Thank you to Michael D. McGee, MD, President, WellMind, Inc; MedCentral Editor-at-Large for Clinical Excellence & Physician Wellbeing who published the article Perspective: Touching the Trauma of Homelessness, from which this series is shared.
Supportive housing can work to treat psychiatric disorders in homeless individuals when that housing is paired with social and clinical services. When you give people safe housing and caring support, they will sometimes accept help for their mental health, too – including for addiction and substance use disorders.
I recently read an article in one of the psychiatry trade journals advocating for the reopening of state hospital beds for those with severe mental illness. Others in the field have suggested this as well, and many, including Vice President Kamala Harris, are also pushing for the removal of the IMD exclusion which prohibits federal funding (ie, Medicaid coverage) for facilities with more than 16 beds serving those ages 22 to 64 years.
(See which mental health programs and services Biden’s American Rescue Plan will fund.)
State hospital beds can serve as a type of intensive “supportive housing.” They integrate comprehensive clinical and social services and have the potential to benefit those who are homeless and diagnosed with a psychiatric disorder. Unfortunately, these types of programs require an investment in resources, and perhaps a revisiting of commitment laws that favor allowing severely mentally ill people to refuse treatments they desperately need. It is a difficult ethical dilemma.
How much do we passively allow people to suffer from severe mental illness and addiction – often at a tremendous cost to themselves and to society? If they go to prison, these individuals are often further traumatized. Some of them may end up at a forensic state hospital. But what if we had an ethical and proactive way of intervening before it is too late?
