Innovative outreach services for the homeless mentally ill

The authors describe the activities of the Homeless Emergency Liaison Project (H.E.L.P.), a psychiatric outreach program in New York City. The purpose of H.E.L.P. is to identify and offer services to homeless mentally ill people of varying levels of disability and risk. Although many of the project's outreach efforts are initially rebuffed, persistent engagement has often proven effective in encouraging the homeless mentally ill to accept care. Only a small proportion of those reached are judged imminently at risk to themselves or others (approximately 3% of the H.E.L.P. population) and are involuntarily committed for emergency care. The authors call for the mental health community to make available a series of graded outreach services for this population, addressing basic medical, shelter, and long-term residential and rehabilitation needs.