Street Outreach to Persons with Serious Mental Illnesses:

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Street Outreach to Persons with Serious Mental
Illnesses

• Perspectives from Psychiatry and Primary Care

Richard C. Christensen, M.D. James Withers, M.D.
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Unsheltered Homeless Persons with Mental
Illnesses

• Unique Challenges for Street Outreach Medical
  Workers

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Unsheltered persons with mental illness tended to
exhibit

• Higher rates of chronicity (i.e., longer time on
  the streets)
• Higher rates of psychotic disorders
• High prevalence of co-occurring disorders
• Lower receptivity to accepting formal case
  management services
• Lam JA, Rosenheck R.
• Med Care, 1997

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Most Common Reasons Expressed for Declining
Services and/or Care

• Pervasive mistrust of mental health care
  providers
• Belief that outreach workers deliver empty
  promises
• Belief that services would be of little personal
  benefit
• Care and services would be too short-term and
  unhelpful
• Kryda AD, Compton MT
• Comm Ment Health J., 2008

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Core Components of Effective Street Outreach
The 3 Rs

• R elationship
• R econnection
• R ecovery

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Relationship The Foundation of Engagement

• Overcoming suspiciousness, mistrust and fear
• Cultivating mutual respect for one anothers
  dignity and worth
• Establishing the groundwork for future encounters

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Reconnection Rediscovering Ones Place in
Community

• Fostering inclusion and personal sense of
  belonging
• Establishing a pathway into a system of care
• Ensuring entry into a caring system

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Recovery The Ultimate goal of all Outreach
Efforts

• Collaboration and partnering in treatment and
  housing efforts
• Losing ones former identity of being
  homeless addicted or mentally ill
• No longer needing the assistance of the street
  outreach team

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Case Illustration