Psychiatrists Devoting Time to Treating Homeless

Last fall, a stocky older man could often be seen standing on the corner of L and 22nd streets, N.W., in Washington, D.C. His name was “Colonel Sanders,” he told this reporter, and he proudly informed her that he had attended Cambridge University in England, had fought in both Iraq and Afghanistan, and was still active in the military. “Look out there!” he exclaimed. “Can you see those red, blue, and yellow helicopters? I'll be boarding one of them in a few minutes.”

“Colonel Sanders,” who presumably had schizophrenia and was homeless, nonetheless indicated after several encounters that he was reasonably content with his delusional world.

Unfortunately the same cannot be said about most of the estimated 1 million or so Americans who have a mental illness but no place to call home (see How Many Americans Have a Mental Illness, but No Home?). So what is being done to help this disenfranchised population?

Perhaps more than one would expect, authorities on the subject say.

For example, during the 1980s, few psychiatrists worked at places where people who were mentally ill and homeless received services, such as shelters or drop-in centers, or with outreach teams, Van Yu, M.D., medical director of the Center for Urban Community Services in New York City, reported during an interview. But since then, more and more have done so, he said, and because of various initiatives.

One is the Project for Psychiatric Outreach for the Homeless. It got its start in 1986 as a task force of an APA district branch and since then has taken off, he noted. In fact, Yu has headed the project since 2003, and it is now part of the Center for Urban Community Services.

Stephen Goldfinger, M.D., chair of psychiatry at the State University of New York Downstate Medical Center and a longtime advocate for people who are mentally ill and homeless, concurred with Yu that the project has come a long way from its modest inception. “When I first got involved with the project, there were a couple of volunteer docs, and we had our first meetings in the living room of one of them. The project now has multiple full-time psychiatrists.”

Another initiative that has increased the number of psychiatrists working with homeless mentally ill individuals in recent years is a training session offered at APA's annual Institute on Psychiatric Services. The session is run by Goldfinger and other psychiatrists. “We probably train 80 residents or medical students each year,” he estimated. “So in 10 years, that means we have trained something like 800 clinicians.”

In 1999, the Psychiatric Foundation of Northern California launched a project to help mentally ill homeless people in San Francisco. By 2003, psychiatrists, psychologists, and social workers participating in the project had helped some 300 individuals (Psychiatric News, July 18, 2003). Now, seven years later, the project is still “alive and well,” Mel Blaustein, M.D., president of the foundation, said in an interview, “and it also includes a bicultural aspect where we're working with Latinos and illegal immigrants.”

More efforts are likewise being made today than a decade or two ago to find supportive permanent housing for people who are mentally ill but without a home, M. William Sermons, Ph.D., director of the National Alliance to End Homelessness Research Institute in Washington, D.C., said. “This is happening around the country. There are lots of communities, big and small, that are doing things. For example, Pathways to Housing was established in New York City in 1992 to provide housing first, and then treatment, to mentally ill homeless people. Quincy, Mass., has done a pretty remarkable job in scaling up its housing-first-and-treatment-next strategy. Another place is Maine, both in Portland and rural areas. Still another is Seattle, with a housing-first intervention called 1811 Eastlake.”

But are these efforts making a difference? Numbers and progress reports indicate that they are.