Psychiatry takes to the streets: the New York City initiative for the homeless mentally ill

Article Abstract:

In response to the growing number of homeless individuals who are chronically mentally ill, New York City instituted a program in 1987 to address this problem. The mandatory removal from the streets of the severely mentally ill with or without their consent was begun, which caused a great deal of controversy. Because the problem of homelessness among the mentally ill is growing, especially in urban areas, many other cities are closely observing the progress of New York's program. A review of the program's first two years of operation is presented in this article. The treatment strategies employed are reviewed, along with characteristics of the patients affected. In the first year, 298 patients were hospitalized; 66 percent were male, 77 percent were single, and 79 percent were from outside of the New York City area. Most of the patients (92 percent) had been previously hospitalized, and 66 percent had been homeless for over one year. Eighty percent of these individuals were diagnosed as schizophrenic, and many (73 percent) also had other mental disorders. Despite the controversy that this program has aroused, the overall effects have been positive, and the program has had a tangible effect on many who required assistance. At follow-up two years after the program began, 55 percent of the patients were residing in a community environment or were receiving institutional care. The New York program is a good example of how mental health professionals and urban policy makers can cooperate in the development of intervention programs for the homeless mentally ill. Additional studies are still needed to formulate optimal intervention programs and to explore the overall impact of these programs. (Consumer Summary produced by Reliance Medical Information, Inc.)

Psychological aspects, Social aspects, Housing, Social policy, New York, New York, Homeless persons

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Care of chronically mentally ill patients in a managed care environment

Article Abstract:

A psychiatrist uses the case of a child with autism to illustrate the treatment of mentally ill in a managed care environment. Too often, managed care organizations focus on providing the minimum treatment necessary for acute problems, but fail to adequately treat those with chronic conditions.

Care and treatment, Services, Managed care plans (Medical care)

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