CLINICAL HANDBOOK OF SCHIZOPHRENIA

422 VI. SPECIAL POPULATIONS AND PROBLEMS8. Be a “doctor without borders.” When at all possible, the clinician should followup with patients beyond his or her own niche. Ideally, an outreach team and drop-in centeruse the same psychiatric providers. It is even better if the same providers extend theirservices to those who are later housed. Agencies should employ programs, such as CTIand ACT, that promote enhanced continuity of care. Even when there are practical impedimentsto providing this level of continuity, phone calls to follow up referrals, outreachto make sure patients are receiving care, and being available to help when gaps incare become evident are all ways to help patients negotiate a complex and all-too-oftenfragmented system of care. Outpatient providers should routinely visit patients in thehospital and plan care jointly with the inpatient staff. Likewise, it is tremendously helpfulfor inpatient staff to follow up with outpatient staff after discharge to make sure all is goingas planned.9. Be an advocate. Implicit in some of the previous recommendations is the notion ofchanging the system when it does not meet the needs of individual patients. This can bedone by helping patients to obtain benefits and to access appropriate medical, mentalhealth, and legal services. And, of course, this can be done by helping patients accesshousing. It can also be done on the agency level by changing the type of services deliveredand the manner in which they are delivered. And it can be done on the service systemslevel by providing expertise in court cases by testifying or offering amicus briefs. Otherways to influence the system of care for homeless people with schizophrenia includeworking alongside consumers and other advocates to fight for improved housing, treatment,and benefits. This can be done by joining committees and workgroups of professionalorganizations, governmental agencies, and advocacy groups, or through othermeans of political action.KEY POINTS• Homelessness and housing instability are common in people with schizophrenia.• People with schizophrenia who become homeless tend to have one or more comorbid conditions,such as substance abuse or undiagnosed medical disorders, as well as histories oftrauma, separation from family, and contact with the criminal justice system.• The previous two points provide the rationale for a comprehensive team approach to treatmentand rehabilitation of people with schizophrenia who are either homeless or at particularrisk for homelessness.• People with schizophrenia who are residentially unstable often move between the streetand shelters, and various institutional settings. This recurrent cycle necessitates modelsthat enhance continuity of care regardless of residential status.• Psychiatrists treating this population must think and act outside the box. Effective engagementmethods, use of harm reduction, and doing outreach often require psychiatrists to actin ways contrary to traditional training.• Evidence-based practices for this population do exist and can be utilized for both primaryand secondary prevention of homelessness.REFERENCES AND RECOMMENDED READINGSBreakey, W. R., & Thompson, J. W. (1997). Mentally ill and homeless: Special programs for specialneeds. Amsterdam: Harwood Academic.Caton, C., Shrout, P., Dominguez, B., Eagle, P., Opler, L., & Cournos, F. (1995). Risk factors forhomelessness among women with schizophrenia. American Journal of Public Health, 85(8),1153–1156.