GPs take a stand for ‘housing first’ in healthcare

With the cost-of-living and housing crisis compounding longstanding social issues in Australia, the RACGP has released its position statement on homelessness and housing instability.
 
Central to its position are three key policy responses; a ‘housing first’ approach to healthcare, adequately resourcing for GPs to deliver healthcare and make it accessible and better integration of health and social care in the community.
 
Dr Liz Sturgiss, who is co-founder of RACGP Specific Interests Poverty and Health, told newsGP it is important for GPs to advocate in this space as they are often the first point of contact for people within vulnerable communities.
 
‘As GPs, we’re really at the forefront of seeing the impacts of poor housing on people’s health,’ she said.
 
‘It’s very important we show that we understand the link between housing and health, that we have a really strong advocacy position and that these positions really talk about involving GPs at policy level.’
 
As a GP researcher working at the National Centre for Healthy Ageing within Monash University, Dr Sturgiss says she sees the impact it has on patients’ health when they don’t have safe, secure and affordable housing.
 
‘If you haven’t got a safe place to call your home, then you really can’t build on your own personal health and wellbeing,’ she said.
 
‘Nothing else really works in your life if you don’t have a safe place to call home.’
 
This ties into the RACGP’s ‘housing first’ approach, which states that ‘no person experiencing homelessness should be expected to meet health or recovery goals without first being housed’.
 
People experiencing housing stress is a growing cohort in Australia, and Dr Sturgiss says it is not always obvious which issues patients are facing.
 
‘In our minds, we often go to people who are rough sleeping and think that’s the only people that are affected but actually there’s a huge spectrum of people who are experiencing housing instability,’ she said.
 
‘Some people might be in an insecure rental situation, where their rent is being increased, or they’ve been told they have to move out for whatever reason, and that huge financial stress on people’s mental health really affects all aspects of their life.
 
‘With the way the housing is in Australia now, anyone can fall into a place where their housing is less secure than they ever thought it could be.’
 
She said GPs working to provide care in these settings are often left at a disadvantage and hopes this position from the RACGP will help generate some alternative approaches.
 
‘The health system really is set up for people who have an address, or who have a mobile phone, and are able to engage in the health system in a way that’s pretty linear and standard,’ Dr Sturgiss said.
 
‘The fee-for-service model is funded toward doing more patients per hour but patients who are experiencing homelessness have some of the most complex, physical, mental health and social issues, so that takes a lot of time to spend with them and give them the care that they rightly need.
 
‘It’d be great if we saw some different opportunities for thinking about how the health system could work for people that have much more complex lives.’
 
The RACGP advocates for change here as well, pushing for ‘appropriate resourcing and support’.
 
‘General practice can be a place to recognise housing stress and to coordinate patient-centred care to improve outcomes for people experiencing homelessness and housing instability,’ its position statement reads.
 
‘Additional support for this complex work could be delivered via existing funding channels, including the MBS, allocation of Primary Health Network funding towards homelessness supports, or new allocation of Federal Government grants.
 
‘Funding should be available to enable GPs and their teams to coordinate wraparound supports for these patients rather than relying on time-based face-to-face MBS consultation item numbers.’
 
Although it might be some time before existing policies are changed, Dr Sturgiss recommends GPs start to integrate questions around this issue into their patient care now.
 
‘I encourage GPs to ask patients about housing and financial stress, because often patients won’t offer it themselves,’ she said.
 
‘It’s really important to flag this with our patients, about if they have got a safe and secure place to live, and to know what services are available in our communities to point people in the right direction.
 
‘As GPs, if we can know more about our patients’ social situation then that means that we can offer them more person-centred care.’
 
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access to care homelessness mental health vulnerable populations