Mamamia Investigates: 'I would rather be in prison than living on the streets.' The reality of access to healthcare when homeless.

It's a dreary Friday morning in Sydney's CBD when we come across *Tanya.

She sits on the edge of one of the city's main streets, holding a sign that lists the topline details of her story. Of course, there's far more to it than just four sentences.

Tanya has breast cancer. She's in her 50s. She's experienced a family breakdown, a subsequent divorce, which has left her vulnerable. And a complex mental health issue is a factor for her, along with limited access to accommodation and low financial stability.

This morning, she's sitting on a bath towel cross-legged, reading a book, with a red bucket sitting in front of her to request money from passersby. 

She is one of many Australians currently experiencing homelessness.

I'm with Erin Longbottom and Emma Barnett, two of the figures behind St Vincent's Hospital's Homeless Health Service, a community health service that aims to improve access to healthcare for people experiencing homelessness in Sydney. 

Watch: Jai talks about his experience of being homeless on and off for twenty years on the streets of Sydney. Post continues below.

Emma, who is a registered nurse with the Homeless Outreach team, says that care given to people who are living on the streets can be a balancing act. 

"Making sure they're emotionally supported is just as important as providing that tangible medical healthcare. We saw the impact during COVID, when places like The Wayside Chapel shut down — for those who are homeless, it felt like their community was gone. And that has a big impact," she says to Mamamia.

On any given night in Australia, more than 122,000 people experience homelessness, according to Mission Australia.

A good portion of these people rely on couch surfing, loved ones, and temporary accommodation like hostels, caravan parks or cars. But some don't have any shelter, resulting in them sleeping rough on the streets.

In Sydney's CBD, there are hundreds who sleep on the streets. 

It's this group that the Homeless Health Service aims to support directly, with their multidisciplinary team made up of nurses, doctors, allied health staff, Aboriginal health workers, and peer support workers.

Erin, the Nursing Unit Manager, has been in this field for over a decade now. 

"Many of the people we come across in our work are really untrusting of outsiders. And you can't blame them. These systems, whether it be government, health or housing, can be really traumatising to navigate — especially those from marginalised groups and people who have been thrown to the curb their whole lives," she explains.

"Any man that's sleeping on the streets in his 50s, chances are he would have been brought up in some kind of institutional out-of-home care and have experienced incarceration."

For Steven*, this has been his lived experience. 

"You don't want to know about what it's like here [on the streets']. I've thought about going back to prison," he says.

He sits on one of Sydney CBD's main thoroughfares on a blanket, along with his Staffordshire Bull Terrier Roxanne.

"If the shelter would take her back," he says pointing to the dog, "I would go back there to jail straight away. She's more a headache than anything, she ate four packets of treats today."

Despite what Steven says about Roxanne, it's clear that she brings a lot of comfort and care — things Steven rarely gets from the hundreds of people who pass by every day.

"You see all these people walk past, they never look [at me]. Never," he says. "It's rough here. They're good eggs," he says about Erin, Emma and the service they represent. "But no, it's pretty bad in general here."

Soon after speaking with Steven, a man approximately in his 30s storms past us. He is shouting at the general public who walk by obliviously, the man violently swaying from side to side and swearing. 

Emma says after we're a distance away: "I think the longer you do the job the more you can just trust your gut about when is a good time to go up to someone, assess and offer them medical help, and when it could be a danger.

"My worry is obviously he is not having a very good time, and he's unwell. You also don't want him to assault anybody and then for him to end up with a criminal charge on top of having what is likely a psychotic episode. 

"I wouldn't approach somebody who is like that right now. But if I was on patrol and on the job with my team, we would look into it further and assess if police or an ambulance would be needed to de-escalate the situation before we help the individual."

When it comes to treating someone for a mental health issue when they're experiencing homelessness, Erin says it's a combination of healthcare and support.

"We prioritise supporting that person into accommodation – treating any health issue (mental health or otherwise) is a bandaid solution," she notes.

Image: Supplied.

"If the person declines accommodation, which does happen as people often have had previous negative experiences in housing, or with healthcare, we continue to offer them care and support on the street. The important thing is to keep going back."

It's often building a non-health related support, like bringing food or clothing, that can establish a rapport. And with this trust, the team has a greater chance of assisting the individual with their mental health care. 

As myself, Erin and Emma walk throughout Sydney's CBD — meeting some of the people they work with regularly — it's clear there are very few women visibly sleeping on the streets, compared to their male counterparts. 

"Because they're more vulnerable statistically speaking, women tend to find crisis accommodation like hostels, couch surfing or cars. You don't usually see many end up sleeping on the streets," Emma says to Mamamia. 

"Women over 50 are the fastest growing demographic experiencing homelessness. And a lot of that comes down to domestic and family violence, a lack of financial literacy and/or security, and other factors. But accessing adequate healthcare remains a challenge for many of them too."

The most common health concerns that she and the team come across among the homeless include ill management of chronic diseases such as diabetes, cardiovascular disease, asthma, dental, seizure disorders and occasionally (but increasingly commonly) cancer.

Age-related illnesses are also becoming increasingly noticeable, given the mortality gap for people experiencing homelessness is between 10 to 30 years higher than the general population.

Then something as simple as a cut can also get infected easily. And for women, access to reproductive healthcare is key too. 

"Reproductive health-wise, we have people with fibroids, previous abnormal pap smears that need repeating, ovarian cancer and occasionally we find pregnant women. We would usually refer and support people to attend specialist women's reproductive services," Erin says.

Rochelle Courtenay is the Founder and Managing Director of Share the Dignity, a national charity with the mission to ensure that everyone is afforded the dignity of having access to period products. She is also the Queenland recipient of the Australian Awards for Excellence in Women's Leadership.

Rochelle said to Mamamia she has seen firsthand the scope of period poverty in Australia, particularly for women who are experiencing homelessness.

"The story that always sticks with me is of a young girl who was age 14 and living on the streets in Adelaide. She talked to us about stealing socks from the laundry mat to deal with her period and make makeshift pads. She was then on a waitlist for housing for years," Rochelle explained.

"The stories are endless. Homelessness can be a sliding doors reality — it could happen to anyone of us depending on the cards we've been dealt. Eight years on from doing the work we do, we've collected over four million period products for homelessness shelters and community centres. It's about keeping the conversation going and trying to bring solutions to such a multi-faceted issue."

Despite the challenges and often lack of funding given to helping the homeless, Erin says it fuels herself and the team to push on and fight for greater advocacy and reform.

"It's about trying to create systemic change. We want to look at how we can prevent people from becoming homeless in the first place. I'm also passionate about helping those on the streets who are temporary visa holders or not Australian citizens — because for them, accessing adequate care is even more limited. So my job is to coordinate the healthcare we're delivering and make sure the care is being evenly distributed."

*Gary has been homeless for over a decade and says he's seen improvements in the medical resources that are provided to people living like he is. 

He says to Mamamia that healthcare for Sydney's homeless has improved in his eyes, feeling that the services and visibility of their collective needs have grown.

"I myself was a binge drinker. I've been to the hospital, used their programs, and got help from the homeless healthcare service, which has been really good."

But when it comes to really living on the streets — it remains tough.

"It's pretty crazy on the streets. There's so much hard drugs, debt and alcoholism," Gary says. 

"The other day was really depressing, as it was just pouring with rain and I'm trying to make some sales, working with The Big Issue, and it was a slow sales day. I could easily be sitting in the park, drinking. But I'm not ready to go and die. And without the drink now, I'm happy."

For Erin, she says that hearing these sorts of stories has moulded her into someone who isn't quick to judge. Someone who understands that for everyone who has lived on the streets, there is always a lingering trauma or disadvantage that speaks to their circumstance. 

"I think that everyone has unconscious, and sometimes conscious, biases and judgements and it is important to be self-aware/aware of them. The most important thing to remember is that people are only ever on the street if every system has failed them and more often than not, have experienced poverty, trauma and difficulty throughout their lives," tells Erin 

"And to be honest, the public are usually very caring and we do get multiple calls from them a week (and other homelessness services too) trying to make sure people have help and support."

This sentiment of aiming to acknowledge and address unconscious bias is something Gary agrees with too. 

"The kindness and the coolness of people [makes a difference]. Just a little smile from others makes you feel human. It's so important. Everyone's become dehumanised. But I'm not going to."

*Names have been changed for privacy reasons. Their identities are known to Mamamia.

Feature Image: Getty stock image.

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