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Implementing Housing First in Australia

Overview

This implementation brief from The ALIVE National Centre examines the Housing First (HF) approach for people living with serious mental health issues (MHI) who are experiencing homelessness. It outlines the evidence base for HF, implementation research including lived experience perspectives, scalability considerations, and practical guidelines across systems, community, service, and individual levels for implementing HF in the Australian context.

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Developed by The ALIVE National Centre for Mental Health Research Translation

Key insights

This implementation brief presents evidence on the Housing First (HF) approach as a global and Australian response to homelessness among people living with serious mental health issues. It affirms HF's effectiveness in securing stable housing and improving wellbeing outcomes, while acknowledging structural, funding, and sustainability challenges to scaling it in the Australian context. Practical implementation guidelines are provided across systems, community, service, and individual levels, emphasising the importance of collaboration, lived experience integration, and person-centred values.

<p>Housing First provides direct access to permanent housing that creates the foundation for people to work toward other recovery goals. Research confirms that HF enables people to secure and maintain stable housing, leading to improvements in physical health, mental health, employment, and overall wellbeing. However, stable housing alone may not be sufficient — people with serious mental health issues may also require additional support to address social isolation and loneliness, with some benefiting from on-site services and communal spaces.</p>

<p>Residents who have experienced Housing First programs report that control over their own home is strongly associated with positive outcomes. People with lived experience of HF have described the profound significance of having their own home on equal terms with others. Research indicates that exploring resident experiences during the early adjustment phase of a HF program yields valuable insights that can directly inform program design and implementation strategies. Integrating peer support and lived experience workers into HF programs is identified as a key service-level implementation strategy.</p>

<p>Achieving the scale needed to meaningfully reduce homelessness among people with serious mental health issues requires coordinated effort at systems, community, service, and individual levels. HF programs have been shown to effectively end homelessness for those who access them, but broader population-wide impact requires scale. The brief draws on the concepts of scaling up, scaling out, and scaling deep, emphasising that social policy, organisational culture, and willing services must work in tandem. The Australian context — including the findings of the Royal Commission into Victoria's Mental Health System and the Australian Productivity Commission Mental Health Inquiry — highlights the urgency of this work.</p>

<p>Significant structural, financial, and systemic barriers can limit the effective implementation and sustainability of Housing First programs. Key barriers identified include insufficient funding, bureaucratic hurdles, lack of cross-sector coordination, stigma and discrimination against people experiencing homelessness, and limited availability of affordable housing. The Adelaide Zero Project and the Victorian Doorway Model both illustrate the complexity of implementation at scale, including elevated costs and the challenges of maintaining program fidelity while ensuring long-term tenancy continuity.</p>

<p>Practical, level-specific guidelines are provided to support policy makers, community organisations, service providers, and individuals to implement Housing First effectively. At the systems level, policy makers are called on to understand the multifaceted nature of homelessness and support affordable housing supply. At the community level, adherence to HF core principles and sustainable local funding are emphasised. At the service level, coordinated cross-sector approaches, staff training in HF principles, and integration of lived experience workers are recommended. At the individual level, person-centred care, self-determination, and an unconditional approach to program entry are central.</p>

Did this resource draw on transformative evidence?

<p>Yes — The brief explicitly incorporates lived experience perspectives as a distinct section. A first-person quote from a Doorway program participant (provided by Wellways with permission) is included, and research on HF residents' experiences of home control and the early adjustment phase is referenced as informing program design.</p>
<p>Yes — The implementation guidelines table draws on practitioner and organisational experience across systems, community, service, and individual levels. References to the Doorway Model in Victoria and the Adelaide Zero Project reflect the integration of practice-level learning into the brief's recommendations.</p>
<p>Yes — The brief is grounded in a body of peer-reviewed and grey literature, including systematic reviews, evaluations, and evidence reviews. It references eleven sources including Killaspy et al. (2022), Dunt et al. (2022), Roggenbuck (2022/AHURI), and others to substantiate its findings on HF outcomes and implementation.</p>

How can this resource help me as a...?

Toggle audience types below to explore.

The brief directly addresses government policy makers and housing authorities, providing systems-level implementation guidelines and calling for policy reform to support HF scalability in Australia.

Service leaders will find practical guidance on building coordinated, cross-sector HF programs and embedding lived experience roles within service delivery.

Frontline workers and service providers are a core audience, with service-level guidelines on target population identification, coordination, peer support integration, and training in HF principles.

The brief synthesises a substantial body of research and flags areas for further implementation science, making it relevant to researchers working in housing, mental health, and homelessness.

People with lived experience of homelessness and serious mental health issues are the population central to this resource. While not written for consumers directly, the inclusion of lived experience perspectives and person-centred values makes it relevant to consumer advocacy and engagement contexts.

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Categories

Resource type

Practice Guideline

Evidence Summary

Target audiences

Consumers

Practitioners

Policymakers

Researchers

Service Leaders

Translational research priority theme

Community-based models of care

Alternatives to compulsory treatment, seclusion and restraint

Workforce capability

Working with diverse consumers, families and communities

Embedding responsible, safe and ethical practice

Understanding and responding to trauma

Understanding and responding to mental health crisis and suicide

Delivering holistic and collaborative assessment and care planning

Delivering compassionate care, support and treatment

Promoting prevention, early intervention and help-seeking

Supporting system navigation, partnerships and collaborative care

Enabling reflective and supportive ways of working

Embedding evidence-informed continuous improvement

Population cohort

Adults

People experiencing homelessness

Culturally & Linguistically Diverse Communities

Collaborative Centre core function

Lived Experience Participation

Service delivery