“Street psychiatry” is an innovative model that serves people experiencing unsheltered homelessness, a vulnerable population with increased rates of mental illness and substance use disorders. Through community-based delivery of mental health and addiction treatment, street psychiatry helps the street-dwelling population overcome barriers to accessing care through traditional routes. Throughout the United States, street psychiatry programs have arisen in multiple cities, often in partnership with street medicine programs. We discuss the philosophy of street psychiatry, document operational highlights involved in the development of a street psychiatry program in New Haven, CT, suggest key ingredients to implementing a street psychiatry program, and explore challenges and future frontiers. Street psychiatry is an effective person-centered model of service delivery with the potential to be applied in a variety of urban settings to serve people experiencing street homelessness.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
Tax calculation will be finalised during checkout.
APA Gold Award. (2013). Accessible care for New York City residents with serious mental illness and a history of homelessness: Center for Urban Community Services Janian Medical Care, New York City. Psychiatric Services, 64(10), e4-6. https://doi.org/10.1176/appi.ps.641113
Baggett, T. P., O’Connell, J. J., Singer, D. E., & Rigotti, N. A. (2010). The unmet health care needs of homeless adults: A national study. American Journal of Public Health, 100(7), 1326–1333. https://doi.org/10.2105/AJPH.2009.180109
Bond, G. R., & Drake, R. E. (2015). The critical ingredients of assertive community treatment. World Psychiatry, 14(2), 240–242. https://doi.org/10.1002/wps.20234
Bradford, D. W., Gaynes, B. N., Kim, M. M., Kaufman, J. S., & Weinberger, M. (2005). Can shelter-based interventions improve treatment engagement in homeless individuals with psychiatric and/or substance misuse disorders?: A randomized controlled trial. Medical Care, 43(8), 763–768.
Buhrich, N., & Teesson, M. (1996). Impact of a psychiatric outreach service for homeless persons with schizophrenia. Psychiatric Services, 47(6), 644–646. https://doi.org/10.1176/ps.47.6.644
Christensen, R. C. (2009). Psychiatric street outreach to homeless people: Fostering relationship, reconnection, and recovery. Journal of Health Care for the Poor and Underserved, 20(4), 1036–1040. https://doi.org/10.1353/hpu.0.0216
Connecticut Counts: 2016 Report on Homelessness in Connecticut. Connecticut Coalition to End Homelessness. (2016). Retrieved from http://cceh.org/wp-content/uploads/2016/05/CT-Counts-2016.pdf
Fazel, S., Khosla, V., Doll, H., & Geddes, J. (2008). The prevalence of mental disorders among the homeless in western countries: Systematic review and meta-regression analysis. PLoS Medicine, 5(12), e225. https://doi.org/10.1371/journal.pmed.0050225
Fisk, D., Rakfeldt, J., & McCormack, E. (2006). Assertive outreach: An effective strategy for engaging homeless persons with substance use disorders into treatment. The American Journal of Drug and Alcohol Abuse, 32(3), 479–486.
Folsom, D. P., Hawthorne, W., Lindamer, L., Gilmer, T., Bailey, A., Golshan, S., Garcia, P., Unützer, J., Hough, R., Jeste, D. V., & Jeste, D. V. (2005). Prevalence and risk factors for homelessness and utilization of mental health services among 10,340 patients with serious mental illness in a large public mental health system. American Journal of Psychiatry, 162(2), 370–376. https://doi.org/10.1176/appi.ajp.162.2.370
Hecht, C. (2020). Citing CAHOOTS as a Model for Reform [Press release]. Retrieved from https://whitebirdclinic.org/senator-wyden-to-visit-cahoots-citing-as-a-model-for-reform/
Henry, M., Watt, R., Mahathey, A., Oulette, J., Sitler, A., & Associates, A. (2020). The 2019 Annual Homeless Assessment Report to Congress. The U.S. Department of Housing and Urban Development. Retrieved from https://www.huduser.gov/portal/sites/default/files/pdf/2019-AHAR-Part-1.pdf
Hogan, M. F., & Goldman, M. L. (2021). New opportunities to improve mental health crisis systems. Psychiatric Services, 72(2), 169–173. https://doi.org/10.1176/appi.ps.202000114
Hwang, S. W., Tolomiczenko, G., Kouyoumdjian, F. G., & Garner, R. E. (2005). Interventions to improve the health of the homeless: A systematic review. American Journal of Preventive Medicine, 29(4), 311–311.
Jego, M., Abcaya, J., Stefan, D. E., Calvet-Montredon, C., & Gentile, S. (2018). Improving health care management in primary care for homeless people: A literature review. International Journal of Environmental Research and Public Health, 15(2), 309. https://doi.org/10.3390/ijerph15020309
Koh, H. K., & O’Connell, J. J. (2016). Improving health care for homeless people. JAMA, 316(24), 2586–2587. https://doi.org/10.1001/jama.2016.18760
Koh, K. A. (2020). Psychiatry on the streets-caring for homeless patients. JAMA Psychiatry, 77(5), 445–446.
Koh, K. A., & Roncarati, J. S. (2019). Health Care Spending and Utilization in Unsheltered and Sheltered Homeless. Paper presented at the International Street Medicine Symposium.
Lam, J. A., & Rosenheck, R. (1999). Street outreach for homeless persons with serious mental illness is it effective? Medical Care, 37(9), 894–907.
Lawrence, D., & Kisley, S. (2010). Inequalities in healthcare provision for people with severe mental illness. Journal of Psychopharmacology, 24(4), 61–68.
Levitt, A. J., Culhane, D. P., DeGenova, J., O’Quinn, P., & Bainbridge, J. (2009). Health and social characteristics of homeless adults in Manhattan who were chronically or not chronically unsheltered. Psychiatric Services, 60(7), 978–981. https://doi.org/10.1176/appi.ps.60.7.978
Lo, E., Balasuriya, L., & Steiner, J. (2021). A street psychiatry rotation for medical trainees: Humanizing the care of people experiencing homelessness. Academic Psychiatry. https://doi.org/10.1007/s40596-021-01461-8
Martins, D. C. (2008). Experiences of homeless people in the health care delivery system: A descriptive phenomenological study. Public Health Nursing, 25(5), 420–430. https://doi.org/10.1111/j.1525-1446.2008.00726.x
Montgomery, A. E., Szymkowiak, D., Marcus, J., Howard, P., & Culhane, D. P. (2016). Homelessness, unsheltered status, and risk factors for mortality: Findings from the 100 000 homes campaign. Public Health Reports, 131(6), 765–772. https://doi.org/10.1177/0033354916667501
Morris, D., & Warnock, J. (2001). Effectiveness of a mobile outreach and crisis services unit in reducing psychiatric symptoms in a population of homeless persons with severe mental illness. The Journal of the Oklahoma State Medical Association, 94(8), 343–346.
Morse, G. A., Calsyn, R. J., Allen, G., Tempethoff, B., & Smith, R. (1992). Experimental comparison of the effects of three treatment programs for homeless mentally ill people. Psychiatric Services, 43(10), 1005–1010.
Morse, G., Shields, N., Hanneke, C., McCall, G. J., Calsyn, R. I., & Nelson, B. (1985). Homeless people in St. Louis: A mental health program evaluation, field study, and follow-up investigation. Missouri Department of Mental Health.
Sullivan, G., Burnam, A., & Koegel, P. (2000). Pathways to homelessness among the mentally ill. Social Psychiatry and Psychiatric Epidemiology, 35(10), 444–450. https://doi.org/10.1007/s001270050262
The 2010 Annual Homeless Assessment Report to Congress. (2011). Retrieved from https://www.hudexchange.info/resources/documents/2010HomelessAssessmentReport.pdf
Withers, J. (2011). Street medicine: an example of reality-based health care. Journal of Health Care for the Poor and Underserved, 22(1), 1–4. https://doi.org/10.1353/hpu.2011.0025
Dr. Balasuriya is supported by the Yale National Clinician Scholars Program and by the U.S. Department of Veterans Affairs (VA) Office of Academic Affiliations through the VA/National Clinician Scholars Program and Yale University. These views do not in any capacity represent the federal government or the VA. This work was funded in part by the State of Connecticut, Department of Mental Health and Addiction Services, but this publication does not express the views of the Department of Mental Health and Addiction Services or the State of Connecticut. The views and opinions expressed are those of the authors.
Conflict of interest
The authors have no relevant financial or non-financial interests to disclose.
This retrospective chart review study involving human participants was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The Human Investigation Committee (IRB) of Yale University approved this study.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Lo, E., Lifland, B., Buelt, E.C. et al. Implementing the Street Psychiatry Model in New Haven, CT: Community-Based Care for People Experiencing Unsheltered Homelessness. Community Ment Health J (2021). https://doi.org/10.1007/s10597-021-00846-1
- Street psychiatry
- Street medicine
- Unsheltered homelessness
- Serious mental illness