCD on ability to gain and sustain housing • Recognising the impact of social isolation and its impact on housing tenure

DISCUSSION High levels of complex disability High levels of NCD High levels of MI High levels PTSD High levels of abuse and trauma Chronic and acute illness Lack of understanding of disability and its impact Loss and grief Extreme disadvantage and lack of resources • Poverty of experience • Financial • Educational • Skills • Training Intergenerational lack of agency Cultural difference around homelessness - temp. mobility vs homelessness Structural violence • Affordable supportive housing • Consistent and supportive services • Reliable and sustainable funding • Employment opportunities • Income supports

CULTURALLY APPROPRIATE METHODS • Ensures community understanding • Developed in collaboration with communities • Recognises the importance of both family and community support • Ensures culturally appropriate assessment and interventions • Includes skilled Indigenous workers • Enables flexible models of funding and services • Local problem solving

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