Mental Health Services Take to the Streets

The challenge of reaching out to the homeless mentally ill initiated a period of creative development in mental health services delivery. Early in the post-deinstitutionalization era, the difficulty of engaging a disaffiliated and hard-to-reach population prompted clinicians to “take to the streets” (Cohen, 1990) and relate to homeless people where they could be found, whether on the streets or in transportation depots or abandoned buildings (Cohen, 1990; Cohen & Marcos, 1992). “Outreach” and “crisis intervention” became the established terms for new mechanisms to deal with the low rates of attendance and retention in outpatient mental health services. Over time, health and mental health services have been provided in shelters, community residences, and apartments to meet the needs of severely mentally ill people wherever they are living in the community. This chapter will describe and assess the evidence for the various approaches that have been developed or adapted to assist homeless mentally ill people to achieve stable residence in the community, including interventions based on case management (deVet et al., 2013), peer recovery support (Reif et al., 2014), critical time intervention (CTI; Susser et al., 1997), assertive community treatment (ACT; Bond et al., 2001), integrated treatment for people with dual disorders (Drake et al., 2004), and interventions to move individuals toward recovery and use of mainstream services (Rosenheck & Mares, 2007).

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