“Of more than 580,000 individuals in the U.S. who experience homelessness on a single night, estimates suggest that more than half have a mental illness or substance use disorder and at least 1 in 5 have severe mental illness.” So wrote Katherine A. Koh, M.D., M.Sc., a member of the street team at the Boston Health Care for the Homeless Program and Massachusetts General Hospital, and Benjamin Land Gorman, B.S., a medical student at Harvard, in a Viewpoint article in JAMA.
“People experiencing homelessness with mental illness face alarming rates of incarceration, discrimination, chronic disease, suicide, and premature death. This is intolerable—and preventable,” they continued.
They described recent political momentum to invest in solutions to these challenges—including recent steps taken by politicians in California, New York, and Portland, Ore. While they acknowledged that “each proposal has prompted debate on ethical and practical grounds, this momentum provides an urgent opportunity to implement community-based care options, reimagine institutionalization, and finally build a functional continuum of care for those experiencing homelessness and mental illness.”
The authors pointed to several community-based services that have shown promise in reducing homelessness and improving outcomes for those with mental illness:
- Assertive Community Treatment connects individuals with intensive support through multidisciplinary teams.
- Housing First provides individuals with immediate housing to subsidized, supportive housing.
- Critical Time Intervention offers time-limited case management to individuals during transitions between hospitals, shelters, and/or jails and the community.
Though many individuals are likely to benefit from large-scale investment in the above programs, “short-term hospitalization can be necessary for the humane care of those for whom the above options have failed and suffering persists,” they continued. They recommended three principles to guide the creation of programs for individuals with severe mental illness:
- Prioritize community building over isolation and security in recognition that purpose, meaningful relationships, and nourishing environments are fundamental to recovery.
- Be attentive to the microculture of the facility by showing compassion, acknowledging trauma, and ensuring the needs of patients and staff are met.
- Partner across care settings to ensure continuity of care once the patient leaves the inpatient program. “The Homeless Outreach and Mobile Engagement program in Los Angeles, funded through California’s Mental Health Services Act, is a successful example of dedication to active partnership across care settings—including crisis care, inpatient hospitalization, and housing—to ensure continuity.”
The authors concluded, “If health care professionals, patient advocates, and policymakers seize the moment and fight for investment in innovative and evidence-informed strategies, we may witness the dawn of a new era.”
For related information, see the Psychiatric News Alert “Involuntarily Hospitalizing Homeless People With Serious Mental Illness May Backfire, Experts Caution.”
(Image: iStock/DianeBentleyRaymond)
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