Noelene Garlett spent 15 years sleeping rough in Perth.
One of her most devastating experiences was asking after people she had not seen in a while.
"You're thinking that the homeless mob got houses and stuff, and they haven't got houses, they end up dying," Ms Garlett said, standing under one of the bridges where she used to sleep.
"A lot of people come onto the streets healthy I suppose, but after they've lived on the streets they don't look so healthy."
Over those years, Ms Garlett estimated she had known 20 or 25 people who had died, either while homeless or not long after.
According to recent research, that problem only seems to be getting worse.
And while new data shows improvements on some metrics, the state has also seen a rise in the number of people sleeping on the street or in tents, as well as the number of people support services are having to turn away.
WA has highest rate of rough sleepers
Figures from the Australian Bureau of Statistics, collected during the 2021 census and released on Wednesday, show WA's success in ending homelessness has been mixed.
While WA has the lowest rate of people experiencing homelessness anywhere in the country, the overall number of people without a home still grew from 9,005 in 2016 to 9,729 in 2021.
That includes people in supported homelessness accommodation, people temporarily staying with others, people living in boarding or lodging houses, or in severely crowded dwellings which need four or more extra bedrooms.
One of the biggest concerns for Shelter WA though – the peak body for homelessness services – is that Western Australia has the highest rate of homeless people sleeping rough, in places like tents or on the street.
That group more than doubled from 1,083 people (12 per cent of all homeless West Australians) in 2016 to 2,315 (24 per cent) in 2021.
"If we've seen an increase in people that are rough sleeping, we will see an increase in the health issues of people that are presenting [to services]," Shelter WA chief executive Kath Snell said.
"Homelessness has an impact on people's health, not only when they're on the streets but sometimes afterwards as well."
Research shows deaths almost doubling
Professor Lisa Wood researches the links between homelessness and ill health at the University of Notre Dame, and for the last few years has tried to track how many people die in Perth either while homeless or not long after.
Her work involves comparing records from multiple sources including hospitals, GPs, and the Registry of Births, Deaths and Marriages.
Her analysis of last year's records found 107 deaths, about double the number from two years ago.
"Most soberingly of all, from my perspective, is the fact that the average age of death is only 50, so that's three decades younger than anyone else in Australia can expect to live," she said.
Professor Wood said while some of the increase may come down to her team getting better at collating the data, it was likely the true figure she was trying to get to was also rising.
'Different factors' among homeless: minister
When her research was presented to a parliamentary committee last week, Housing Minister John Carey said the government had previously questioned Professor Wood's methodology and said the "multitude of health factors" experienced by homeless West Australians should not be underestimated.
"We've got to be very cognisant that there's a number of different factors that apply — that people can have pre-existing conditions, that it's not simply about saying that someone's on the street, and as a result that has this direct consequence," he said.
"All the feedback that I'm getting from the sector is that the initiatives that we are rolling out are making an impact in terms of assisting homeless people to end rough sleeping but also assists with their health issues."
But Professor Wood disagreed with his assessment of her research.
"You can't separate out health and housing," Professor Wood said.
"The two go together, and the longer people are homeless, we consistently see that their risk of premature death increases."
Accessing healthcare on streets difficult
A big part of that, she said, was a result of people experiencing homelessness struggling to take care of their health, or even access healthcare.
"If people don't have a phone, they don't have a diary, they don't have a computer, they don't have internet access, it's very hard to keep track of your health appointments, to be on time," Professor Wood explained.
"We hear about people who don't have transport to get to appointments, they don't have a mailing address to receive their follow up referrals.
"It's really hard to imagine how you would fully manage your healthcare, particularly if you have 10 or 12 health conditions, if you don't have a safe place to call home."
Ms Garlett said it had been difficult to access healthcare on the streets, and that after being in a public housing home for the last two years, her health had improved.
"It's just changed my life right around," she said.
"I had a drug problem when I was on the streets, but now I gave all that up, and my health is getting much better since I've been away from the streets."
Some 5,000 houses needed per year
While a medical respite service for people experiencing homelessness has been welcomed, Ms Snell said member agencies continued to report a lack of housing as one of their biggest challenges.
"This government has a real commitment to delivering social housing, and that's very much welcome," she said.
"But it's just not happening quickly enough and to the volume we need, so we're delivering at the moment around 500 houses a year in Western Australia and the need is around 5,000."
Ms Snell said that gap was a result of "decades of underinvestment" into social housing, but acknowledged it would be difficult to address with the state's heated construction sector.
"That's why we've been trying to think outside the box," Mr Carey said.
"Modular, timber frame, spot purchasing, buying hotels. We are throwing everything at this."
Funding for WA services lagging
Those pressures are just one of many ways service providers are struggling to meet rising demand, with data from the Productivity Commission earlier this year showing as of 2021-22, WA organisations were turning away an average of 59 people a day – higher than anywhere else.
Ms Snell said part of that came down to WA's lower levels of funding for homelessness services, which lag behind every state and territory other than Queensland.
"What they're seeing is just such a rise in demand for their services, more people living in cars, more people living in tents, more people staying on the street," she said.
"And then physically having to turn people away daily because they just don't have the funding that they need to be able to deliver the services in the demand that it currently is."
Mr Carey said a review of how many services' contracts were funded was currently underway.
"We are investing $2.4 billion in social housing and homelessness over four years. It's a record injection, the biggest in our state's history" he said.
"We're investing $225 million in homelessness [services], we fund more than 130 organisations and I announced a package last year that was increasing transitional and crisis beds.
"At every opportunity, we're looking at practical ways that we can provide a boost for homelessness support services."
