The results have been presented according to the research questions. The materials identified in the environmental scan and included in the review for analysis are presented in Supplementary Material Table 1.

To What Extent do Current Australian Policies Address the Needs of Homeless People with Disabilities?Policy and Strategy Response to Homelessness and People with Disability

No national housing or homelessness policy exists in Australia. There is also no national legislation for the right to a home, despite Australia being a signatory to various human rights conventions. These include the United Nations Declaration of Human Rights (Assembly, UN General, 1948) and the United Nations Convention on the Rights of Persons with Disabilities (United Nations, United Nations, 2006), as two examples.

Responsibility for housing and homelessness is at the state and territory level, funded through the National Housing and Homelessness Agreement (NHHA) with specific commitments at the state level outlined in the bilateral agreement between State and Commonwealth governments. Six priority groups are identified within the NHHA. These are women and children who experience domestic violence, children and young people, First Nations people, people experiencing repeat homelessness, individuals leaving institutions and older people. People with disability were not identified as a national priority cohort. The NHHA is currently under review, and of the 101 submissions to the review made online, 71 mentioned people with disabilities specifically.

State governments have the scope to include additional priority cohorts within their bilateral agreements. Four States include some reference to people with disability (Tasmania, Queensland, New South Wales, Australian State Territory) to varying degrees of specificity. New South Wales and Queensland explicitly refer to people with disability as an at-risk group and offer potential solutions for that group. The state governments of Western Australia, Victoria, South Australia and the Northern Territory refer to people with mental health and psychiatric disability as an at-risk group.

Furthermore, the agreement as to the provision of disability services between the Federal and State governments is outlined in the National Disability Agreement (Council of Australia & States and Territories, (COAG), 2009). The Productivity Commission reviewed this agreement in 2019 (Australian Government, Productivity Commission, 2019) and named the NHHA as the tool to address housing needs for people with disability. It also reaffirms that housing for people with disability will be provided by state bodies. This agreement replaces the National Affordable Housing Agreement (COAG 2018e, cl 9) (Australian Government, Productivity Commission, 2019). In addition, recommendations by the House of Representatives Standing Committee on Social Policy and Legal Affairs Inquiry into Homelessness (Parliament of the Commonwealth of Australia, 2021), state that people with disability should be acknowledged as a priority cohort for responses to homelessness and housing.

The NDIS Supports for Participants Rules 2013, (Australian Government, 2013a), described the agency as being broadly responsible for behavioural supports to maintain a tenancy, home modifications in both private and congregate housing (however, it remains the responsibility of housing authorities to develop, maintain and refurbish stock that meets the needs of people with disability) and financial support for users who require an integrated housing and support model. The NDIS is not responsible for either providing housing for people in need of housing assistance or ensuring that new publicly funded housing stock incorporates Liveable Housing Design features, government homelessness-specific services or improvement of community infrastructure.

The proportion of people with disability who will be eligible for the National Disability Insurance Scheme is estimated at around 6% (Allen et al., 2016). Thus, any discussion of what the National Disability Insurance Scheme can and cannot do in relation to housing and homelessness must be interpreted with this in mind, and the greater majority of people with disability who are not eligible for NDIS must not be forgotten. This was highlighted in the Disability Housing Futures Working Group Final Report (Allen et al., 2016) which stated “Alternative housing assistance options should be developed for people with disability who will be ineligible for NDIS specialist housing. This includes improved access to social housing, co-investment opportunities for family members and charitable organisations, and shared equity home ownership.”

The Joint Standing Committee on the National Disability Insurance Scheme Progress Report (Commonwealth of Australia, 2019) recommends action from the Council of Australian Government Disability Reform Council in relation to housing for people with disability. The government’s response to this reinforced the responsibility for housing lies at state and territory levels, including responsibility for ensuring accessible housing options.

The Commonwealth’s response to the Standing Committee Recommendation 16 was one of support in principle which stated that.

Responsibility for the provision of accommodation for people with disability is a shared responsibility between the Australian Government and states. The division of responsibilities of different sectors delivering supports to people with a disability is set out in the National Disability Insurance Scheme (NDIS) Applied Principles and Tables of Support, which seeks to guide the interaction between the NDIS and mainstream supports, agreed by the Council of Australian Governments in 2013. The Australian Government and states, through Disability Ministers, are continuing to work to improve the availability of short, medium and longer-term accommodation options, provided through the National Disability Insurance Scheme and mainstream systems, for all people living with disability.

Concern regarding housing for people with disability in Australia was raised by the Committee on the Rights of Persons with Disabilities concluding observations on the combined second and third periodic reports of Australia (UN Committee on the Rights of Persons with Disabilities (2019). Specifically, there were concerns regarding the continued placement of young people into aged care facilities and a shift towards re-institutionalisation as a result of the Specialist Disability Accommodation scheme under the National Disability Insurance Scheme (NDIS).

What Evidence of Effective Interventions or Approaches to Support Exit from or Entry to Homelessness for People With Disabilities Exist in Australia?

Policy approaches range from crisis and emergency responses to preventative measures and early intervention. These policy approaches have informed the use of a number of models and approaches in the Australian context, with varying degrees of evidence behind them. This section describes the key intervention models identified in the scan.

Interventions and People with Disability

A variety of preventative measures were identified across the scanned literature. Housing First (HF) was identified as a model which was adopted by many OECD countries. The inclusion of this model was evident in the Australian policies and practises identified in the review. When Housing First was referred to, people with disability were not named specifically, with it applied in more universal terms.

Housing First is primarily a structural- and system-level intervention, includes the provision of physical housing and has at its core the improvement of systems collaboration. There are many examples of Housing First models and principles being implemented across Australia. These are described with other housing models identified across the literature in Supplementary Materials Table 2. There is no nationally consistent approach or commitment to Housing First but states and non-government organisations have adopted Housing First in various contexts.

Examples in Australia include the Together Home and Supported Transition and Engagement Program (STEP). However, though principles of Housing First are incorporated into these programmes, neither are long-term programmes, and both require service engagement (New South Wales Audit Office, 2021). The Common Ground intervention was identified as another model which uses the principles of Housing First. Common Ground seeks to provide permanent housing to people who have experienced long-term homelessness. It also offers onsite wraparound support, with housing assigned irrespective of the engagement with support (Mission Australia, 2022).

The majority of the literature recognised that the inadequate supply of housing stock in Australia is a substantial contributor to the issue of homelessness. In particular, the state housing plans almost universally agreed that the physical provision of affordable and appropriate housing is a fundamental element of reducing homelessness. The state housing plans had reference to facilitating land development and rezoning, as well as in some cases rent assistance for people who required it.

Sustaining Tenancies in Social Housing (STSH) programme assists people living in the Department of Communities and Justice (DCJ) Social Housing to maintain their tenancy and increase their overall well-being. It is based on a shared-care approach, working collaboratively with organisations and people to address at-risk tenancies and subsequently homelessness, and increases the participants’ social connection to improve overall well-being. A pilot was run in NSW and deemed successful with recommendations to expand the model to private as well as social tenancies (Mission Australia, 2021a, 2021b, 2021c, 2021d). This approach is deemed a structural intervention, as it focuses on the improvement of housing stock and income inadequacy.

The Community of Schools and Services (COSS) model is an early intervention model targeted at supporting young people who are vulnerable with an exemplar in Australia known as the Geelong Project (Spinney et al., 2020). This approach is a cross-system approach with a strong focus on maintaining young people in education and supporting family networks. There is a strong focus on collaboration, data sharing and shared decision-making across organisations (Spinney et al., 2020). The Geelong Project demonstrated a reduction in early school leaving by 20% and a reduction in homelessness by 40% (Spinney et al., 2020).

Wraparound services refer to a collaborative care approach at the point of delivery, rather than system-level collaboration. The process of delivering wraparound services involves team-based case management. The term wraparound support is used to describe any programme that is flexible, family- or person-oriented and comprehensive—that is, a number of organisations work together to provide a complete programme of support.

Point-of-delivery approaches, such as wraparound services, are in practise in Australia. The Common Ground programme is an example of a wraparound service currently operating in Sydney, New South Wales. This 6-storey residential space, with inbuilt support services through Camperdown Support Services (CSS) prioritises people who have experienced long-term homelessness. Individual case management and interdisciplinary support across health, social, and welfare are provided. Specific outcome data is not provided within the report (Mission Australia, 2022), although Bullen et al. (2016) suggest that this is an effective model of care which results in improved outcomes for participants.

In addition to the specific interventions above, the review of Australian policy and practise also identified a shift towards models of systems integration and collaboration with services and systems outside of the homelessness sector but with the goal of reducing homelessness. Crisis responses continue to be needed, the policy shift is one to reduce future homelessness and reduce the over-reliance on crisis management. Gaetz and Dej (2017) identified six factors which can support the prevention of homelessness. These included engaging all levels of government, integrated systems responses at both government and community levels, data management and sharing across systems, co-ordinated prevention and housing first strategies and a robust evaluation and feedback system (Gaetz & Dej, 2017).

What are the Current Gaps in Policy in Relation to Housing, Homelessness and People with Disabilities?

In reviewing policy and practise, a number of gaps in the response to homelessness for people with disabilities were identified. A siloed approach and response to homelessness continues to be prevalent in Australia and there is a continued failure of systems outside of homelessness to work collaboratively to prevent people with disability from becoming homeless. The “No exit to homelessness” or “no wrong door” approach relates specifically to people in the criminal justice system or with mental health diagnoses. (New South Wales Government, NSW Government, 2020).

System bureaucracy has been found to make accessing social housing difficult for people with disability (O’Donovan, et al., 2021). This is nowhere more evident in Australia with the NDIS. The Protocol for Homeless People in Public Places (Committee on Community Services, 2020) noted how people with disability who are homeless were challenged in accessing disability support. Pathways and access to the NDIS are another noted challenge for people who are homeless (Committee on Community Services, 2020). These access and bureaucratic challenges within the system are reported more broadly (Carey & Malbon, 2021). Yet, there is a specific lack of understanding within the NDIS on the experience of and risk of homelessness for people with disability (Frankish, 2018). Accessing the Disability Support Pension is another challenge for people with disability identified in the inquiry into homelessness in Victoria (Parliament of Victoria, 2021).

The ways in which sectors and service systems work together need to be addressed. Consistently, in international examples, collaboration and partnership are central to success in eliminating homelessness, and a core aspect of this is sharing information between sectors and agencies. Infrastructure to support this is required. Collaboration and partnership across sectors are demonstrated in South Australia through the South Australian Housing Authority and the five South Australian alliances set up (Government of South Australia, 2021a, 2021b, 2021c, 2021d). This is in line with international examples, which demonstrate that partnerships are core to the elimination of homelessness. Evaluation of outcomes from SA is warranted and learning to inform scaling up of the model is required.

A major policy and practise gap identified in the environmental scan was the quality of data available as well as the sharing and transparency of data across systems. The policies and practises identified in this review highlight the limited application of policy and interventions to people with disability. This was identified by the Disability Housing Futures Working Group (Allen et al., 2016) which noted the poor quality and depth of data and policy on housing for people with disability. How this will be addressed through policy is unclear.

Data on social housing, private rental market as well as interaction and integration across systems is required. There is a need for better data on social housing which is disaggregated by disability (Pawson & Lilley, 2022). The authors also note the need for better quality data that reflects the true need for specialist homelessness services rather than provision which is the current case. Though people with disability are less likely to engage in the private rental market due to the range of structural and system factors, there is a need to understand the entry to and affordability of the private rental market for people with disabilities (Australian Government, Australian Institute of Health and Welfare, Australian Government 2020).

Drawing on the situation in Canada, Buchnea et al., (2021) highlighted the importance of data mining and the greater utility of data as part of a systems approach to homelessness prevention: “Currently, however, the uptake of tools and the data that is collected and shared within and across organisations, jurisdictions and systems is inconsistent. Similarly, we have yet to unlock the full potential of leveraging administrative data from the many systems that directly or indirectly relate to homelessness”.

The work of the Housing and Homelessness Data Working Group in assisting the implementation of a Housing and Homelessness Data Improvement Plan (Commonwealth Government, 2019) should be reviewed in light of the data and policy gaps identified in this environmental scan.

The environmental scan of policy and practise related to housing, homelessness and disability identified a wide breadth of documents, key points of intervention and further research. The findings of the scan are discussed within the context of the Australian housing and disability landscape.