DESN 9201 - Design Innovation Catalyst - Research Report for Workshop Design

Research Report

MENTAL HEALTH AND HOMELESSNESS DESN9201 | GROUP 5 Aditya Srivastava Damien Chung Evey Liu Sabrina Thomas Sreevisakh Varmayil Gopalakrishnan

APRIL 2021

TABLE OF CONTENT Introduction Care Care for the Homeless & Mentally affected

Research Scope

01 01 02

02

Establish the problem

02

Research Goals

03

Research Approach

03

Methods & Process

03

Background research Causes & Triggers of Homelessness Mental Health in the context of homelessness Existing solutions and support systems From Government Efforts at State-Level Non-government Support Recent efforts by The University of Sydney for the Homeless and Mental health Institutional Level Individual, silo-ed contributions

04 04 04 04 05 05 06 07 07 08

Interviews

08

New research areas and insights

09

Demographics Gender Pets Trolley man

09 10 11 `12

Challenge in Seeking for Help

13

Insights & Summary

14

Next steps - way forward

15

References

16

Appendix

20

01

INTRODUCTION The context of the brief introduced us to the concept of care in today’s world and how an interdisciplinary approach can be used to drive meaningful innovation in healthcare systems throughout the world. The DESN9201 cohort for Semester 1, 2021, was divided into 5 groups of between 3 - 6 members. Collectively, we were given a design brief, “Care Beyond Boundaries.” for a Design Innovation Catalyst project. Each group interpreted the brief in their own ways to initiate the DIC project. The first part of the project was to conduct background research to understand:

"What is the context to the challenge we will be addressing?"

"What are the stakeholders' perceptions of the situation?"

The findings from the research addresses the questions to inform and guide our thinking for the design intervention plan

Mental Health and Homelessness".

and facilitation. Our group's interpretation of the brief led to an investigation of "

The following report documents the research process, findings and the group's deepened understandings of the issue.

CARE Care is around us in various aspects such as healthcare, financial care, preservation care and protection, yet there is no absolute definition for ‘care’. In this report, we will explore care in the mental healthcare aspect specifically for the homeless.

Mental health care is as important as physical health care but easily forgotten, it is one of the main elements of a person’s general well-being that includes all demographics. General practice plays an important part in providing care access within the entire healthcare system, but people with severe mental illnesses are facing difficulties in obtaining mental health care services.

The Care system has changed severely throughout the

years,

pandemic.

especially The

during

outbreak

of

the the

COVID-19 coronavirus

brought mental health issues into the centre of our attention yet the mandatory social distancing force changed mental health care delivery from in-person care practice into online care practice.

It

is

critical

to

understand

the

current

mental

health care system and its impact on our society.

02

CARE FOR THE HOMELESS & MENTALLY AFFECTED Homelessness can be defined as the lack of shelter for an individual or a group but it doesn’t always mean living on the streets. There are many different ways of being homeless, for example staying with friends or family because you don’t have your own space, staying at a hotel or a hostel, living at risk of violence or living in poor conditions.

Soon after research into homelessness begins, another major healthcare issue arises- Mental Health among them.

According to a report by the Specialist Homelessness Services (SHS), 1 in 3 Australians experience mental health issues above the age of 10. Each year, from 2011 the cases have been consistently rising and clients with mental health issues have been identified as one of the fastest-growing sub-groups within the SHS collection. The top reason for mental health issues has been identified as one of the fastest-growing sub-groups within the SHS collection. The top reason for mental health issues listed by the clients surveyed was housing crises or inadequacies followed by domestic violence and financial difficulties.

Therefore, we begin to see a pattern of cause and effect rising, sometimes homelessness leading to mental health and sometimes vice-versa. Homelessness is traumatic in itself and can aggravate mental health issues and there is a multifaceted link between the two. Many contributing factors show that it is a vicious circular cycle of cause and effect, one triggering the other and on and on. By tackling anyone alone, the cycle is difficult to break.

By undertaking this research, we hope to find ways in which we can intervene through the cycles to contribute to caring for them through collaborations.

RESEARCH SCOPE ESTABLISH THE PROBLEM The team was provided with a brief on the requisites of defining the problem space taking care as the focal point while involving various faculties of the University of Sydney to come together and collaborate to devise a solution/ way forward. We supplemented this information with an analysis of Mental Health and Homelessness through desk research to define our research scope and goals.

We conducted preparatory research on defining what care means and understood how homelessness and mental health issues go hand in hand and as a result, is a complex problem with current solutions being siloed.

03

RESEARCH GOALS Our goals were to understand the various aspects leading to mental health problems and homelessness and work out the two issues that are interrelated. Another aspect was to understand the problem space through the lens of two faculties of the University of Sydney (Faculty of Architecture, Design and Planning and Faculty of Medicine), what they've experienced, what their thoughts are and how they define the problem space. *Assumptions were made, please refer to Appendix 1

RESEARCH APPROACH METHODS SECONDARY RESEARCH

MINDMAPS

PRIMARY RESEARCH

THEMATIC ANALYSIS

To map our own ideas

Understand our own

To gain multiple

To understand

of homelessness and

ideas and perceptions

perspectives and

overlapping areas of

mental health issues

and formulate research

perceptions of the

concern

questions

problem

aware of our own

To design suitable

To uncover new areas

points to stage the

assumptions

activities for the

of interest

design intervention

To note and be

Identify possible pain

interviewees

for

PROCESS We began our research process by undertaking our individual background To uncover research new insights into homelessness and overlapping and themes mental health- aiming to develop an understanding of the different facets associated with it: the different definitions of homelessness, leading causes, triggers and support systems in existence.

After

developing

a

surface-level

understanding

and

noting

how

complex

the

issue

is.

Research

questions

were

formulated based on our initial umbrella of care and then narrowed focused on our problem space. nterviews were organised with the design and medical faculties within the University of Sydney to shed light on their perspective of our topic, trying to uncover areas of importance to them.

We conducted an offline activity prior to the interviews

and

were

able

to

speak

with

3

members of the Faculty of Architecture, Design and Planning and 1 member of the Faculty of Medicine. participants

The to

Offline

activity

illustrate

their

asked

first

the

thoughts

when they think about ‘Mental Health for the Homeless’

which

gave

us

an

Interviewee's were asked to create an online canvas of visual mementos

initial

understanding of the participant’s perspective.

Appendix 1

04

Mind maps were drawn through some interviews to understand the ways the faculty introduced new sub-topics and how they interconnected them. As new problem areas emerged, we underwent more desktop research on areas we hadn’t come across before such as ‘The Trolley Man’ and ‘Importance of Pets and Pets as a barrier in seeking help’.

Finally, to make sense of all the different angles and data, we did a thematic analysis in an attempt to lay the path for what comes next.

BACKGROUND RESEARCH CAUSES & TRIGGERS OF HOMELESSNESS The main trigger of homelessness in Australia is human rights violations which briefly includes:

Domestic violence

Social isolation

Psychiatric disorder

Poverty

Trauma

Lack of affordable housing

Addiction

Domestic violence and Post-Trauma Stress Disorder are the two main factors resulting in homelessness, around 83% of the homeless youth have experienced both sexual and physical abuse.

MENTAL HEALTH IN THE CONTEXT OF HOMELESSNESS Mental illness is a general term for a group of illnesses that may impact a person's thoughts, perceptions, feelings and behaviours. This usually affects personal and working relationships. The mental health problems which usually end up in homelessness Dissociative

of

the

particular

disorders,

person

can

be

Obsessive-compulsive

broadly

disorder,

listed,

not

Paranoia,

exclusively

as

Post-traumatic

Anxiety stress

disorders,

disorder,

Schizophrenia.

EXISTING SOLUTIONS AND SUPPORT SYSTEMS Most federal government funding for the homelessness sector is provided through the states and territories under two agreements: The National Affordable Housing Agreement (NAHA); and The National Partnership Agreement on Homelessness (NPAH) There are around 1,300 organisations around Australia funded under these two agreements. Not for profits play a very important role in helping people who are homeless or at risk of homelessness.

Depression,

Psychosis

and

05

Government Support The state and territory governments are primarily responsible for the delivery of housing and homelessness services in Australia, while the Australian federal government aims to ensure that all Australians have accessible, safe and sustainable housing. Three main services are supported by the Australian federal government are:

Social Housing Services Subsidised rental housing provided by not-for-profit, non-government or government organisation to assist people who are unable to access suitable accommodation through the private market

Specialist Homelessness Services Direct assistance to homeless people

Financial Assistance Private rental assistance or home purchase assistance

Role of Housing and homelessness sector services (HHSS)

Along with initiatives from the Australian government, each state and territory have their own support plans

for

homeless citizens.

Efforts at State Level Similar to the National Level, all state governments are responsible for having strategic and action plans to tackle homelessness and provide mental health support to people in need. All states in Australia have various plans and schemes in place to cater to this and have future plans as well in place. Some of the major initiatives that tackle homelessness and mental health issues are listed below -

NSW Housing and Accommodation Support Initiative (HASI) In 2002, the NSW Housing and Accommodation Support Initiative (HASI) was started in which Housing NSW, NSW Health, and various Non-Government Organisations collaborated to provide accommodation support, clinical care (by mental health services), and secure and affordable housing arrangement to people with lived experience of mental ill-health and housing crisis. It was targeted to help the people with a need for high mental health support but gradually it was expanded to provide support for accommodation needs as well.

06

NSW Future Plan The State of New South Wales published the Intersectoral Homelessness Health Strategy for 2020-2025, which includes

providing

the

right

care,

access,

prevention,

service

environment,

developing

workforce

skills,

and

collaborations.

The plan will target existing homeless problems such as increasing numbers of PTSD cases, limited access to diagnosis, care, and correct treatment, as well as accidental discharges from health services. NSW governments are committed to training and exploring innovative treatment methods and environment specificity for mental health care for the homeless.

Victoria - Doorway Program It is an initiative by the Government of Victoria which aims to provide housing and recovery support to assist people with lived experience of persistent mental ill health who are at risk or are already experiencing homelessness. The Doorway program brings together various housing, mental health providers, service providers, and hospitals to work in tandem to provide support to people who are experiencing homelessness. The program links consumers with private rental housing and psychosocial support while providing time-limited rental subsidies, brokerage, and tenancy support. The model is highly innovative as it changes the model of providing housing through social housing providers in favour of private rental housing.

Non-Government Support Along with the federal and state government, there are a number of Non-government and Not-for-profit organisations working towards tackling the problems of homelessness and mental health issues either on their own through charity and volunteer work or by partnering up with Government initiatives and research. The organizations are trying to help the government in tackling the issues and while the government plays a major role in policy change and devising strategic plans to drive away from the problem of homelessness and mental health issues there are many great organisations that are making big grounds for individual support, shelter, funding, awareness initiatives, access to grants, local community support and many more.

Homelessness Australia is the national peak body for homelessness in Australia.

They provide systemic advocacy for the homelessness sector. It was defunded by the Federal Government in December 2014 and now operates on a voluntary basis. They do not provide or manage accommodation or deliver direct client service but instead, they work with a large network of organisations to provide a unified voice when it comes to preventing and responding to homelessness.

Australian Red Cross has been constantly working towards the betterment of people who are suffering from homelessness and mental health issues. They provide

support

mentorship

by

programs,

offering

Homestays,

providing

among many other initiatives.

housing

assigning

support

to

personal mental

helpers

health

and

patients

07

Mission Australia is a charity organization that has been around for 155 years, helping Australian’s who suffer from homelessness, employment,

alcohol

and

drug issues, youth services, family & children services, mental wellbeing, and help form strategic initiatives and policy development and advocacy.

StreetSmart was formed in 2003 with an aim to tackling stigmas and inaccurate prejudices

surrounding

homelessness

and

mental

health

issues

and

helping

smaller organizations to raise vital funds to provide innovative and localised solutions to the communities.

Recent efforts by The University of Sydney for the Homeless and Mental health The University of Sydney aims to enrich lives through best in class research and education. The activities could largely be classified as institutional, or individual level efforts.

Institutional Level Matilda Centre for Research in Mental Health and Substance Use The Matilda Centre for Research in Mental Health and Substance Use aims to generate innovative and workable solutions to address substance use and mental disorders, which are currently the leading global causes of burden and disease in young people. This centre aid the development of evidence-based programs for the prevention, early intervention and treatment of mental and substance use disorders.

Sydney Social Sciences and Humanities Advanced Research Centre (SSSHARC) Huddle “One-day intensive group discussion was attended by art researchers and educators, performing arts practitioners and potential philanthropists.”

“The SSSHARC Huddle on Re-storying homelessness through the Arts: Can creative, arts-based intervention transform the way we frame homelessness? was held on November 18, 2019”

SSHARC, with CREATE MDI, invited Milk Crate Theatre and Professor Peter John O’Connor from Centre for Arts and Social Transformation (UOA, NZ) for an interdisciplinary, academia-industry collaborative ‘huddle’, to fathom a future roadmap to construct sustainable symbiosis for a system of emotional empowerment for the homeless. It’s unclear how the project sustained post-session.

Wayside Chapel – Side By Side The conference was interesting to take note of as Sydney Policy Lab had partnered with the Wayside Chapel and its network of organisations as an event that aims to address, “How can we create a fair and equitable society”. Since the set scope is social justice in Australia, homelessness was also in scope yet in practice it appeared to be a mere perfunctory nicety without having concrete actionable outcomes – it is particularly so since the event seems to have an insular structure with no real outreach

08

Individual, silo-ed contributions Dr Justine Humphry, Senior Lecturer in Digital Cultures Undertook

study

on

mobile

phone

ownership

by

the

homeless

via

Australian

Communications

Consumer

Action

Network’s Grants Scheme Dr Humphrys’ ACCAN-funded research is a good precedent led by an individual academic in our problem space with informative insight around 95% of homeless people in Sydney and Melbourne has a mobile phone, highly relying on it for their communication needs

Professor Lina Markauskaite - Mapping the Interdisciplinary Expertise Professor Lina Markauskaite’s ARC Discovery Project-funded research seemed valuable to take note of as relevant precedents in light of addressing our Design Brief.

+ several other academics such as the ones we’ve interviewed

*Unexpected finding During research for precedents, an unexpected finding was discovered. The new insights identified about 5% of PhD students in Australia – one of the demographics of the university populace, are under credible risks to be homeless.

Also, about 50% of the PhD students across Australia were considering disengaging their studies. The pandemic was a significant factor in this issue. Other university students have also been under pressure due to the housing crisis (Rickert & Roberts, 2018; Woolston, 2020; Zhou, 2019). This was worth noting, to take into account as relevant insights for the oncoming DIC.

Overall thoughts It seems as though there is a prevalence of MDIs (Multidisciplinary Institutes) which aims to apply a multidisciplinary approach to research, government(s) and industry(s) partnerships for a diverse range of issues. It is worth considering the academics’ level of awareness and access to such MDI initiatives, as well as the efficacy of the current MDIs’ endeavours at an institution-wide scope.

INTERVIEWS BEFORE (WHY AND HOW) Interviews were conducted with four professionals who have knowledge or research experience on mental health and/or homelessness. (Appendix 4). Each interview complemented our secondary research with a comprehensive overview of specialized research findings and academic points of views which deepened our understanding of the issue, as well as some galvanizing personal anecdotes steering further research directions. Key insights from each interviewee were;

Jo Martin (PhD. Candidate), Tutor, Design Lab, Faculty of Architecture, Design and Planning Gender and homelessness Trolley Man, emblematic figure of homelessness for Sydney + Australia

09

Dr Caitlin Louise Buckle, Research Associate, Faculty of Architecture, Design and Planning Different types of homelessness, particularly in relation to housing/ living conditions cf. international students Homeless and their animal companions, and their difficulties accessing support & service providers

Dr Marlee Bower, Research Fellow, Faculty of Medicine The impact of stigma presenting a further challenge for the homeless' access to support Lack of communication and collaboration between existing support systems

Dr Karen Cochrane, Lecturer, Faculty of Architecture, Design and Planning Overview of interconnections and variations of mental health issues Shortcomings in current support systems

NEW RESEARCH AREAS AND INSIGHTS INTERVIEWS DEMOGRAPHICS

In the event of an emergency, youth are also less likely to have savings. Government pension and youth allowance is the primary source of support

In Australia, one in three of the homeless population is under the age of 18

for two-thirds of the youth who seek help from specialised homelessness services. Youth incomes are

often

poverty,

inadequate

ranging

to

from

hold

youth

30%-60%

of

off the

from adult

minimum income. Simply put, many youths would not have enough resources to support themselves.

Youth homelessness is closely linked to both physical and mental health issues. Around 48 to 82% homeless youth suffer from a diagnosable psychiatric condition (including mood disorder, PTSD, anxiety disorder and substance abuse).

Homelessness

increases

the

risk

of

emotional

and

physical

disease,

and

mental

illness

increases

the

risk

of

homelessness.

Homeless youth are often more likely to suffer from mental illness than those who have access to stable housing. When compared to those with permanent homes, the rate of mental illness is projected to be 300 to 400 per cent higher for the homeless. Up to 90% of homeless youth match diagnostic requirements for at least one mental illness.

10

Homeless youth are often more likely to suffer from mental illness than those who have access to stable housing. When compared to those with permanent homes, the rate of mental illness is projected to be 300 to 400 per cent higher for the homeless. Up to 90% of homeless youth match diagnostic requirements for at least one mental illness.

A paper by C.Martin & L. Sharpe examined the pathway to homeless youth in Australia. They identified the role of childhood adversity, trauma and the presence of psychological disorders as important risk factors for homelessness.

This includes parental indifference, antipathy, parental control) , abusive (physical, sexual or both) situations in the family, PTSD and drug and alcohol-related problems. From the study, they identified five pathways to homelessness, two of which are linked to mental health issues- Trauma (including PTSD) and Psychological Problems.

The diagram created illustrates just how complex the risk factors are for homelessness and mental health.

The pathways (Trauma and Psychological problems) that

lead

to

the

onset

of

homelessness

are

often

pathways (Psychological problems) that also follow as a result of homelessness. This is an indication of the cyclical cause and effect.

Given

the

problems,

increased homeless

prevalence

youth

are

of

less

mental willing

health

to

seek

mental health treatment and are much more likely to drop out of school or become unemployed.

Among the homeless youth with mental illness, 40-80% had suicidal thoughts and 23-67% conducted suicidal activities.

The National Youth Mental Health Foundation suggests that one out of every ten homeless youth has engaged in suicidal behaviour, and one-third of them did not talk to anyone else regarding their suicidal thoughts.

GENDER The interview with Ms Jo Martin guided additional research direction as she shed new insight on the topic regarding gender and homelessness. She shared her anecdotal experience of encountering an increased number of homeless women.

"In 2016 census, 116,427 Australians were experiencing homelessness of some form.

58% were male, and 42% were female" In 2016, the statistics revealed there were more men who were experiencing homelessness compared to women, at approximately a 6:4 ratio. This sparked further research trying to find the most up-to-date data.

Further research revealed, compared to males, females have consistently comprised a higher percentage of clientele of the Specialist Homelessness Services for the last decade (AIHW, 2020). One of the highest correlations to this is the findings by AIHW (2018) which shows women to be at greater risk of domestic violence:

11

“One in 6 Australian women and 1 in 16 men have been subjected, since the age of 15, to physical and/or sexual violence by a current or previous cohabiting partner”

In addition, it was found that older women are one of the most susceptible demographic to become homeless. It was found that high-risk factors for the homeless – such as domestic violence, unemployment, private rental housing, lone-person household, lone-parenthood – compounds the overall risk for the demographic,

placing

particularly

precarious

risks

for

factor

for

older

women

to

homelessness (Faulkner & Lester, 2020).

The

findings

suggest

gender

is

a

significant

homelessness.

The

insights are two-fold: firstly, the research clearly reveals the compounding of various risks, each of which must be dealt with systematically to address the most vulnerable demographic to homelessness which are older women as well as women more broadly. Secondly, the focus must be given to uncover why there are significantly lower percentages of homeless men who receive SHS when overall there are more homeless men than women.

PETS With the rules and regulations of boarding houses and temporary accommodation very few allow housing to pets of the homeless which automatically means that the eligibility to access accommodation if you have a pet is reduced many folds. Under such circumstances, undue pressure is put on the individuals to surrender their pets and most of the people opt out of it to not lose their constant companion.

Refusing accommodation or being ineligible for it puts them in a position where they need to compromise on their physical well-being to enrich their mental well-being by being with their companion. This results in them sleeping rough, in tents or in abandoned buildings with no power or running water. For most people

"For homeless, their companion becomes their closest Family"

who

are

homeless,

their

companions

become

their

closest family and losing them can acutely affect their mental well-being.

Their

pets

don’t’

judge

them

and

are

also

dependent on them which helps boost their own self-worth and purpose.

Although pet ownership greatly enriches the lives of those who are homeless, it also comes at a significant financial cost with annual vaccinations, flea treatments, food etc. which can cost hundreds of dollars. Many programs like Pets in the Park, Ruff Sleepers etc. aim to help homeless people care for their pets by providing veterinary treatments, food, clothing, daily care etc. which takes off some burden of providing care from the people who are homeless and are able to have their companions with them and have better mental well-being.

12

TROLLEY MAN The

discussion

with

Jo

Martin

introduced

Joseph

Cindric (1906/08–1994), the “Trolley Man” to us. He is considered a symbol of homeless people in Sydney.

He used to push a handmade trolley around Sydney CBD. It was a common city scene, as he used to live around Town Hall and Hyde Park from 1960 to 1980.

He migrated to Australia from Europe after world war 2. His ability to speak in English was limited. He used to work in Coal mines and railways in NSW. But due

Photography by Raymond de Berquelle.

to his loneliness, he started developing mental health

Collection: Powerhouse Museum.

issues.

He started believing that other immigrants are threatening his life. He soon left his job and started walking from town to town. Due to his mental condition, he constantly believed that there was a threat to his life and he started making handmade guns and ended up in jail for six months. After that period, he used to end up in front of court frequently, often charged for vagrancy. From the 1950s to 1965 he was arrested for homelessness multiple times.

After the last release from prison, Joseph made his first of several trolleys and began pushing around inner Sydney. He began to be defined by his trolley as later known as trolley man. This city scene started inspiring sculptors and artists in the city. Joseph passed away in 1994 and his trolley was acquired by Powerhouse Museum.

When we analyse the life of Joseph and the reason for tragedies in his life, there are multiple reasons to trigger his first mental unhealthy situation, but due to the lack of proper medical attention, it affected his mind deeply and eventually led to homelessness. Society and the machinery of law failed to treat the problem of the problem and his mental health further deteriorated. Even if he was given the opportunities to stay in care homes, the mental health issues lead him again to the streets. This cyclic phenomenon kept happening till it took his life.

Analysis of Joseph's life and reasons for homelessness

13

CHALLENGES THE HOMELESS FACE IN SEEKING HELP One of the major questions before beginning our research was why don’t the homeless seek help when there are many healthcare centres offering free services for physical and mental health check-ups. Turns out there are many barriers structural and social.

Structural Barriers Structural Barriers

include limited clinic sites, limited hours of operation, other

health conditions being given priority over mental health at these centres and long wait times. Even if they do approach these health centres for help and make appointments, they may not keep it due to their physical inability to reach these locations on the given date. Often this is due to transportation issues- not being able to walk to the centre or being unable to obtain a bus ticket due to lack of funds. Many homeless people don't have a phone which means there's no way to reschedule the appointment even if they do want the help.

Social Barriers Stigma, perception of discrimination by uncaring healthcare professionals, negative encounters with law enforcement and society are some of the social barriers that exist.

Distrust of authority Homeless

people

often

aren't

able

to

trust

the

police

and

the

doctors

with

sensitive

information in the fear that they might be misunderstood and judged. A fear that could lead them to prison or be detained. Some people who have had a prior run-in with the police fear that they have to give up their name and identification details to a health care worker to get help. This puts them in a compromising position and they want to avoid putting themselves there.

Stigma Pride and stigma can get in the way of asking for help. Until they reach extreme distress, hopelessness and fear, many of them refuse help. Harsh or judgemental commentary can be ingrained in the minds of these individuals that go onto becoming a barrier to seek help.

14

INSIGHTS STAKEHOLDERS INVOLVED

Academics Private Institutions

Government

NGOs

Hospitals

Society

The diagram above represents the various stakeholders we've mapped out that have an impact on the Homeless.

INSIGHTS UNCOVERED A complex bi-directional relationship between homelessness and mental health.

There is a lack of trust from homeless populations to stakeholders who wants to help.

Pet Companions of the Homeless play an important role in maintaining their mental well-being and give them a

purpose, sense of responsibility, and a sense of self-worth. As a starting point for developing probable solutions, we

need to think about pathways that consider both aspects of providing help to the homeless and taking care of their

pets instead of having individual siloed programs.

Contrary to our assumptions at the beginning, the challenges the homeless face goes far beyond finding suitable

employment and gaining an income.

Social factors and the way people treat them play a huge role in the

decisions the Homeless take in seeking help.

15

SUMMARY AND WAY FORWARD After being introduced to the initial brief of ‘Care beyond boundaries’ our first response to it was to think of jobs and models that relate to health care in our own circle of society, making connections to what we feel care means to us.

But on diving deeper into the problem space we were able to see areas which we hadn’t noticed before.

We see Homeless people around us all the time, but never stop to think about what it is like for them. We assume they’re there because they don’t work hard or have gotten involved in things, they shouldn’t have and are eccentric and not stable but that’s only a surface level issue. Why did they become Homeless? What could have happened that they have to live like that? What are their circumstances? What is being done for them? How are they feeling physically and mentally? We don’t ask ourselves those questions.

With this research, we tried to break our own boundaries and assumptions to look beyond the surface and explore the problem of the problem. There is a complex between

bi-directional housing,

relationship

homelessness,

and

mental health, one that we see from many

research

interviews

with

papers different

and

our

faculty

members.

Through the interviews, we were able to uncover many perspectives and problem areas that need to be addressed like demographics, gender, ownership of pets, challenges in seeking help and the cycle of being homeless and having mental health issues. From the example of the Trolley Man, we can argue how his mental state and isolation - a result of migration and difficult work environments led to him taking action in an attempt to do something to feel better, albeit perhaps not the right one.

So how can they access the ‘right’ help at the ‘right’ time? How can they ‘correctly’ identify the troubles they face and the root of that in order to get

better?

There

might

be

many

pathways

to

homelessness and mental health issues but being unable to identify which pathway one is on and gain

access

to

the

appropriate

means

and

personnel in order to get better, might be one of the most crucial pieces of the puzzles in caring for them.

So for the next stage of our design intervention, we’d like our collaborators to explore and tackle the challenges the homeless face in seeking help and possibly get them to think about what they can do to minimise these challenges.

16

REFERENCES 7NEWS. (2020, October 7). The homeless look after their pets better than us. 7NEWS.Com.Au. https://7news.com.au/lifestyle/pets/the-homeless-look-after-their-pets-better-than-us-c-1369967

A welcome home: youth homelessness and mental health - Orygen, Revolution in Mind. (2020). Orygen. https://www.orygen.org.au/Policy/Policy-Areas/Population-groups/A-welcome-home-youth-homelessness-andmental-health

About Mission Australia. (2021). Mission Australia. https://www.missionaustralia.com.au/about-us

About us | Homelessness Australia. (2021). Homelessness Australia. https://www.homelessnessaustralia.org.au/about/about-us

AIHW - Australian Institute of Health and Welfare. (2020, December). AIHW - Australian Institute of Health and Welfare.

Homelessness and Homelessness Services. https://www.aihw.gov.au/500.html?aspxerrorpath=/reports/australiaswelfare/homelessness-and-homelessness-serviceshttps:/www.aihw.gov.au/reports/australias-welfare/homelessnessand-homelessness-services

Australian Health Review, vol. 41, no. 5: 573–581.

Australian Housing and Urban Research Institute. (2018). Housing, homelessness and mental health: Towards systems change. https://www.ahuri.edu.au/__data/assets/pdf_file/0023/29381/Housing-homelessness-and-mental-healthtowards-systems-change.pdf

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mage References:

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Unsplash (2020). ‘Homeless’. https://unsplash.com/s/photos/homeless

Canva Elements

Image/Diagram made by us

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APPENDIX APPENDIX 1 - ASSUMPTIONS MADE 01. Being homeless means people without a shelter, usually living on the streets.

02. Homeless individuals don’t necessarily care about their mental health as much as their physical health 03. A lack of income and a place to call home affects an individual’s physical health and that in turn can affect their mental health 04. Individuals may not be able to identify that they are suffering from mental health issues, these individuals may assume that, what they are experiencing is normal

APPENDIX 2 - BRAINSTORMING

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APPENDIX 3 - ACTIVITY SUBMISSIONS

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APPENDIX 4 - INTERVIEWS Interviews were chosen as our main research method to discover primary insights from both design and medicine faculty.

We looked into professionals from both faculties and contacted professors and researchers who have existing mental health or homeless knowledge or research for interviews (Appendix 5).

Once the interview was scheduled, we requested each of the interviewees to collate the first thoughts and images coming to their mind when they hear the words, care, mental health and homelessness. Most of the interviewees prepared a collage of pictures. Our interviews started with a discussion of these pictures. This gave a unique perspective to each of the interviews, which are highly tailored to each individual.

Interviews were conducted with pre-written open-ended questions (Appendix 6) in order to limit biases from both ends.

Activities were included during the interview process to encourage engagement and help guide deeper thinking processes to generate more insights. Each person was assigned different roles as facilitator, recorder and observer during the interview, it helped generate follow up questions, body language, facial expression, reframing insights and monitoring and updating the interview environment.

All interviews were recorded and transcribed for future references when writing the report (Appendix 8). Mind maps were created after each interview highlighting the interviewee’s experiences and insights.

The interview followed the order of:

PART A: Asking for the elaboration of the interviewee's response to the pre-interview activity This gave us more information and insights into the interviewee's thoughts and perspectives on homelessness and mental health. Some stories, such as Jo's personal encounter with the Trolley Man among others, was eye-opening and led to adapting our research.

PART B: Asking the interview questions Each question was asked in turns by each group member as planned beforehand (please see Appendix for the questions and the order they were asked). Again, the interviewees' answers provided further insights which informed our subsequent research direction. We could also build our understanding of the perception of each interviewee leading on from PART B

PART C: Asking any new questions that arose from the interview After PART B, each of us took turns and asked any questions that arose. This helped clarify and also to address any knowledge gaps from the session

PART D: Thanking the participant + tentative invitation to the upcoming DIC. End interview After PART C, we thanked the interviewee again for partaking in the interview. We've also asked for their rough availability in near future (sometime in May) while also extending a tentative invitation to the Design Innovation Catalyst session. The interviewee's response also allowed us to forecast the turnout whilst trying to choose a time and date that could accommodate the most number of invitees. The interview was then concluded

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APPENDIX 5 - PROFILE OF INTERVIEWEES

PHD CANDIDATE

PHD

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APPENDIX 6 - INTERVIEW QUESTIONS

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APPENDIX 7 - MINDMAPS

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APPENDIX 8 - INTERVIEW TRANSCRIPTS Ms Jo Martin, DESIGN FACULTY Student Speaker 1 0:06 So, obviously, we want to know what's the reasons behind all the pictures like why do you pick specific one of them.

Okay. Do you mind talk you through?

Ms Jo Martin 0:18 No, not, not at all, I'll probably start from the right hand side which I know isn't unusual but that particular picture is of a well known homeless man that used to go around Sydney from about, I don't know when he started probably about the 1950s or whatever, up until about the 1980s He's not and they refer to him as the trolley man. And he used to walk around with trolly made of woods, and he would wear a helmet. And you would see him regularly around Hyde Park.

And so apart from the fact that I would see him regularly when I went into the city. He also punched my girlfriend's mother. For some unknown reason, which everyone thought that he was particularly harmless, but you know she had an altercation with him so that was just one of my memories, and he probably represents. There used to be when I used to work in the city, because I worked in the city for such a long time, there were people that you would see. And you would recognise by face. There was a particularly tall man that used to walk around without shoes, and he would walk the same route. Each day, and he would stay in a bus stop outside of Wynyard. And then there was another guy that used to say that walking down crown Street on the way into work, and he was an Asian guy that when he first started walking down the street. He was very well dressed and he was quite young, but he would always carry a bottle of alcohol. And as the year went on, you could see him deteriorate, which was really sad. Um, I guess the other ones represents sort of. I also used to go out and in Kings Cross a lot, and you would, we would talk to the straight kids that had sort of issues, and I'm usually kids from the country that had come into, into the city, and then ended up around Kings Cross around the fountain. And, you know, they're, they're really nice kids but they're, you know, they were homeless. They had problems. And it was a realisation that they weren't the same age as what we were at the time. The lady under the, the bridge, I imagine it's lady is representative of all the people that I have seen over the last 10 years.

She coming in the tent city round, which is down near the Harbour Bridge and the fact that people here, it doesn't seem to discriminate for age or sex or nationality or whatever anymore. So, The one in the middle is down by Matthew Talbott, which are my daughter did sort of care they what is a cold, she did a, they had to do community service and I had to drop her down at Matthew Talbot so that she could work on I think she was doing the soup, have a lunch for a couple of weeks. The guy on the left, who is. Looks like he's squatting. Some of my friends scattered, and some of them sort of ended up in that situation from mental health problems, and drug addiction. So that kind of reminded me of the fact that, you know, that's often that you don't necessarily see the homeless outside bag lady. She looks very similar to a bag lady that I used to say around town, carrying all her, her sort of worldly goods in a, in plastic bags. And, you know she was among quite a few ladies that would be around there. And finally, the symbol of the Wayside Chapel is basically one of the organisations that have always helped, and particularly around the cross, and they've always, You know, been very good at it, being compassionate with the people around there and sort of being accepting. So for me, they have a good. The good sort of representation of people willing to, you know, to help from sort of US based charity, and community. So I think I've gone through it all. Haven't I?

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Student Speaker 2 5:33 Yes, thanks.

Student Speaker 1 5:38 Sabrina, do you want to take over. Yeah.

Student Speaker 2 5:43 Our next question is about care and care is a big term. So, in your opinion, how do you think it has changed through through the years?

Ms Jo Martin 5:55 I think I can only talk about my understanding, up until the last probably five or 10 years because from I live a very suburban life so I don't see many homeless people. My, my experience of homelessness now is when I drive into the city and I see the people that are living in the middle of the medium strip. So, I can't, I don't really know how much it's changed. I think that the, the organisations that work with the homeless are wonderful. I think it's great that there's people that go out there and just provide services like shaving or washing. But I think that, I think they're overwhelmed.

So, to a certain degree like rights perience of. When I first used to go into the city. When I first started to work that you knew the homeless that yeah, they were, they were there. But now it seems that the problem has got it has gotten a lot worse. So, Yeah, I think that the people that are out there working are struggling to keep up.

Student Speaker 2 7:19 Do you have any idea why they would be struggling to keep up.

Ms Jo Martin 7:23 I think that homelessness in a city like Sydney is becoming more prevalent. I think that there is a population, particularly of aging women, and that that is something that has never been really considered that there are now a greater number of women that are homeless. And I think that the prices in Sydney, mean that it's more prevalent to families. Yeah. That never used to, perhaps, you know, for me, my, my, sort of experience when I was younger was of a single men that that had mental health issues that you would see around now, you see people every second street and city. So, yeah, it's I think it's part of the, the way in which our society is now going into two extremes of the haves and the have nots.

Student Speaker 2 8:33 So we've been just resetting homelessness and mental health issues and that interconnection. We found that it seems to be a circular cycle of cause and effect, one triggering the other. What, what would you think is the problem of the problem like the root cause of it.

Ms Jo Martin 8:52 I think to a certain degree there are underlying issues that happen within people's lives that are not, they don't have the support for. And I think in some instances they they used drugs and alcohol to get as bandages. So I think that to a certain degree, it's not, not dealing with the mental health issues at the root. So, yeah, that's that's pretty much where I think because we don't deal with it at the root of the cause.

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Student Speaker 2 9:31 Right, thank you. Sree, do you want to take the next one.

Student Speaker 3 9:36 Yeah, before I go to that question, May I ask one question from the canvas? So you said you talk to people. Previously, and you are maybe 10 years 15 years back when you were working with working in the city, so do you. You talk to particularly to the kids, or the young people, when, and what was their response, Like, why they had out there.

Ms Jo Martin 10:16 Mainly they were misunderstood a time. They had issues at home. A lot of them had weren't accepted for their sexuality, and had escaped from the country to the city Sinem also found were unemployed. I couldn't find employment.

Okay, Yeah, primarily they're escaping from the country.

Student Speaker 3 10:54 It is very interesting that you put the point that the number of people, number of women has increased over a time period, which we didn't see when we were researching. Yeah, so we would like to discuss what are the existing solutions you I think you were mentioning about channel, and some other. No nonprofit organizations, going to help them, including washing them shaving. So, what is your opinion about current solutions available and what is your expectation, an improvement in those solutions.

Ms Jo Martin 11:47 I think the people that are out there doing it, and helping are doing a good job. I think things like Matthew tab provides accommodation but I do understand that that accommodation is limited, there are shelters for families and other people that are disabled, but I understand that that is also limited. and that they are waiting lists, and issues. I think that, I think that we need to give them more funding. I think there should be a bigger, bigger slice of the tax pie going to them. I also think it's, yeah, there are these great organisations that are, that are trying to help. Particular I'm aware of. Once clicked walk woods to try and help people set up, and clothing, although it's very difficult without major sort of sponsorship to get some of the, it's to a certain degree, it's the problem transport, and the operational issues that they cost a lot of money. So, generally, I think that we as individuals should be helping them, where we can. And potentially, you know, as designers, we should be. I don't mean to a certain degree, I'm not even sure that, as helping the individual directly is the solution I think it is us supporting the right people that I hope that you know, the ones with the training, the ones with the understanding and compassion, necessarily us going out and finding somebody and giving them 10 bucks or whatever to adopt McDonald's or whatever, you know, I don't necessarily think that's the right solution.

Student Speaker 1 14:20 I have a long question because you said um there's a lot of organisations that are, that are doing a lot of support for homeless people. Personally, I know there's a lot of hospitals, that's giving mental health counselling or therapy for homeless people. But why do you think people are not really the homeless people are not going there because it's free, it's open to everyone.

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Ms Jo Martin 14:51 I could only imagine trying to get this one thing. There's the stigma that goes within going for help. Some people might not feel they need the help. And I don't know I mean I can't, I can only put myself myself in the position of considering it I don't know whether it be right but maybe that they judged. I also think that to a certain degree would also be like just the difficulty of trying to, if you're homeless, it's not easy to get a bus. By bus drivers don't want you on the bus. Now you don't have the money to the bus fare or. So, unless we have support to get the mayor, or people that are encouraging them to go. I say that there's been tension issues, getting them there in the first place. So, yeah, but some people with mental health issues, don't want to be in the hospital.

Student Speaker 3 16:13 Or maybe they're not realising that there is a health issue.

Ms Jo Martin 16:17 That's right. I work in a hospital for a little while as a as a part time job. And I had, I had to go around, visiting the mental facilities, and I had people offer me money to get them out by, you know, this will certainly agree that they don't understand why they're there. Yeah.

Student Speaker 1 16:48 So, you know, we're all, we're in design, faculty, and one of our main goal is to have, like, as a member of design faculty, how do you think that we can contribute, how do you think that design faculty can contribute towards this problem.

Ms Jo Martin 17:08 It requires that we're restricted in some areas. For example, not the area that my research is would not be beneficial to the homeless. It would be more about surveillance, which is I don't because I'm because on my sort of focus is computer vision and designed for that so I don't really think that that's as much hope, where I can see potential is when, when we get design briefs, or students to explore the potential using these as design briefs and encouraging students to consider designing for, for different, I suppose. We're already designing, to a certain degree for mental health in some of our, what we have in the past. Particularly, it's where coordinators are choosing board is going to be the final project. That could be a potential for students that do come up with fantastic ideas to try and think about designing to to assist others to help them. For example, One of the courses that I was helping with the course coordinator decided to design, to get them to design for learning disabilities. You know, we, and we have designed for other disabilities. So I think it's quite right, it's. I suppose that that means that it's up to the individual coordinator to decide that that's going to be the project. But I think it's definitely something that we can do.

Student Speaker 1 19:11 Right, so, you know as designer, one of our job is to space. And what kind of method or approach do you think design faculty should. Well as you know, a part of design faculty what methods to use or what approach would you go to design a problem, just use it, find a problem. Okay,

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Ms Jo Martin 19:35 I would probably reach out to the different organisations that are supporting the homeless and talking with them. And then from them being introduced to people that are homeless and talking to them as well. And then looking at what, how we can support. We can design to support that the support systems that are already in place so that they can better provide for the people that need them. We can also design to make people more aware, the individuals you know, the outside public, to make them more inclined to provide financial support order to provide make it easier for things to be collected and distributed or make it easier for somebody to organise being like the Uber, that takes people to their, their appointments. So, we can design the support is what I say.

Student Speaker 1 21:01 Okay. Should you have any questions, I know you get

Student Speaker 3 21:06 those great ideas. So, yeah. Our plan is planned for this project as this will be our first interview. And later we'll have a two hour workshop with you and other faculties to get that which we will need as a design intervention. Okay, so I think we covered most of the questions we have come up with our notes. I have one more question on the canvas. This particular person Joseph, he was there. Instead, Sydney for more than a decade, he was moving around so deep. His presence, or his that truly influence designers who are working in, or interested in their area or.

Ms Jo Martin 22:15 I know he he influenced artists, there's a exhibition about him in the, in the, I think it's in Sydney museum now that's now the Powerhouse Museum. So, in terms of designers. I don't know, I don't, I mean, design. As such, wasn't really a thing back around. Yeah. There was just one other thing that I've thought about in terms of design, what you could get the design faculty to do is you could, like, the inner circle intervention that you're doing, doing something like a design hackathon, you know, that could be organized, and you could get sponsorship from different sort of corporates. As part of that sort of hackathon. And then you could get designers to come in, and people are willing to give up their time for things like this. Whereas, if it's something that's less worthwhile they might not. So, yeah, yeah, that was just a thought off the top of my head.

Student Speaker 3 23:39 So, Anything else we need to ask with Evy?

Student Speaker 2 23:44 I think we're going to be trying to host the designing sometime in May, we'll send out all the details for a short day so you can let us know your availability. Okay. About half a day workshop. Okay,

Ms Jo Martin 24:01 I have said that I'm not quite sure whether I'm going to be able to do half a day,

Student Speaker 2 24:05 two hours, would you be available for two,

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Ms Jo Martin 24:08 probably two hours but yeah half a day might be a bit. Alright, so we'll,

Student Speaker 2 24:12 we'll try to organize it so that you, everyone's available to two hours would be, would be good if you could make. Right, yeah.

Ms Jo Martin 24:22 I think you're doing a great job

Student Speaker 2 24:27 for participating and helping us out. Okay.

Ms Jo Martin 24:32 See you next week. Bye You too, bye.

Karen Cochrane, DESIGN FACULTY Student Speaker 3 0:01 Thank you for joining us Karen. We would like to hear about your initial thoughts about mental health and homelessness.

Please.

Karen Cochrane 0:04 Yes, when we talk about mental illness, things like depression or anxiety, which are a lot easier to understand what what's going on in the situation but then you have. So example is I have a family member that has literally every single mental health condition you could possibly think of. So, the complexity of understanding that situation is a lot more difficult to grasp and be able to find maybe some kind of design innovation area versus someone who just not that I'm marking or grading people's mental health, but you have to, you might want to think about that if you're just doing mental health in general is there's there's the PhDs about us, about a specific mental health disorder so if you're looking at everything, it might be a bit broad,

Student Speaker 3 0:53 If that makes sense. Yeah, makes sense. Our initial thought was to tackle the problem as in not too specific disorder, like, not too specific mental health, because there's too many out there like, we want to design something that could help in general as in. So, our next question can probably kind of answer your your question, it would be because mental health, and homeless. It's like a circular cause like, you know one cause letter and cause another. And then we want to find out like what is like the biggest problem like wish what is the most important point, so like the problem of the problem. And then we want to tackle that problem.

Karen Cochrane 1:38 So you're finding the gaps in the area. Yeah,

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Student Speaker 3 1:41 you're trying to find out. Like surrounding space. Yeah, so

Karen Cochrane 1:47 you're exactly right, so there's two different ways that. So, mental health itself, you can, it can be diagnosed because of a situation that happened to you, or it can be genetic. So for example, um, for example, If you have a disability so autism can cause mental health disorders so if you are autistic or if you have some kind of disability, or you can think of it like maybe they were war veterans, and they have PTSD that's also a mental health disorder. So there's a lot of different factors and it's so complex mental health as a general, that it might be difficult to tone down in a problem, just saying generally mental health. I'm just warning you, because it's so varied and fast. And it's such, it's like a hole.

Even doctors they don't often specialise, they say they specialise in mental health but they often specialise in specific types of mental health, because it's so complex.

Student Speaker 3 2:49 Yes, that actually would be a good thing to think about for us, because

Karen Cochrane 2:55 that's better to be specific and then once you find a solution, then you can start generalising. So when you're, when you're designing something it's better to be super specific about something and then you can look at okay maybe this can help this population as well maybe this can help this population as well. Yeah, is you'll find more successful ways to validate your design, by doing that.

Student Speaker 3 3:19 Can you hear me now? Okay, thank you. We were thinking not only about mental health. We are trying to figure out the relationship between mental health and homelessness. And, and, because of homelessness, mental health will be affected. It is kind of circular thing right yeah

Karen Cochrane 4:04 absolutely so there's different factors why someone who's homeless, and had a mental health disorder. One was their genetic. So something like bipolar disorder or schizophrenia or some of those most severe, things are have been proven to be a more genetic disease. With the brain, but then you can have like anxiety or depression or PTSD different factors like that more those kinds of mental health disorders that had could potentially happen after they became homeless or maybe before because of a tragedy that they had to leave their home. So there, it's it's very again, your understanding it's very complex. Again, when I'm building something for mental health, I focus on something specific, I don't broad everything. Because for example I do a lot of work in meditation which helps with anxiety and depression often, but someone was had severe schizophrenia. Meditation is not preferred because they're already hearing dirty in their brain too much. So, pushing them back in there, could actually have negative effects on themselves. I didn't know that's a coping strategy for, so you can look at something that might be interested in looking at positive coping strategies for mental health, and what you can do but if you look at things like yoga or meditation. That might not be useful for some mental health disorders, until they get to a point where they can use it.

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Student Speaker 3 5:26 Yeah, that's interesting. I mean I've never thought about meditation as friends, when, when there is

Karen Cochrane 5:36 an example that I'm very familiar

Student Speaker 3 5:37 with, I tried to meditate, I don't know really, which have been correct or not but

Karen Cochrane 5:43 there's also lots of different types of these kinds of coping strategies that are non medical, so their social coping strategy so it really varies. So, what the government wants to do is try in, especially people with severe mental health and especially homeless is trying to make them independent, so that's certainly because once they're independent, they're

not.

They're

not

being,

they're

not

taking

money

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the

state.

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I'm

looking

at

this

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governmental perspective, not from an ethical perspective. Yeah, I, as you read in my notes I have a very different point of view than this, but this is from the government so you could maybe potentially look at the stakeholders of different areas and see how what their goals are long term. Yeah, yeah,

Student Speaker 3 6:25 we are trying to build that. Yeah. So ask on question, which you have written about in the canvas. So, can you explain your previous experiences and so what are what are the images come to your mind when this should have been the first question actually, what are the images that comes to your mind when you hear about mental health and homelessness, harmless, from your experience

Karen Cochrane 7:00 with images,

Student Speaker 3 7:02 yeah images from your, from your experiences, or it can be anything which you read or anything. Um,

Karen Cochrane 7:12 I think, more empathetic images, so giving a perspective of understanding the community. A lot of people, especially in Australia or I'm from Canada. We definitely go on our lives very distinctly and kind of ignore these things so it's almost an invisibility and making sure that you understand that this can affect anyone. The idea so for example is my family member who hasn't severe mental health if he didn't have the support of our family he would be homeless. So the other reason he's not homeless is because I come from an affluent family, I'm very privileged I'm very lucky that way and he's very lucky because he gets to. He doesn't understand this. And as he's gotten older, his mental health has very much deteriorated. So he's his last memory he's thinks he's, he's definitely acts much older than he is. Because of mental health and so I like to use this as an example for empathy is this service isn't an image, but this maybe hopefully will help, but if you had two people go into the hospital that needs a heart transplant right they're gonna die in three days.

34 and there's only one heart, one has severe bipolar one is completely healthy, they're the exact same age, the exact same profession everything's exactly the same, it's just that mental health factor that's the difference. They're gonna choose 100% of the time the person who does not have the mental health. So there's this biases even in the medical field, and they're not going to think of any other factors, potentially, he could cure cancer in five years, it doesn't matter he has mental health problems we're going to choose the other person. Right. So there's this, there's this bias, even in the medical field of if you've got a mental health disorder versus not. You're going to be treated differently, and you're not going to get the same care as someone who doesn't have mental health disorder, even if it's about your eyes or you broke your arm like it doesn't matter what the what the medical condition is it has nothing to do with your mental health.

If

you

have

that

on

your

record,

you're

going

to

be

treated

differently.

So

there's

a

lot

of

biases

and

interpretation from everywhere, that they deal with in everyday life. So I, my research and what I'm interested in doing is really showing people the perspective of them. I don't, I, I sometimes probably have depression or anxiety, welcome to Life everyone goes through phases, right, but I don't, I don't deal with being afraid to leave my house, I don't deal with being afraid to talk to people I don't know. I'm very vocal in my life and just my profession I'm also very vocal, so you have that you have that disconnect, understanding it, I think is the biggest thing that I personally personally pushes having that empathy factor, and understanding their perspective. Like I can't imagine being afraid to leave my house every day yet my family member does. So, like, there's been cases where they lived in an apartment building and I think the person upstairs is following them, like you can't imagine what that unless you've, of course experienced that. I can't imagine how that would actually feel like to actually believe that. So, understanding that perspective and a lot of people choose there, not a lot of people, sorry, some people do choose as mental health to be homeless because they don't trust people, and they don't want to go into a home, they don't want to go into a group, they don't want to do this because they don't, because their brains telling them not to trust people because they're sick. So, there's, it's again very complex, and this is a couple of perspectives of what I personally experienced in my life or that I've worked with people that have had this happen to them before, and could explain it to me, but really understanding the empathetic and understanding that it's not like these people want to be homeless. It's not like they want to be a burden on society, because they don't. It's just, it sucks, really. But it's just brains are complex and we don't understand them completely yet I can't wait till we can just snap a finger and fix these problems but like we can't a broken arm. But until then, we'll just have to learn how to cope with them.

Student Speaker 3 11:30 We'll discuss the about when price to make the beeper independent so what are your other opinions about existing solutions, like, wow,

Karen Cochrane 11:41 honestly, They don't have distinct solutions. No one does, they just try their best, they try everything I've had I've worked with occupational therapists that work with clients with schizophrenia, and they've literally tried everything from buying them a Nintendo like switch and bind them like Nintendos to see if they could take care of a virtual dog to help them care about people, or if, or they bought them like, it's not like these areas don't have money which is funny, it's just they don't know what to do. So being independent giving them responsibility, getting them to be able to go to the grocery store, buy their own food, be able to clean their house. Go to a social activity without being afraid or imagine being afraid all the time. Like someone's going to kill you at any minute. I'm not even kidding.

35

Karen Cochrane 11:42 Some of these people feel this way, and it's just terrible. So, I'm talking about severe mental health someone with minor depression or anxiety can cope enough, it's still hard. And if you look at it from a medical perspective so if you're in fight and flight mode all the time. Your heart's pounding, you're, you're hurting yourself, right, like in a medical perspective as well so it's, it's all connected. Yeah, but it's trying to get people to be independent by making them buy their own groceries be able to clean their house, like, really simple things you don't often think about as much as I hate doing laundry I do get it done, and I wear clean clothes, you know, but these people they just can't. They don't have the, it's, it's not, they're not lazy, they're not. It's just in their brains. It's just their thought process is that logical. Yeah, yeah.

Student Speaker 1 13:24 I think the existing solutions that we're talking, we're kind of talking about is like, for example, St Vincent hospital like homeless people have been homeless, health, mental health, you know,

Karen Cochrane 13:38 if you're afraid to go to those places, what are you going to do.

Student Speaker 1 13:42 And there's another it that's that's what we're trying to to say like the existing solutions. There's another one called better pathway housing program. So there's people inside with mental health workers mental health clinic. Just people inside to help with, you know, they go from housing to housing. The housing, to talk to people to kind of, with like mental health diagnoses.

Karen Cochrane 14:10 A lot of the buildings and things like that, the landlord is very corrupt, they take advantage of these people, they use power dynamics to actually destroy these people's lives, and I've seen it firsthand, of, they just don't care about them and there's no empathy was involved in this process some of these situations, these people that are homeless are in, and they just don't care so examples like I've seen people have like broken showers for a month in these homes, and things like that I'm looking for from a Canadian perspective because I haven't done a lot of work here in Australia, and the landlord just doesn't care, he's like I'll get it done when I get it done, and what are the people gonna say they don't even want to talk to these people to begin with, so they just live in these conditions. It's almost like they're living in a third world country versus the rest of the world,

Student Speaker 3 15:03 or it can be similar as I have seen similar thing in India.

Karen Cochrane 15:12 Doesn't matter what country you're in, it's parenting, you know,

Student Speaker 3 15:16 people are more. Yeah, it would be like,

36

Karen Cochrane 15:20 I'm not trying to be morbid, by the way I'm sorry I'm not trying to be

Student Speaker 1 15:25 okay.

Student Speaker 3 15:27 Um, so, um, another question would be, because we are, you know, design faculty student and you are working design faculty. How do you think that we as design. Faculty can contribute towards this problem so it's like what kind of area like what method would you use, what tools or research so

Karen Cochrane 15:52 I would especially if you're not familiar with the area that you're designing for either designing with the population or designing with experts would be a really good factor for that, because we all come in and I come in the same way as biases and you want to think about areas so example even when I work with a lot of people in these areas. The problem is they don't tell me a lot personally because they number one they don't trust me. And number two is they think I'm, they think I think I'm better than them. To be quite frank, I'm never to just as a human but they don't know that they're like, Oh, I'm trying to help less fortunate than me I just made me feel good. So, so that's a lot of fact, especially working with disability community I work with a lot of adults, that's my interest, not working with children I don't work with seniors.

And sometimes when you're working with these communities they do think you're coming in because you think you're better than them, and they have that attitude, and you have an I have an attentional biases as well coming in, as I have minor disabilities but nothing serious. So, so I have my own biases I'm like why don't they just snap out of it. Sometimes you feel that way, you know, you can't. You really can't just change your, it's much more complex than that but, but I think everyone, just be careful of your biases, I got a suggestion from one of my supervisors, which I've taken to heart, is they actually write down, almost like a manifesto, but I'm working with a community of like what my biases are and I am very honest with myself no one sees us except me. But I'm very honest with myself with my own biases and I'm very honest with it and try to use those to help me run sessions. The other thing you can do is you can work with experts in the area. If you can't find it if you can't work with the community, or exactly what you're doing, have conversations with people who have worked with them before, is a really really good way to do it, and understanding the gaps and areas but I would highly suggest being specific. So looking at one thing, start there, just one tiny little thing that maybe you can fix or you can change in these people's lives. And then you can expand from there, because if you try to fix everything and you try to fix all of mental health, you might struggle with finding something that just checks out your boxes. Just by personal experience, maybe, maybe, maybe you're great, you don't need that but.

Student Speaker 3 18:33 Absolutely. Appreciate your effort and time you had shared with us today. Thank you very much. We will be in touch and will check if you can join the design workshop in May. Thanks a lot.

37

Dr. Marlee Bower, The Matilda Centre, Faculty of Medicine Dr Marlee Bower 0:02 Good morning. So, get more context. So you want me to talk about my experience, like just what I've been doing. Is that what you mean?

Student Speaker 2 0:13 No, so. I think what we would like for you is your when when you first hear about mental health among the homeless, what are your mental images that come across your mind like what are your first top three images that you think of a situation that people like me what you've experienced in your ether, anything, just your first mental images.

Dr Marlee Bower 0:38 You know it's funny because they actually have that thing where I don't imagine images I

have no images. I have concepts I suppose I could talk in words. Okay good cuz I didn't really have a visual mind. Okay, well, I suppose if I haven't talked through concepts, but I think about his connection. So, interpersonal connection and the importance of the social support of people experiencing homelessness so people that from life. Pray homeless, and this and, and, and service providers. Now the connections during homelessness. I think of. Think about complexity. So, Yeah, it is not just the people often don't have the one particular issue in their lives or they're dealing with a really complex, interconnected sense of things that they're dealing with, so it could be real be to do with mental health issues but also substance use, interpersonal problems. The difficulty of what it is to not have constant income or constant housing not constant access to food and, and the, and the complexity that was there in life. And the final thing I think would be, would be stigma, I think. Because to be, unless, or to fall into homelessness is a stigmatised position to be in, and I think that is the thing that people know that they're going into when they go into homelessness, and it's a much large part experience and a large part of the mental health issues that people face while homeless is around, navigating what it means to be have a stigmatised identity. Yeah, I think they would be my three.

Student Speaker 1 3:21 That's a really good way to start on it and I think what I'd like to ask you is, like you're talking about how you can care for it and how it's stigmatised and what do you think has happened through the history and in your experience also, how has the process changed in, you know, dealing with such thing with the mental health issues that the homelessness.

How has it changed through the years.

Dr Marlee Bower 3:56 I think . I, well I think that the way that homelessness has been conceptualized has changed a lot over the years so primarily it. First of all, it was the idea that it was generally older than with alcohol misuse. And, you know, and that was kind of seen as the mainstay of what homelessness was and that was, therefore, about the time that what services catered towards. But over time, the image of what homelessness is Haddington who experiences homelessness. And there's now more recognition that the definition of homelessness is not just those who don't have housing, but extends toward all these definitions definition is Australia uses a kind of cultural definition of homelessness to count in the census who's homeless and who isn't, and to provide services, and you're seen as homeless, if you don't have housing

38 that people consider kind of the normative housing that a person needs not meet particular names. So to be safe at home, to be able to have some space to socialise and to have social health and security of tenure, which is basically that you just can't just go get kicked out tomorrow, you know. And so, there's primary homelessness, where people are, you know, what we often think of as homelessness and people sleeping rough on the street that kind of thing. The secondary homelessness, which is people in boarding houses, or perhaps in caravans and that kind of thing where they have often less secure tenure, and not private conditions. Definitely not as much space to socialise and this tertiary homelessness, which is things like alright so classes accommodation and stuff also post them, Perhaps, secondary and tertiary. Places like write group situations. Advocate petition to be more specific about what that would be, but there are degrees of homelessness or overcrowding, for instance, just type of tertiary hoarseness, so if you live in a place that you would need four extra bedrooms, in order to accommodate all the people that lived in that house. So if you had two adults to a bedroom, and that means that there's eight too many people for the house and that's considered homelessness and actually if you look at the homelessness stats in Australia. I think that the largest group of any population experiencing homelessness is international students often led by international students, is people who are in overcrowding situations. So, so yeah it's often not as you would expect. That way, the care of people experiencing homelessness has changed over time to cater to what a broadening of what we define as homelessness in terms of mental health care. There is, I suppose. Mental health care is now often articulated are included as part of a lot of service delivery to like housing, or support service delivery to people experiencing homelessness because as well acknowledged that there's so much mobility in mental health and substance use issues amongst that population that it there needs to be a medical component to to most care delivery to to that population. But the best case, the best kind of practice scenario is to have onset kind of satellite staff mental support to people experiencing homelessness. That services because people tend to feel a lot more comfortable at services because they are there all the time. And they kind of know this service providers and they feel comfortable there. So now, services might have their own psychologist that comes in on top nurse, or it might be kind of on a rotation from a local health district or help hospital, and because they know that people are unlikely to go and seek that service if it was in a mainstream location.

Student Speaker 1 9:30 Just to build upon the types of homeless situations that you thought about. What do you think, in which type, it's the most prominent where mental health issues are usually uncovered. So like in the primary one or secondary one or the tertiary one, which is the most likely to be affected by which set of people would be most likely to be affected by mental health issues.

Dr Marlee Bower 9:59 It's a really interesting question because there is has been a perception that people who are receiving have the worst mental health of anyone, but that is actually not necessarily the case. So, it is very stressful to live, and most people aren't just one type. You can rotate between different kinds of homelessness, that's really common. And so, you know, can you say that a rough sleeper, or someone experiencing prior homelessness is always rough sleeper. No, because there might also speckle into press accommodation sometimes. And I have plans in place and they might circle back into homelessness, like it's very common and situations like living in Crisis Accommodation or living in overcrowded situations are associated with particular stressors that can be linked to a mental health issue. So, there doesn't seem to be evidence doesn't suggest that there is a particular sub population that has worse mental health than any other

39 population. I think the issues that you know there are certain issues that would mean some of them are likely to experience and health issues, expressing, while homeless, like this, the stress of uncertainty of not knowing where your next meal is coming from, or not knowing the future and, and, you know, having to deal with a lot of kind of socially stressful situations on a daily basis. A car, kind of common amongst lots of different types of homelessness. So, yeah, it's not as simple as that, unfortunately,

Student Speaker 1 11:54 I just asked my team members if they have any questions right now, if they want to chime in. Anyone

Student Speaker 2 12:11 know, I just want to I want to talk about mental health and homelessness and how, you know, in the research that we've been doing, I'm sure you have come across as it seems to be so complexity interconnected, like a circular cycle of cause and effect. One triggering the other. So, what is the what is the root of the issue in the problem of the problem, to sort of say,

Dr Marlee Bower 12:42 yes, there's been a lot of research is trying to get to that point, but that there. There isn't. There isn't really there's no answer to that, I think, um, you know, there's been one study in Australia that looked at, you know what comes first, is it.

People with mental health issues, do people become homeless because they're mentally unwell, do people become mentally unwell because they're homeless that's stressful. And the answer is. Sometimes yes, sometimes no. And that people, you know, that if you don't have a mental health issue before you become homeless. Then you have a reasonable likelihood of developing one why there must be a stressful situation. But we do you know that there's a large prevalence of adverse childhood experience amongst people experiencing homelessness. So that's 10, tends to be really stressful situations in childhood like abuse or take them around a lot or a death of someone close to you, that kind of thing is really common, most people experiencing chronic homelessness. So, it's, it's often there is I don't know if you've come across this. This concept made popular by Fitzpatrick, in the UK called multiple exclusion homelessness.

And that is a catch all term to describe the kind of sub group of people who have really complex needs. So then not only experiencing homelessness or likely a substance use issue and they might become really involved within the culture of homelessness in terms of really making a lot of friends what people is pointing to more things, and became more ingrained in the last style. And the theory goes that the more ingrained you get the more difficult it is to exit. But not everyone fits into that category of kind of point to that end, and for a lot of people might fall into homelessness, and then you no doubt, and, and, you know, never fall into it again but the narrows that kind of multiple exclusion group with more complex needs, often we come up with mental health needs that tends to fall into homelessness again and again.

But I think it's something crazy like one in 10 people in Australia have experienced some kind of homelessness over their lifetime. So, I mean you might wonder that the ABS stats have that in terms of lifetime prevalence. So some people say that it's really rare. And in fact that's becoming more and more common. But what I think is that we may think about homelessness broadly that then you start to consider that yes it's a good experience a lot of people have gone through that kind of house and living between housing and for a lot of people it's just kind of a small moment moment in time adjustment to come to define them. But then for some people it becomes an ongoing issue in their lives and something that does that define them. Very if I didn't answer your question, it's just, it's hard. I think the answer is you can't there is

40 no one cause of homelessness. And the only thing people are missing is it's really diverse group. And the only thing that often people have in common is their homelessness, you know, rather than a fountain defining aspect about them.

Student Speaker 2 16:32 In your experience, what has what has helped the homeless people want to work, what are the potential opportunities that haven't been explored.

Dr Marlee Bower 16:45 Yes, so I think that one of the most commonly described programs that people love to talk about in terms of homelessness is housing first. So this idea that you give someone that they used to be a prominent stepped models of care, where you'd have to. You'd have to prove that kind of overcome any mental health issues you have, and become abstinent from using drugs and alcohol and then you would be provided a house, as you prove that you were able to do that. But the housing first model says, No, you get, you should have a house that infrastructural support, and then maybe you'll have Ghibli given support and resources to then overcome other issues in your life if you so choose, but it shouldn't be it shouldn't be that you must prove yourself before you're given a house that's human right. And this, and Housing First is generally seen as more successful in terms of tenancy outcomes rather than the format because it's more sustainable. I would argue that's a really strong point and that it is really important. But I'd also argue that that often people are not given the support they need to post housing in their situations and that's often the funding issue to do with the way that Australian services are funded. And you do need people do need ongoing support. Often quite attended support for years after they've been hired to help them, Especially if people are experiencing chronic homelessness listeners for years and years of their life, you know, there's a lot of things that you need to learn how to do again, keeping house, paying bills changes how you do that all the time you need to know there's so many things, and then reconnecting with family. Getting retain maybe getting work or study if you want. There's so much to do and it's, it's, and I think that often places, stop too early in provision, giving provision help because they will go in. They'll give how someone knows, set them up, they'll do that kind of infrequent visits, and then they'll just taper off and then the person would left to their own devices to what is really an alienating time, so I think there is a much better opportunity in terms of in housing, providing housing in creating more intensive ongoing support. Post has post that housing point not to make in order to support someone to live well post homelessness.

Student Speaker 2 19:48 Could you expand on the types of support that we could provide post, providing them home to follow up. Is it is it to do with only mental health, or funding.

Dr Marlee Bower 20:02 Yeah so, I mean, There's different kinds of models of support, which look up. There's a third of case treatment of case management, there's intensive case management. I think there are some really interesting work done around the role that of occupational therapists, from what they might be able to do with that population, because that's their expertise is really helping people live well in new spaces with an considering impairments that can might have an handicap.

41 Yeah, So there is a lot of fun lot of potential there. What I'm saying that's been interesting in terms of mental health support that they've found is that people who have experienced homelessness. As I said before, are much more likely to access mental health support if it comes to them to places that they're comfortable rather than the mainstream says we might feel stigmatised or uncomfortable. But then when people into housing, they're often no longer meet the needs of God, attend people where they are, they, you know people are expected to go to mainstream services. And that's just not really conducive to what people are comfortable with and it means that people step back from treatment, rather than continue to, to attend. So there does need to be that kind of what I said quiet led mental health support people actually prioritise what clients need. But, I mean, mental health care in Australia. Anyway, there isn't very much.

There's acute mental healthcare. So there's, you know, hospitalisation, community treatment orders. Kind of the current community mental health support that's very very intensive if you're very very ill. And then there's kind of Pac blood triple support on the other side, where you have, you know, a non acute mental health issue but need God and psychologist, every so often to get support, and that can be very expensive. There are many book build available there's not much in between. So, I mean, people's Christian homelessness also fall into that same gap issue that mainstream population does where there isn't ongoing mental support to those anywhere in between those two lines and especially not for people with a lot of income. So, I suppose, the answer is as a lot of support, be needed. Probably a lot of targeted around just case management of social worker support, occupational therapists support specialised mental health support. There's so much that could be needed, and I don't know, I, it's hard to really articulate what that would like precisely look like but it's fine to explore.

Student Speaker 2 23:09 Thank you. Evie, do you want to take up the last question.

Student Speaker 3 23:15 Yep. So, before the last question I'll actually want to talk about how do you think, University of Sydney. How can we, like where do we stand in this entire problems but it's like, how can we help as University of Sydney like what kind of potential Do you see. Well,

Dr Marlee Bower 23:39 I don't know what a university can do. I mean, there's a lot of funding. I suppose you can. There, there is an opportunity to make sure to trial out. Ensure that homelessness is part of the curriculum and different practitioner roles. So, social work,

occupational

therapy

groups

like

that.

I

mean,

these

are

groups

that,

you

know,

make

sure

people

have

experience and a well able to to work with convex populations, I suppose. There's outreach that could be done. I mean, I suppose, Sydney University is a very wealthy institution that they could create. Yeah, I mean, even trial housing models that are amenable to people who, who are low cost housing so like for instance housing that has stainability built into its modelling so that you know, people don't have to pay lower amounts for electricity, and other costs, kind of, I suppose the other issue is that a lot of housing for people experiencing homelessness is pretty poor quality. And so, you know, that kind of older retrofitted to kind of house condition places maybe you'd better take old, you know, created housing that was actually nice to live in, you know and feel proud of communities that they were living in. In terms of, I suppose, the path for money, the benefit the Sydney Uni has is that it pumped out a lot of professionals that could support people experiencing homelessness. And so I think the best thing they could probably do in that space is to

42 create models of care, and make sure that their clients, or their alumni are actually the well schooled and have support different populations, and have a socially conscious mindset that incorporates people experiencing homelessness within, like, to get the kind of support and care needed. Other than that I don't really know what to do and you could do.

Student Speaker 3 26:13 Yeah. As a member of the medicine office, sorry, faculty, how do you think specifically that you and your faculty can contribute towards a problem space. Specifically,

Dr Marlee Bower 26:39 I mean I'm not sure really, I suppose, one thing I've had to change in my researches to provide findings back to people experiencing homelessness, and services so that they can use the findings to advocate for funding, and to advocate for the needs of coalition so it's not just research finding staying within the silo of academia but also being pushed back.

So related, I suppose, in terms of faculty of medicine help. I mean, I don't know I don't really have much contact with medical students or anything so I wouldn't know that that, I mean I'm only research oriented. Yeah, I suppose, would be if the University of Sydney, and the faculty of medicine could. I mean, in our faculty and all faculties of the university really there's no ongoing research money so you have to do research where the money is. And if the faculties, or the university were able to provide the small amount of funding he to do local projects or support local communities in issues that they thought were important, and, and, you know, he service things that you could share tie around and do and do work that directly supports communities, and I think that could be a way that they could see the help that researchers could help them to actually do things that would, if community focused rather than always having to do what you can with them, kind of, where you can get funded, because they don't have ongoing salaries or anything like that. Yeah,I think that's all I can think of. Alright, Thank

Student Speaker 3 28:29 you, Sree you have any more questions

Student Speaker 4 28:37 on, you talked about before we giving house, or before the approach as Housing First, we need to get ready for the people to get to get back to that kind of life. Can you please elaborate on that. Do you have any experience or how you come across something similar to that, or are you afraid that even if we give them house, there is a chance that they will go back to the previous slide. Yeah,

Dr Marlee Bower 29:17 I suppose in a housing first model, what I'm saying. I suppose I may I wasn't clear I think that the, the housing readiness thing. So those waiting there someone's like, not went to someone sober, or has no mental health issue before you have them, is not the right way to go. I think people should be given housing first and foremost because that's a human right.

I think saying for was that, yes, it's very common for people to get into housing, especially if they're from that group, who are experiencing chronic homelessness. So for some people, you know, experience homelessness. And then, and then find housing, and then will no longer be homeless in that situation, then not only once you've been to homelessness

43 in their lives, whatever, but for others who have experienced much more homelessness over their lives. It's really hard to get out, it's really hard to change. So we had to go back to a live kind of house life because lifestyles very different and no longer spending your day trying to find a house at night, or shelter at night or fifth at night, you've got a base, but that can be very intimidating for people and scary, because they're not used to living in private, they're not used to doing the kind of things you make do and a house like organizing bill payments, or organizing, food, organizing, you know like the things cleaning products like getting back into that kind of routine. It can be really difficult. After living in a very intense space for so long, and yes it's common to people to go back to homelessness, because the other issue, maybe

issue

with

neighbors

or

issue

with,

not

feeling

comfortable

or

safe

and

housing

and

returning

back

to

homelessness. So I suppose what I'm trying to discuss this paper people with people get more support to stay in housing, rather than people living people in their own post housing, which is fairly common.

Student Speaker 3 31:38 Yeah, if that makes sense. I think Damien has a question.

Student Speaker 5 31:46 Hello, Molly. Hi. So I just had couple of quick questions to discuss, sorry for jumping back and forth, but I didn't want to, you know, raise questions so my question first and first one was on. Just could you tell us a little bit more about your.

Once you briefly mentioned about the universities decisions around research funding and direction, the scope and direction for the research as such, things like that and how that usually goes about how he how he sometimes can or doesn't impact your area of research, or focus and things like that. Yeah.

Dr Marlee Bower 32:32 I work in a research center. So, and there are some people who work in raised in academia who teach, teach as well and there are others that just do research. And if you do teaching as well, and some of your salary is paid for, for support for teaching. But if you're a research early person, you'd need usually need to get external funding. So grants from outside to do research, and that say you have an ongoing salary, and you need to find grants to fill out your name to fund your salary. So, and the grants that you do get access to or access to a very, very competitive, you have like a 5% or less success rate. So, 100, you know, five and 100 people who apply might get it. So, yeah, it's very competitive space and so you end up being limited in the kind of research that you can do.

Student Speaker 5 33:42 So does the university actually have any internal funding schemes for the research, only academics as well.

Dr Marlee Bower 33:52 It's not really, no. I slipped up a little bits here and there but not really know.

Student Speaker 5 34:03 So yeah, my I guess my second follow up. I kind of wanted to ask which is what has been your experience like with any kind of cross faculty work. If, if there's been any. Yeah.

44

Dr Marlee Bower 34:23 Yeah so, I run a network research network, looking at the relationship between the built environment and mental health.

So looking at the ways in which the space that we live in, and spend our time in can influence our mental health. And so, There's researchers in that from architecture and planning, mental health, physical health, those areas but some in policy and planning as well. And so that's been interesting getting to meet a lot of people from outside of medicine and health and more in practitioners, and also people in architecture design and planning. Also I've really enjoyed getting to know people. And it's interesting because, yeah, you often do this in silos, but I've really enjoyed being able to write with different people, and I'm now part of the housing lab but occasion design I'm planning to from that. And I'm doing. For instance, a drink. like a snack review with some people from artistic design planning on relationship between the built environment and loneliness and so what kind of environments, close loneliness, which is really really really interesting. So, yeah, it is possible, It's something that's done easily. They do get to learn a lot which I enjoy. They do also have to really fight to find connections because, yeah, it's often they're often very siloed faculties.

Student Speaker 5 36:12 These projects in the labs come about, like, how did they happen, like how did, how to, um, well that's

Dr Marlee Bower 36:24 for those ones that happen because, well, I like meeting people and I often go to different events and meet different people so, so that I got to meet people through that who would who would attend the network means that I've grown.

And I suppose, you have to be interested in the first place and those things so I tend to go to different events, and meet people there, different academic events outside of my usual space, and through friends as well, making friends that I have there in different areas of study and interest in disciplines outside and inside universities that kind of magnitude, they make more people who are outside of your usual space. I think it's all about who you know and being interested really

Student Speaker 5 37:14 show thank you very much.

Student Speaker 1 37:17 I think that's what we're trying to facilitate to this workshop. So, our core faculty that we chose were medicine and architecture. So that the faculty or the both the departments are able to collaborate and, you know, come up with solutions or at least some ideas into how we can tackle this challenge. So I think the upcoming workshop that may be planning. It will be really interesting to you know see you and other faculty members. So, Dr Caitlin referred us to you do contact you about this.

Student Speaker 1 37:56 you'd probably be a lot more interested in this, so she will be interviewed her also a couple of days back. So and we are now planning to do a little chop. In the end of me, where we'll have all the faculties that we have interview. Then we'll just kind of set the base together so that you can discuss the problems and then you know come up with solutions and ideas to how to, You know that will this is old school.

45

Dr Marlee Bower 38:27 Have you, have you found anyone else in Faculty of Medicine and Health?

Student Speaker 1 38:33 I tried to contact Dr. Professor Timothy ward. He's also in the mental health, medicine. Okay. He also showed a lot of interest into it, we're trying to you know get him on board as well, we're kind of looking over to how it will, you know, not turn out and see ya,

Dr Marlee Bower 39:02 people together.

Student Speaker 1 39:03 Yeah, what you just talked about is just sort of the thing that we're trying to you know facilitate in a better environment also.

Dr Marlee Bower 39:10 Oh great. Awesome. Well, yeah.

Student Speaker 1 39:15 And thank you, thank you so much for talking to us today. I think anybody has any questions, any more training questions that they have.

Student Speaker 2 39:29 Now, just like to add that, taking the time out, we were trying to get the thing the workshop is going to be about two hours. Sometime during May so we'll try and contact you and hopefully you'll be able to join us for the workshop.

Dr Marlee Bower 39:47 Okay let me know.

Student Speaker 1 39:49 Yes, absolutely.

Dr Marlee Bower 39:51 All right. All the best. Thank you.

46

Dr. Caitlin Buckle, DESIGN FACULTY Student Speaker 1 5:07 So thank you, first of all for agreeing to do the thing or helping us with our project. So the the umbrella is care. And the topic we've chosen is mental health among the homeless. This is part of our project for the design innovation catalyst.

So we're trying to facilitate a workshop between cross faculties in at University of Sydney.

Hopefully we can work together to come up with solutions and discuss the problem at hand and see how we go. Okay, awesome. Yeah.

Student Speaker 1 5:46 So I think we just like to start off with your canvas. So if you could talk us through the images you put on the and what was what were you thinking when you put it on there?

Dr. Caitlin 5:58 Yeah, sure. Okay, so the, I guess, I've had a bit of recent background, looking at homelessness and sort of some links with

mental

health,

but

not

directly

sort

of

indirectly

through

housing

resources,

housing,

so

it

hasn't

started

background, I'm assuming that you looked at my profile. So to recap.

So the reason why, when, when I was thinking of homelessness, what some of the pictures are sort of rough sleepers.

But I was also thinking about other forms of homelessness as sort of as described by the Australian Bureau of Statistics.

So like overcrowding or just living in, in for environments, which is not necessarily street sleeping. And so I was also thinking about the sorts of homelessness that you see regional areas where it might be crouched, couch-surfing or things like that. So the reason that I chose these pictures were so this is, this was an image of what I consider to be overcrowding, and so within the realm of homelessness, and obviously, or it could even be hostile for the homeless. And so yeah, just to me, that shows lack of privacy. And, and that's what I think of when I think of homelessness in this sort of housing sense. And also this image you were thinking about families. So it's not just the sort of stereotypical, maybe like, Man sleeping on the street, but you're thinking about families that are having to overcrowd or live in not great places.

So these three images were pet related. And the reason why is a recent research that I've done in collaboration with a couple of others from different universities, was looking at housing pathways with pet ownership. And one of the biggest barriers for homeless people. In that scene, the broad definition of homelessness is, if they have a pet, sometimes they're blocked from going into certain housing options. So even some people will even choose to keep their pet and remain rough sleeping, if given the option between being overly housed, or having an having to get rid of their pet, or keeping their pet and saying rough sleeping, so that's kind of why I chose those pets images. And I guess that links to mental health because a lot of these animals are really important to them. That's their companions. That's their best friends. And the links to mental health for the housing situations, obviously, lack of privacy law, lack of safety and security in tents. Yeah, and, and mental health issues that we're finding out about living in crowded spaces or pore spaces. And not withstanding even those people that have pre existing mental health conditions, but the exacerbation of that plus living in poor circumstances, yeah. So that's what your research, how have you come across anything that talks about what comes? First is the mental health issues.

So I haven't looked at that personally. I do know - There's a researcher that I've been collaborating with Molly was Yeah.

47 Yeah, she's, she's great. So she, she is in the health science, I'm obviously just looking at sort of like dwelling and structure and that sort of thing. Whereas she, she's got more of an understanding of the mental health side of the issue of loneliness. So she looks at loneliness, but also other aspects too, like depression. And but from conversations with her, this, to try to untangle that it's really challenging. I mean, you're trying to understand, you know, it's hard to say, to imply that one creates the other, but obviously, it's sort of a flow on effect. And for some people, they could have been living in poor housing conditions all their life and also had health mental health issues all their life. So to try and untangle that's possible. But certainly, what we're seeing coming through the people being forced into poor housing conditions through COVID-19, is that who has actually impacted their mental health? So there is it's sort of there's links both going both directions, it's not in one direction. Yeah. Yeah, there's been some pretty bad, pretty bad outcomes of COVID-19. So

Student Speaker 2 11:28 that's, that's our team member, she'll just introduce I'm sure we're just all talking through the PowerPoint, we've just finished up that.

You talked about people having companions with them, and then not being able to, you know, get them to shift into a shelter

Dr. Caitlin 11:50 So it's more to do with the people are willing to sacrifice on the physical side of things. Yeah. Or to be more comfortable mentally.

So as in with the companion. Yeah. So companion animals is a really interesting thing. And this is the companion animals often, I don't know if you guys do have pets. But yeah, but people get extremely attached to them, they become certain people find them as family members. And I think in particular, people that with mental health problems can be very dependent on the, on their companion animal. And in the homelessness research, we've also found that compound companion animals can really alleviate mental health problems and can even prevent some homeless people from committing suicide. So it can be expected can be extremely beneficial. But a lot of shelters are not pet permissive. And so people will voluntarily stay out of shelters because or hostels for homeless because they can't bring their pets. They will also if they can't, if social housing is not permissive, and they forego social housing, a lot of rentals private rentals don't allow pets. So that's been a really big issue that's come through in some research that we've done, obviously, most people have pets, but for those that do, that's a really, really important issue. Yeah, and especially for those with mental health issues, it's companion animals can actually there are people that that get that their pets considered an assistance animal because of their mental health issues. And so even in even if there could be considered an assistance, animal assistance, animals, sometimes they they aren't registered in that way. And so a homeless person would not be able to bring that pet into it. Awesome. And as always very reasons. important reasons for that, too, because not everybody wants to have pets around but yeah, those people with pets, it's a big issue.

Student Speaker 1 14:22 And it's quite an interesting different angle to the homelessness. We didn't come across that way.

48

Dr. Caitlin 14:28 Yeah, it's a that's a it's kind of a recent. I mean, it's not it's not a recent finding in other countries, but for Australia, it's something that's really that's coming up a lot in the video right now. Especially with people around Coronavirus. People were trying to house homeless people as quickly as possible. And then that's one of the barriers because you don't want to separate someone experiencing homelessness from there their pets or their family member, basically. Yes.

Student Speaker 2 15:04 So I think that's what's your take on the confusions that the community and the government is planning, you don't have housing for the homeless or social housing?

Dr. Caitlin 15:16 Well, so one, think it's really great that you looking at mental health and homelessness, because I think a lot of the times the solutions are siloed, where you're either looking at sort of the housing side of it, or you're looking at the mental health support, where it makes, it actually makes sense to have the sort of wraparound support of the both thought of together. I guess the term homelessness implies that health is the issue, but then there's obviously mental health areas to people staying in housing for a long period of time. Yeah, so I suppose I think that's something that's just starting to happen is that consideration of the care of both of those things at the same time, and which is really good. And that's also been some really great teams that have come through the pandemic, where people were actively trying to think about how we can keep people in housing, what are the barriers for them seeing and being comfortable in housing, especially if they've been living on the streets for so long, and being in a room can actually be very distressing for them?

So yeah, I think the the, that link between housing and health has, it's occurring to people more strongly now than what it might have previously. So and that's a really positive thing. And hopefully, that will actually see you guys doing that will actually translate into the design and the Yeah, the sort of the the physical structures that are made to support people experiencing homelessness, the resulting that goes into it, and also about mental health care to

Student Speaker 3 17:18 go to when we were first introduced to the topic, and we were discussing what we need to do. First, the idea when we decided that we want to work on the coolest side of things. The first idea was to, you know, go when designing a shelter, because Sabrina and I both are architects. Yeah, it was it was it's it was that, okay, we'll do do a design for it.

But then then we started to look deeper into it and throw them into delta aspect as well.

Dr. Caitlin 17:46 that was kind of my mentality to like, it didn't the solution is in the, in the term, right, homelessness, or maybe the heart.

But obviously, if it was that simple. Yeah. But I don't think that the sort of, I don't necessarily think that means that this sort of structural designs are not important. Because obviously, that's the way that hostels for homelessness, designed is also is a barrier for some people to want even wanting to stay there. As I said, like this, the PIP thing, but also effects that you're for some people it really works that you tend, they tend to be in close quarters, and that sort of community feel that's that works for some people follows that's really distressing. And they need their privacy. They even need the open air because that's what they're used to. So there is still that divine aspect within that sort of feeds into the mental health in the way that they. Yeah, what they their ideal experience. Yeah. Yeah. But basically, what I've heard from anyone that works with people experiencing homelessness, is that there's such a lack of resourcing that there's only so

49 much that you can do, usually, usually the sort of crisis accommodation is so temporary, that people are cycling in and out of it. And it's not, there's no long term solution for them to be housed for long periods of time anyway, so it's kind of just

Student Speaker 1 19:26 so it didn't feel like it's, it's just emotional.

Dr. Caitlin 19:30 Oh, yeah. Yeah. So usually, through through during COVID, which it might have lived in now. I haven't been looking at it for a while. During COVID, the sort of crisis accommodation was extended, and it became a they did that whole homeless hotels for homeless programs across Australia. And in that instance, people were able to stay for months at a time I think that might be within a year. And so that was that's huge temporary accommodation is usually I think, a couple of months, or maybe a couple of weeks. So yeah, so that's, that's a big change for being able to offer that to people was obviously really great thing during COVID. But not common thing. And those are not usually the resources put into, yeah, accommodating. And that also was only for rough sleepers so that it didn't accommodate all the other people experiencing homelessness that were couch-surfing in living in overcrowded dwellings that might have needed to get out of this situation because of domestic violence or anything like that. So yeah, that was only a very small fraction of people that were even offered that in the first place. So yeah, it's really big issue. So it's good, because traveling

Student Speaker 1 21:02 Just zooming out really quickly. How do you think it has changed? Over the years I mean.

Dr. Caitlin 21:12 probably not the person to ask that. So I've, I've only come into looking at the homelessness literature, very recently. So the with the pets and housing project, I didn't even look at it that much, it was only through the lens of pets, which is very, very narrow. And then only in the last. Only since COVID, hit tab I was then looking at through just looking at the hotels for homeless, that sort of like rapid responses to try and house people as quickly as possible. And that was for public health reasons, not for their own mental health reasons not to necessarily support them. And that was for the wider community. So obviously, the moment that the public health concern is gone, then that support is probably going to go away, unless there's a big fight for it. But what I've heard from interviews with homelessness service providers, they have said that they've never had the issues gotten worse for them. So they're missing increasing rates of homelessness, particularly among older age groups, which is a big health concern. They've got less ability to get a job and try to find housing through the private sector. And they've got been given less resourcing over time. So but it's sort of like all of these compounding issues that only in the last year sort of have been alleviated with the sudden focus on free money and support and hotel rooms towards Yeah, accommodate people. So that's what I've gotten from them.

But that's not coming from my personal license. Okay. Yeah. And then another issue that was discussed was the difference in so I look up regional migration and regional housing, and the difference in the difference in types of homelessness that you see in regional areas versus in cities. So again, that perception of homelessness as the sort of city urban homelessness, sleeping in it and mail and but in regional areas, partly you can see homelessness in caravans it's usually hidden, it's usually people that don't have anywhere to stay, except for like, just moving out to friends places,

50 it's less visible, because they don't have a main strip where, you know, you can see people sleeping on the side of the road might be like campgrounds. Yeah, so that's kind of kind of that difference, too. And there's that, and that issue with homelessness has also been exacerbated with the fires from 2019 to 2020. So a lot of lost homes, obviously, that's going to create high demand. So yeah, there's a lot of hidden homelessness in regional areas that is less visible and less enumerated than in the cities. So yeah, kind of, it's the same issues, you still get the same. You still do see that out of city, but it has to be tackled, it has to be looked at in a different way. There's less trying to remove some of it that there's less access to to hostels homelessness in regional areas to because kind of hesitant to move someone to the closest standard, which might be, you know, way away from what they used to. And so that's I guess, the mental health thing. We'd have to actually pull them out of the location that they know where they're familiar with where their support networks might be to, for them to access accommodation, whereas in a city, it might only be a suburb, but we're not that. drastic. Yeah. Those kinds of issues with regional areas. But anyway, I don't know if you think so much of reaching

Student Speaker 3 26:15 Oh,

my

question,

actually,

you

already

answered.

I

had

noted

that

you

had

researching

on

internal

residential

migrations. And he was able to ask that difference. What do you see? So you were researching on internal migration or, or non Australian migrate migration or like we have lots of people like us coming from outside. So do you see in homeless in that demographic difference?

Dr. Caitlin 26:46 As in in terms of people experiencing homelessness, in their migrant status? So I look at more at a domestic migration within Australia. So I mean, that might be involved permanent residents, but it's usually sort of Australian born. But I thinking about internal migration, it does. It definitely played into it. international migration, it definitely played into it during the Coronavirus. So that was one of the questions that I did ask homelessness service providers. If they saw people that were stranded and couldn't get back, I would just sort of temporary visitors that were because the international borders close, we are stuck. And then we're experiencing homelessness. And we did see a chronic total evidence of that people sleeping in cars, especially international students not being able to their work being taken away. And so yeah, and so that that was definitely a concern. So yes, there was a rise in that during the pandemic free pandemic. Most international migration migrants that would experience homelessness, I would imagine, this is probably me just going off the top my head, but I would imagine you would see that would be less rough sleeping and much more democrat living in overcrowded spaces to for cheap rent, especially in maybe illegal boarding houses might see international students that just here temporarily just trying to save money on written and room sharing. We know Zahra nedarim, does work on that. And that does come into the definitely comes in the fraud concept of homelessness.

Because there's no privacy that's can be really uncomfortable. Sometimes very insecure. And yeah, so you can be kicked out which what did happen during COVID people were kicked out because they have insecure Tanja. Yeah. So that I can't comment that much on that. Beyond that interesting time during COVID where that was definitely a concern. That was actually one of the that was a big concern, especially from the like New South Wales health are really concerned that they because the a lot of homelessness services and health services, it's it's a lot easier to reach out to Australian residents, it's usually the best access to care. That was a huge concern for what was happening to international migrants that might not have good English proficiency and might be living in substandard dwellings and not know what Yeah, services they could have access to at that particular time. But yeah, I can only really talk about that COVID period. Sorry, I can't talk more broadly. It is definitely something that needs to be better studied.

51

Student Speaker 2 30:17 As a member of the design faculty, and since the workshop is about families collaborating with each other, and you know, working on the results, what do you think can be the ways you guys can, you know, collaborate with each other and maybe work together on this? How do they go about it?

The design faculty and medical faculty? Yeah, just as a collaboration, how do you think both of y'all come together to contribute?

Dr. Caitlin 30:58 I mean, we've started to do we have started collaborating, as I said, with Marley, who runs her own research.

Forget the name. So the I think, research was the collaboration is starting to happen. But I think, and I think we're sort of starting to talk about it as a combined health and housing design and housing system kind of issue. But I think what's missing is maybe the the, so sort of starting to think about the issue was combined, but we're not starting to think about the

solutions

as

combined

solutions.

I

think

that

will

come

out

of

this

collaboration

starting

when

you

have

conversations, but I still think a lot of the policies are either a housing policy or a mental health will help general health policy or, yeah, so I think that's still siloed. And that's probably based on the fact that the resourcing is, is siloed. The government, the different government bodies that look after different facets don't necessarily talk to each other, until recently.

Okay,

so

now,

after

COVID,

for

the

very

first

time,

a

lot

of

different

government

bodies

are

having

conversations that they never used to have. So yeah, there's a really big opportunity to not only think about just within the university collaborating within the university, but also how different government bodies can talk to each other who have the resourcing to actually, you know, enact really good change. And then, yeah, so talking with all the different facets that used to be quite separate, actually in the room together and talking about what they can do going forward, which they did have to during COVID, they all had to have very serious conversations about what they were going to do. And yeah, so now it was the opportunity to keep that going and continue and not back go back into those silos again. Yeah. So

Dr. Caitlin 33:41 I think it from what I heard from the homelessness service providers, they were very excited. Because this was the first this is sort of the first time that what they wanted to happen, which was proper conversations across the board between all the different stakeholders, I guess you'd call them that it was exciting for them because obviously it was already that situation for them before COVID. Anyway. And they were already dealing with people that had so many vulnerabilities, but now they were actually finally getting resources to do something about it. And they would have conversations about what can be done. What can be done better. Yeah, just really impressive. I know that you're in Victoria. They actually set up this the sorts of buildings they had set up during COVID. They, they had purpose built wraparound support. dwellings like they were they had mental health professionals coming in, they had caseworkers and they had sort of designed the spaces for their sleepers to give them as much support was the ad, which is a bit different to New South Wales. Hotels, which was good. But this different approach? Yeah, a slightly different approach.

Yeah. But I can't direct like me on that I have to look into that a little bit more. This is just from conversations with them about what they've said, what's happening at the time. So I'm not sure I haven't like fact checked it or. But yes, that might be something to look into. Yeah. Yeah.

52

Student Speaker 2 35:33 So they're already cooperating, in that sense, those mental health professionals and care givers. And yeah,

Dr. Caitlin 35:39 yeah. But I don't think that that's that from what people were saying that's not common. So usually, the mental health professionals and the health, people that work in health will sort of do their thing when someone comes to them through whatever channel with an issue, and then the housing, people will do their thing, or the shelter providers will do that thing. And but during COVID, they were speaking to each other constantly. So whether someone, they had pop up clinics with someone, when someone came to a pop up clinic, then they would see whether they also needed a place to stay. And likewise, people that were staying in hostels for the homeless, they were being monitored for any health issues. And then that conversation was, so it was kind of like a two way conversation that was happening, which, from what they were saying was something that just didn't really happen. Yeah. Yes. I think that there were caseworkers would make those connections. But I don't think that the channels of communication were as open and easy. Yeah.

Yeah. And it wasn't just and that's government. And also the nonprofits and, and researchers. So it was like, yeah, that's very, what makes them what you do what everybody was used to.

Student Speaker 1 37:18 I think we've, we've come to the end of our questions. So I just asked Damien if he has got any questions

Student Speaker 3 37:27 I am assuming that govt. may be providing facilities like shelters, mostly outside the city, because the non price everything is cheaper there. But we see lots of homeless people within the city, especially CBD around. So will that be a factor? Because those people like city life or the? Or will there be, will they will feel discomfort to shift to a remote or inner place where the shelters are provided? Using? Have you come across that desperate?

Dr. Caitlin 38:11 Well, actually most shelters are in are actually in urban areas. Because there are some shelters in further out of suburbs, but not necessary. But the regional provision is actually very low for what I imagined that the demand is. But what what you described I'm sure happen, it happens from both directions as in, you'll have regional people that can't have that don't have it, there's no rooms available in a regional area. And so they'll have to be transported into an urban area.

And that could be very unsettling for them. And then yes, possibly the other way around, where you have people in urban areas where there's just no rooms available. And this is especially true in domestic violence shelters. I'm not so sure as much about rough sleeping in hostels for the homeless, I don't know if they transport individuals, possibly not.

But definitely for people experiencing domestic violence. They're basically moved to whatever is most readily available, and that can be very far outside of there. Their networks and where they need to be. Which can be good because it can mean that they're further away from a perpetrator. But I don't know if it's the choice of the individual or whether it's basically up to the service provider who's just saying there's a root key that's the all we've got. Just got to go down.

Pretty much. Yeah, so that I'm not that sure about it, but I did hear that Yes. That the having to read Locate people is that would be as a mental health issue definitely like, you know, being taken away from things that you know of a suburb that you know, I mean, for some people, they can be moved really far out and it's probably not an issue for them, they probably don't mind. But for some people even moving a suburb over might be really distressing.