Warning: This story discusses suicide and mental health issues.
A researcher studying the plight of the homeless says she was "extremely shocked" to discover just how young many are when they die, and how many of them take their own lives.
The University of Waikato's Sandrine Charvin-Fabre says the findings, published in the New Zealand Medical Journal on Friday, aren't surprising but still "extremely concerning".
Looking at 171 coroner's reports over the past 12 years, the average age of death for a person of no fixed abode was just 45.7.
"Nearly 56 percent of people of no fixed abode were found dead in civic spaces like streets, parks and reserves, and 14 percent were found dead in their cars," she told Newshub.
"There was only less than 10 percent of these people who died at hospital."
More than three-quarters of the deaths were totally preventable if the deceased had proper access to health care, the study found. Natural causes led the way, mostly cardiovascular disease, but a massive 41.5 percent of amenable deaths were due to suicide.
"We are not totally surprised but remain extremely shocked."
Of those who died by suicide, more than two-thirds had expressed intent beforehand, nearly a third had a history of self-harm and nearly three-quarters had been previously diagnosed with mental health issues. Fewer than half had received psychiatric treatment, and even less had recent contact with the health system, if any at all.
The average age of those who died by suicide was just 38.
Seven out of the 171 died in homicides, a rate of 4 percent.
While the research didn't go into just why so many homeless die of cardiovascular disease, Dr Charvin-Fabre said it was no doubt down to the difficulty they have accessing medical care. Two weeks ago she was at an emergency department with a homeless person and saw the failures of the system first-hand.
"At the end of the day he needed to be referred to a specialist. We asked the emergency department to directly refer him to the specialist, but it doesn't work like that. He needed to be enrolled with a GP first, and to enrol with a GP you need to provide evidence of an address - which is a nonsense for a person with homelessness.
"So it is quite hard to organise referrals when you have so many challenges you have to face."
Often the emergency department is the only point of contact a homeless person has with the health system, as a result.
"When you have no address, but the only way to have your appointment is to receive an appointment card, it doesn't work of course. When you have no mobile you can't receive a call from a doctor. When you have no access to internet or transportation, it's highly challenging for people to have a follow-up and to access care. In the case of chronic disease - like heart disease - where you need regular access to care, it's very challenging."
She's recommending emergency department staff get training in how to spot suicide ideation, and for dedicated homeless-focused primary care systems and outreach programmes.
"If we can simplify the process, it would be very helpful."
Where to find help and support:
- Need to Talk? - Call or text 1737
- What's Up - 0800 WHATS UP (0800 942 8787)
- Lifeline - 0800 543 354 or (09) 5222 999 within Auckland
- Youthline - 0800 376 633, text 234, email firstname.lastname@example.org or online chat
- Samaritans - 0800 726 666
- Depression Helpline - 0800 111 757
- Suicide Crisis Helpline - 0508 828 865 (0508 TAUTOKO)