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Psychiatric Services and “the Homeless”: Changing the Paradigm

Glick, Ira, D., MD*; Olfson, Mark, MD

The Journal of Nervous and Mental Disease: May 2018 - Volume 206 - Issue 5 - p 378–379
doi: 10.1097/NMD.0000000000000813
Clinical Controversies

Given the changes in our society and worldwide massive migrations across borders, this article argues that we need to change the paradigm of how we think about “the homeless,” that is, to rethink our approach to not only those who cannot afford housing, the “economically homeless,” but especially important also the larger group—those with chronic, serious medical-psychiatric-addictive disorders, the “medically/mentally ill homeless.” We must place a greater emphasis on providing mental health services along with housing, legal, general medical, employment, and other services. The first and most crucial step toward adequate care is to understand these individuals and their lives as well as how we react to them. Second, we must become more proactive in helping those who live on the streets to receive adequate and coordinated services. And finally, for those who are unable to live independently in the community, we need to reinvent long-term, structured, humane residential, and inpatient settings.

*Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, California; and †Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, New York.

Send reprint requests to Ira D. Glick, MD, 2 Scenic Way, San Francisco, CA 94121. E-mail:

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