Bring back the institutions

07.01.2010

"The Australian"

THE wheel has been reinvented. Institutions for the mentally ill, orphans, alcoholics and so on were closed decades ago. Now, under the rubric of solving youth homelessness, they are making a comeback. Sure, a kinder, more enlightened version, but acknowledgment nevertheless that sometimes even in an immensely wealthy country the great desire to house people in the community was an ideal too far.

One commentator posed it as a trade-off between conscience and convenience: institutions were a convenient place to leave society's unwanted. This is too harsh. There was much wrong with old institutions, but in poorer times they were better than the street.

There is now a reappraisal, not that many would be able to read it in the commonwealth's white paper on homelessness, The Road Home. It is shot through with bureaucratese and endless repetition. Kevin Rudd could have drafted it.

Institutions are back. For example, several "foyer models" are operating across Australia. The term itself is so apologetic. These models are large homes that provide young people with longer term accommodation and education, training and employment links. Sounds awfully like a latter-day orphanage.

Foyer homes were developed in France to provide for young people moving from rural areas to the city to find work. As they developed, the focus was widened to providing support on a range of issues faced by young people living away from home. The model has spread through Europe and has also been established in the US. The Australian Foyer foundation is worth watching.

The institutional path has been anathema to the welfare sector. It has argued long and hard that all services should be provided to the needy in their own homes. It then complains that "people are generally expected to find their own way to the right services through a complex and disconnected service system. They often need to tell their stories over and over again."

Here is the heart of the matter. If government wants to live people's lives, it will need to pay for an enormous array of helpers. This may only be possible in an institutional setting. The homeless report never informs the reader of policy trade-offs.

In 1987, Bob Hawke promised that by 1990 "no Australian child will be living in poverty". In 2008 Rudd promised that by 2020 "homelessness would be halved and all rough sleepers will be offered accommodation". Will he be any more successful than Hawke?

In the white paper there are some bright sparks and some dullards. The youth homes are a start. These will inevitably become the stalking horse to institutional settings for all types of people with needs, especially the mentally ill. Another is the possible introduction of compulsory rent payments from Centrelink for public housing tenants at risk of eviction.

One dullard is the idea to establish the Bea Miles Foundation "to channel funding, in-kind support and sponsor innovation and research in combating homelessness". This appears to be quite different from the B. Miles Women's Housing Scheme, which provides supported accommodation for women without dependent children who have a mental illness.

According to the Australian Women's Register, "Bea Miles was notorious in Sydney for her disruptive conduct in public places and her criticism of political and social authorities. She had no fixed address, and claimed to have been falsely convicted by police 195 times, and fairly convicted a further 100 times. Her occupation was listed as `rebel'." Far from addressing the issues of mental illness, such a foundation embeds the ideology of the anarchist and destructive ideas about railing against authority, which in this context means police and social workers.

Other examples are the argument to clean up the residential tenancy database, which records bad tenants, and water down legislation that permits "without-grounds termination". Yet these are legitimate tools for reducing the risk of rent loss and damage to a rental property and managing properties for best return. It may rankle some that a tenant has a record or that a landlord wishes to use the property for other purposes, but if the government prevents a formal record of bad tenants an informal one will operate, and entrenching tenants will force up rents.

The white paper conflates too many people with different problems. Apparently, every night about 100,000 people are homeless. But the vast majority are living in temporary or makeshift accommodation, with family or friends, in specialist services or in substandard boarding houses. In fact, there were about 16,000 people sleeping rough.

Conflating the numbers conflates the issues, for the reasons for homelessness are so different as to not be amenable to similar solutions. An example is the argument in the paper that an increase in the supply of affordable housing is crucial to permanently reduce homelessness. Most of the homelessness occurs for reasons other than price and availability.

Rough sleepers and people who are chronically homeless are more likely to have mental health issues, substance abuse problems and disabilities. The evidence suggests that the longer people with mental health problems are supported by specialist homelessness services, the more likely they are to move into public, community or rental housing rather than return to rough sleeping. The key is how these services are best delivered, on the street or in an institution.

The paper advocates "assertive outreach services" and "wrap-around" or "whole-of-person support" for these groups. Evidence shows that the longer a client is supported, the better the outcome. But how? Personal helpers and mentors provide intensive community support for people who have difficulties in everyday functioning. They help people with mental illness build social networks, gain employment, learn how to better manage their illness and live independently.

This program seems laudable, but clearly too many such people are sleeping rough. There must be a place where they can stay and where services can be readily supplied. Where people refuse services they are either forced to attend or allowed to about their business. Clearly, there needs to be a case-mix approach to better quantify the actual costs of supporting high-needs people.

There will also be more chasing down people, quaintly known as outreach, but at the end of the day some people will have to be housed in institutions. Unless Rudd recognises this, ignores the welfare sector, and acts on it, he will never halve homelessness.