The recommendations put forth in the 1984 American Psychiatric Association Task Force Report The Homeless Mentally Ill
provoked widespread discussion in the media, in government, and among mental health professionals. Why, then, do the homeless mentally ill still wander our streets in ever-increasing numbers? That is the subject of this follow-up report, which makes recommendations for the 1990s based on new knowledge about this national problem.
The report begins with an analytical review of the available literature since 1984—a backward glance at what we’ve learned and how far we’ve yet to go in documenting and responding to the needs of the homeless mentally ill. A discussion of deinstitutionalization in the 1990s underscores the importance of providing community asylum and sanctuary.
The second section of this volume addresses treatment and rehabilitation, summarizing current clinical work with the homeless mentally ill. Contributors use case studies to illustrate how mobile outreach teams, residential care facilities, day treatment programs, and clinical case management can serve as effective interventions. They propose special techniques for dealing with medically ill, substance-abusing, and other dually diagnosed homeless mentally ill individuals. And finally, they suggest approaches for reintroducing these individuals back into the community through effective rehabilitation strategies.
Foreword. Preface. Summary and recommendations. Section I: The Context of Treatment. What we know about homelessness among mentally ill persons: an analytical review and commentary. Deinstitutionalization in the nineties. Homelessness and mental illness: a transcultural family perspective. Mental health problems among homeless persons: a review of epidemiological research from 1980 to 1990. Why clinicians distance themselves from the homeless mentally ill. Training mental health professionals to treat the chronically mental ill. Section II: Treatment and Rehabilitation. Clinical care of homeless mentally ill individuals: strategies and adaptations. Outreach intervention models for the homeless mentally ill. In search of pumpkin shells: residential programming for the homeless mentally ill. The need-for-treatment standard in involuntary civil commitment. Clinical case management with the homeless mentally ill. Homelessness and dual diagnosis. Medical concerns of homeless persons. Day treatment ion a shelter: a setting for assessment and treatment. Challenges and opportunity: rehabilitating the homeless mentally ill. Appendix. Index.
"This is an informative, well-written, easy-to-read, good book by experts in the field. The strength of the book is that it is clear the authors have worked with this population and are not just espousing theory. The ideas are based on actual, nitty-gritty practice."—JAMA
"In 16 well-researched and documented chapters, scientific data and concrete examples of current multiple client and provider needs are outlined. This informative volume offers much to mental health professionals."—READINGS: A Journal of Reviews and Commentary in Mental Health
"This volume is recommended to anyone who wishes to learn more about those persons who have been ‘turned off and out’."—Journal of Clinical Psychiatry
H. Richard Lamb, M.D.,
is Professor of Psychiatry at the University of Southern California School of Medicine in Los Angeles, California.
Leona L. Bachrach, Ph.D., is Research Professor of Psychiatry in the Maryland Psychiatric Research Center at the University of Maryland School of Medicine in Baltimore, Maryland.
Frederic I. Kass, M.D., is Professor of Clinical Psychiatry at Columbia University College of Physicians and Surgeons in New York City.