Roofless in a steel city: Learning from the homeless mentally ill

Abstract

A small, city-wide clinical outreach service for the homeless mentally ill in Sheffield, UK, attained its present configuration 6 years ago. This paper discusses the lessons learnt in the course of the service's existence. The homeless mentally ill identified by the service have disengaged from the 'mainstream' services and society. Most are from disturbed homes, nearly all have had prior contact with psychiatric services and as many as half have served prison terms. As service users, they must be actively sought out and engaged, which places specific demands upon a mental health team: flexibility of approach, patience and a willingness not to judge others' values. Though largely anecdotal, the inferences drawn in Sheffield may have parallels elsewhere, not least since individual lives can turn upon pivotal ('anecdotal') encounters and those evinced by the homeless tell us much about society, psychiatry and the values of contemporary health-care providers. Also, most of the time, the proposed model has been successful.