It was the loud, derogatory voices in her head that propelled Antoinette Croft from the home she shared with her three young children.
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The voices said terrible things.
And they hounded her for years; when she relinquished custody of her kids to her mother, when she took heroin and broke the law to support her habit. In prison. "I was so scattered," Antoinette says.
As her mind roiled, her living situation became more precarious. She lived rough, slept at train stations and boarding houses, had a nervous breakdown and numerous involuntary admissions to hospital.
The clinical name for the voices, Antoinette's mental illness, is paranoid schizophrenia. But treating the mental health of someone who is homeless is tricky; it slips so far down their list of priorities.
"Your day-to-day existence is all about immediate survival, getting a meal and avoiding assault," says Dr Julian Freidin, the consultant psychiatrist to the Homeless Outreach Psychiatric Service, at Alfred Health.
And it can be a vicious circle: Antoinette's mental health drove her from her home, but in other cases a person might become homeless and then develop mental illness because of their new circumstances. Depression and anxiety are common.
So The Alfred's homeless psychiatric service, one of only two in Melbourne, has a team of mental health specialists who visit places where homeless people gather, like soup kitchens, rough sleeping hot spots and other homeless services.
They spend a lot of time with complex clients to work out what kind of help they need, and this extends to far beyond medical treatment to housing support and financial literacy.
And sometimes, even with long-term, chronically-ill clients, they turn things around.
Antoinette was very unwell when her social worker put her in touch with the homeless psychiatric service. "My body felt strangled, like someone was touching me. I was hallucinating to the max and the voices were out of control."
She went onto monthly, then fortnightly, injections to treat her schizophrenia (her worker checked regularly to make sure she took them) and was helped with everything, from finding a self-contained room in a boarding house to travel cards.
The psychiatric team prefers to treat people in the community, rather than letting their mental health deteriorate to the extent that they end up in hospital or jail, says Jess Fyshe, the team leader.
There is growing recognition that mental illness is a significant problem in the community, but it remains underfunded, says Dr Freidin. Programs that work with people who are older, homeless – and at times angry and drug abusing – are less attractive to government and the media, he says.
Homeless people with a mental illness can be a difficult group to house if their illness persists, but The Alfred program is based on the "Housing First" principle.
This sees housing as a basic human right that should be available to anyone, even if they are using drugs or alcohol. And it is at odds with housing models that require the homeless people to seek treatment in exchange for housing, or gives them short-term housing options until they "prove" they are worthy of something long-term.
And it gets results. In Melbourne last year a trial by Sacred Heart Mission found when long-term homeless people were given stable, safe accommodation and then back-up services and counselling, about 75 per cent were still in stable housing a year after the program ended.
Antoinette is overjoyed that she has rebuilt her relationship with her children, who are now adults, and her mother. She speaks to them every week and babysits her one-year-old granddaughter.
"For anyone who is on the streets and finding it tough, I'd tell them to keep going, just keep going, and accept help when someone offers it."
