Sectioning on the street – futility or utility?

Abstract

It seems clear that a small but significant number of people are simply ill-served by the existing format of mainstream mental health services. It may be (as I have heard in a European 'quality' forum) that such people are just peculiarly difficult. This seems unlikely, given a recent outcomes study we did of the most alienated and intractable of our referrals-people who live on the street and who have not been engaged by the sustained efforts of experienced street outreach teams. The intervention concerned was involuntary admission to hospital under a section of the Mental Health Act. 4 One year later, the majority were still engaged with the specialist mental health team and were still in accommodation. Here is an area ripe for research-the vital factors that enable such teams to engage effectively, and to maintain that engagement, with homeless people with psychotic disorders. 1 Craig TKJ, Timms PW. Out of the wards and onto the streets? Deinstitutionalization and homelessness in Britain. J Ment Health 1992; 1: 265-75. 2 Winkler P, Barrett B, McCrone P, Csé my L, Janous ˘ ková M, Hö schl C. Deinstitutionalised patients, homelessness and imprisonment: systematic review. Br J Psychiatry 2016; 208: 421-8.