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Health care practitioners are a key voice in championing the rights of unaccompanied children to survive, to receive health care, and to experience wellbeing, writes Associate Professor Catherine Robinson.
There are few untouched by the current housing crisis in Australia. As housing stress has worsened, Australians are experiencing intensified physical and mental ill-health at a time they can least afford to access health care. In a nation gripped by adult-focused debates over housing investment pipelines and cost of living struggles, it can be hard to maintain attention on the unique ways in which homelessness is experienced by children. In particular, homelessness experienced by children alone, unaccompanied by a parent or guardian, remains largely hidden and is not often well-understood by health and educational professionals who may have earliest contact with families and children in crisis.
The recent release of new data from the Australian Institute of Health and Welfare (AIHW) helps shine a spotlight on the experience and impacts of unaccompanied child homelessness in Australia. Importantly, this data is only able to report on children presenting alone to Specialist Homelessness Services (SHS). In most states and territories however, unaccompanied children are only able to access SHS when they are over the age of 16 and as such, with the exception of Tasmania and New South Wales, there are few services available for those under 16 years in particular. This means that whilst AIHW data is a critical new step in raising awareness of unaccompanied child homelessness as a pervasive issue in Australia, troublingly, the real scale this population is unknown but expected to be much higher. This is likely given children’s lack of system and service knowledge, fear of homelessness services, and not necessarily identifying themselves as ‘homeless’.
The AIHW data reveals some startling evidence about the scale of unaccompanied child homelessness and the extraordinary hardship children are currently experiencing in Australia. Nationally, in 2023-24 13,300 children presented alone to SHS. Over 2 in 5 reported a mental health issue with experiencing family breakdown and violence recorded as significant reasons for seeking assistance. Significantly, AIHW data also reveals high death rates of children with a history of SHS support. Suicide, transport accidents and assaults were the most common causes of death.
The lived reality of unaccompanied child homelessness in Australia
Whilst this data may be shocking for some, it is unsurprising for those working in the youth and homelessness sectors in frontline service provision and social research. The causes of unaccompanied child homelessness remain different to youth, adult and family homelessness. Experiencing violence and abuse at home, family conflict and the inability of caregivers to provide adequate care for children are specific drivers of children’s very early home leaving, abandonment and limited or intermittent access to secure housing and safe, caring adults. In short, unaccompanied children are experiencing a crisis in care rather than in housing.
With very few services accessible because of their young age, lack of independent or adequate income and relative lack of mobility, unaccompanied children are most likely to couch surf amongst extended family, friends and acquaintances. This is a way of surviving that may lead to community members stepping up to provide quality care but also leaves children highly vulnerable to abuse, intimate partner violence and exposure to a range of harmful activity including survival crime such as theft, swapping sex for shelter, and drug selling and usage.
My research has exposed the extraordinary resilience of unaccompanied children and of community service workers who do their best to support their highly complex health, educational and social care needs in the context of homelessness services not funded to provide adequate care. Also revealed is the overwhelming and repeated harm unaccompanied children continue to experience whilst homeless and the resulting layered complex physical and mental health issues.
Unaccompanied homeless children face enormous barriers in receiving basic child and adolescent primary health care — including vaccinations, nutrition advice, sexual and reproductive health care, vision and hearing testing — not to mention the complex mental health and disability care that they may need as they recover from lifetime cumulative trauma, situational distress and suicide ideation, as well as navigate management of cognitive issues and major mental illness.
As illustrated in research on unaccompanied child homelessness and the COVID-19 public health emergency, there is simply a lack of knowledge across the Australian health system of the uniquely vulnerable circumstances of this cohort. This leads to significant deficits in the planning and delivery of public health care that is inclusive of the needs of highly mobile and distressed children who may not have a parent or guardian to directly advocate for — and practically and financially support — their health and wellbeing needs.
How health practitioners can respond
Health care practitioners are a key voice in championing the rights of unaccompanied children to survive, to receive health care, and to experience wellbeing. It is important to consider that unaccompanied children’s poor health may relate not to their ability or willingness to engage in health care. Instead, their poor health and poor health service access may relate to a lack of public health knowledge of this vulnerable cohort, risk-avoidant health care providers, and poor workforce capacity in providing flexible, non-stigmatising, trauma-informed, adolescent-friendly health care.
Health care practitioners should consider what more they need to know about identifying, and providing services for, children and adolescents at risk of or experiencing homelessness. This includes challenging practice scope and models and interpersonal practices of care to ensure appropriate physical and mental health care is made available and accessible for highly vulnerable children and adolescents. It also includes expanding knowledge of local child and adolescent service systems and exploring opportunities to collaborate with, and learn from, child and youth-specialist services in the community welfare sector.
Catherine Robinson is Associate Professor in Communities and Social Justice at the University of Tasmania and a Board Director working with peaks and services in the homelessness and child and youth welfare sectors. She is an impact scholar focused on research translation and strategic policy and system reform to address complex social harms, in particular unaccompanied child homelessness.
The statements or opinions expressed in this article reflect the views of the authors and do not necessarily represent the official policy of the AMA, the MJA or InSight+ unless so stated.
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