Jefferson Journal of Psychiatry



The latter years of the twentieth century have witnessed a phenomenon unparalleled since the depression of the 1930's. Legions of homeless, disadvantaged, often mentally ill poor have emerged thronging cities, crowding public places and presenting perplexing complex, social, political, economic, and medical/psychiatric service delivery issues ( I ). Counting the homeless, and among them the mentally ill homeless, is a task fraught with difficulty, as some studies have illustrated (2 ,3). Estimates of mental illness among the nation's homeless range from 10% to 70% (4). In the District of Columbia, there are an estimated six to seven thousand homeless. Of these, in 1988, 36% were felt to be mentally ill (5).

The increasing numbers of homeless and mentally ill street people are the result of a complex interweaving of political and economic factors including housing policy, urban gentrification, changing requisite job skills in a changing economy, and deinstitutionalization (6). Regardless of their origin, the chronically mentally ill (CMI) homeless present as a population with diverse acute medical and psychiatric needs.

Delivering services to this increasing "underclass" in the Unite d States has mobilized the non-medical private sector in a attempt to cope with the homeless' perplexing needs. This "shelter industry" has repeatedly called for medical and psychiatric support to help provide care to the homeless urban poor , and their medical care needs present an opportunity for training in community and emergency psychiatry unparalleled in recent decades (7). What follows is a description of the planning and implementation of an elective for fourth year psychiatry residents designed to expose them to this underserved population.

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