Essential components of the specialist service

The management of a homeless mentally ill person involves stages of engagement, stabilization, resettlement, and the eventual transfer of care to mainstream providers. Engagement can take a long time, staff must be prepared to leave the clinic and go to where homeless people congregate. Help with welfare and practical problems may be all that can be done at first but the duty to maintain a therapeutic focus must always be maintained. Stabilization requires the specialist assessment and treatments provided to any mentally ill person, including hospital admission if necessary. The task of resettlement typically involves a compromise between personal preferences, available resources, and the level of support needed to promote rehabilitation. For example, independent accommodation may be a person's first choice but may only be a viable prospect if it can be backed up by weekly visits from the mental health team. Core and cluster arrangements, in which residents have their own flat but receive supervision from an on-site warden within the complex is a particularly effective model for those who have failed in independent accommodation but who reject shared facilities.

The eventual transfer of care to mainstream services can be quite difficult to manage and most follow-up studies suggest that fewer than half of those transferred remain in treatment. The extent to which transfers succeed depends on the capacity of mainstream services to manage a mobile, often non-compliant, population.

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