The link between homelessness and suicide risk

Posted 6th August 2021 in General

Homelessness Week (1-7 August 2021) aims to raise awareness of the impact of homelessness on Australian individuals and communities. 

More than 116,000 people are estimated to be homeless in Australia.1 Access to appropriate housing is a critical foundation for people to be able to participate in society and maintain good mental health. Housing insecurity and homelessness are linked to increased risk of mental ill-health and suicide.

An evidence review prepared by the Australian Housing and Urban Research Institute (AHURI) for the National Suicide Prevention Adviser and the National Suicide Prevention Taskforce investigated the role of housing insecurity and homelessness in suicidal behaviour and effective interventions to reduce suicidal thoughts and behaviours.2

The Life in Mind team has provided an overview of the key findings from this review.

An overview of the research linking homelessness and suicide

Evidence indicates that homeless populations have higher rates of suicide than the general population in Australia. A 2014 study in Queensland showed that homeless people took their own life at a rate of 27.6 per 100,000 people between 1990 and 2009 - almost twice the rate of people who were not homeless.3

On average, homeless males had 4.6 times higher suicide rate than women (40.9 per 100 000 for males compared to 8.9 per 100 000 for females). Being unemployed, having a history of legal problems and undiagnosed mental illness were strongly associated with suicide among homeless people. 

Overall, the evidence shows three main channels by which housing is linked to suicide: 

  • Extended periods of financial stress due to the cost of housing
  • Lack of security due to eviction, insecure housing and homelessness
  • The impacts of adverse life events on children and young people on their present and future mental health.2

At risk population groups

Some population groups were highlighted as being at increased risk of suicide or mental ill-health related to homelessness and housing insecurity.

Young people

Young people experiencing homelessness have elevated risk of suicide now and later in life. Domestic and family violence are key drivers of youth homelessness, as well as intergenerational homelessness, i.e. when a parent has also been homeless at some point in their lives.4

Indigenous Australians

Indigenous Australians have higher rates of homelessness compared to non-indigenous Australians (29% compared to 13%),5 but there is no research on the links between Indigenous Australians’ housing circumstances and suicide. Indigenous households experience higher rates of housing stress, related to factors such as affordability, facilities and infrastructure, security of tenure, and overcrowding. All of these factors can contribute, directly and indirectly, to poor mental health.6

Middle aged adults experiencing mortgage stress

The highest proportion of suicide occurs among middle aged adults (30-59 years), particularly males.7 Middle aged adults are the age group most likely to experience mortgage default and foreclosure.8 A study in the US found that rising home foreclosure rates explained 18% of the variance in rise in middle-aged suicide rate between 2005 and 2010.9

Older adults with mortgage debt or in rental situations

Growing numbers of Australians are carrying mortgage debt in to older age and retirement. Mortgage debt for older adults has increased 600% between 1987 and 2015, and mortgage debt to income ratio tripled. Older people still paying off their mortgage have higher levels of psychological distress and lower mental wellbeing than people who have paid off their home loan.10

Older adults, especially men, living in areas with a higher proportion of rental households have an increased risk of suicide.11

Gaps in the evidence

The evidence base on the links between homelessness and suicide is sparse, particularly in an Australian context. The review from AHURI was unable to identify any substantial studies on the link between economic recession, mortgage default or eviction on suicide risk in an Australian context, nor the effectiveness of housing interventions in mitigating suicide risk among homeless populations. There is an urgent need for further Australian studies, particularly on effective interventions.

What is needed?

Interventions for suicide prevention among homeless populations should be comprehensive, and comprise housing and social support, as well as mental health services.

One such intervention approach is called Housing First, which has been investigated in Canadian studies and shown to reduce suicidal ideation. In an Australian setting it has not been examined in relation to suicide, but shown to be effective in reducing hospital admissions and mental health symptoms.

There is also a call for involvement of the banking sector to better regulate mortgage provision and identify those who may be in a financial position that has potential to increase suicide risk. Mental health supports and pathways should be incorporated into court involvement, banks, eviction processes.

Notes

1

Australian Institute of Health and Welfare (2020) Homelessness and homelessness services, Australian Institute of Health and Welfare, Canberra, https://www.aihw.gov.au/report...

2

Brackertz, Nicola (2020) The role of housing insecurity and homelessness in suicidal behaviour and effective interventions to reduce suicidal thoughts and behaviours: a review of the evidence, Evidence Check prepared by AHURI for the National Suicide Prevention Adviser and the National Suicide Prevention Taskforce, commissioned through the Suicide Prevention Research Fund, managed by Suicide Prevention Australia, Australian Housing and Urban Research Institute Limited, Melbourne.

3

Arnautovska, U., Sveticic, J. and De Leo, D. (2014) 'What differentiates homeless persons who died by suicide from other suicides in Australia? A comparative analysis using a unique mortality register', Social Psychiatry and Psychiatric Epidemiology, vol. 49, no. 4: 583-9.

4

Flatau, P., Conroy, E., Thielking, M., Clear, A., Hall, S., Bauskis, A. and Farrugia, M. (2013) How integrated are homelessness, mental health and drug and alcohol services in Australia?, AHURI Final Report No. 206, Australian Housing and Urban Research Institute Limited, Melbourne, https://www.ahuri.edu.au/research/final-reports/206, doi:10.18408/ahuri-8201301.

5

Australian Institute of Health and Welfare (2019) Indigenous housing, Australian Institute of Health and Welfare, Canberra, https://www.aihw.gov.au/report....

6

Bailie, R. S. and Wayte, K. J. (2006) 'Housing and health in Indigenous communities: key issues for housing and health improvement in remote Aboriginal and Torres Strait Islander communities', Australian Journal of Rural Health, vol. 14, no. 5: 178-183

7

Australian Institute of Health and Welfare (2021) Suicide and self-harm monitoring, %20https:/www.aihw.gov.au/suicide-self-h...

8

Berry, M., Dalton, T. and Nelson, A. (2009) Mortgage default in Australia: nature, causes and social and economic impacts, AHURI Positioning Paper No. 114, Australian Housing and Urban Research Institute Limited, Melbourne, https://www.ahuri.edu.au/resea...

9

Houle, J. N. and Light, M. T. (2014) 'The home foreclosure crisis and rising suicide rates, 2005 to 2010', American Journal of Public Health, vol. 104, no. 6: 1073-1079

10

Ong, R., Wood, G., Cigdem, M. and Salazar, S. (2019) Mortgage stress and precarious home ownership: implications for older Australians, AHURI Final Report No. 319, Australian Housing and Urban Research Institute Limited, Melbourne, https://www.ahuri.edu.au/research/final-reports/319, 10.18408/ahuri-8118901

11

Law, C.-K., Kolves, K. and De Leo, D. (2016) 'Influences of population-level factors on suicides in older adults: a national ecological study from Australia', International Journal of Geriatric Psychiatry, vol. 31, no. 4: 384-391