Research Spotlight: A Call to Action to Create Compassionate and Comprehensive Care for Patients Experiencing Homelessness and Mental Illness.

Katherine Koh, MD, MSc physician-scientist in the Department of Psychiatry, is the first author of a recent viewpoint published in JAMA, Reimagining Institutionalization and a Continuum of Care for People Experiencing Homelessness and Mental Illness.

What was the question you set out to answer with this study?

Current rates of suffering, abuse, neglect and incarceration of those experiencing homelessness and mental illness represent an unrelenting humanitarian crisis.

In this viewpoint, we explore how to create a more compassionate and comprehensive continuum of care for patients experiencing homelessness and mental illness.

What methods or approach did you use?

We did a comprehensive literature review, interviewed experts, used our practice-based experience, and synthesized these findings to outline an optimal continuum of care.

What Did You Find?

Investment in solutions to address the ongoing humanitarian crisis of homelessness and mental illness is growing (note recent policy directives in NY, California, Oregon). This momentum provides an urgent opportunity to envision and implement a functional system of care for those experiencing homelessness and mental illness, done quite differently than in the past. Our viewpoint therefore describes the current landscape and inequities facing people experiencing homelessness and mental illness, as well as a vision for how to build a continuum of care to meet the needs of this population that has suffered for far too long, including prevention, community-based care options, and more compassionate and innovative care models.

The vision includes:

• A focus on prevention, including policy that addresses upstream determinants of homelessness for those with mental illness, including increasing housing prices, income inequality, barriers to mental health care, racial inequities, and adverse childhood experiences.
• Community-based models of care, including investing in street outreach; Housing First, which provides immediate access to subsidized, supportive housing without precondition; and Assertive Community Treatment, which offers consistent, intensive support thorough multidisciplinary groups of professionals.
• Short- and long-term inpatient treatment facilities that prioritize purpose, meaningful relationships, and nourishing environments as fundamental to recovery. A recognition that compassionate inpatient facilities and community based solutions are both key components in a continuum of care (not mutual replacements) and thatreliable reintegration after inpatient treatment requires a collaborative ecosystem in which facilities have established communicative partnerships with community programs. 

What are the Implications?

Our hope is that this viewpoint can catalyze action to redesign approaches to care for patients experiencing homelessness and mental illness.

About the Massachusetts General Hospital

Massachusetts General Hospital, founded in 1811, is the original and largest teaching hospital of Harvard Medical School. The Mass General Research Institute conducts the largest hospital-based research program in the nation, with annual research operations of more than $1 billion and comprises more than 9,500 researchers working across more than 30 institutes, centers and departments. In July 2022, Mass General was named #8 in the U.S. News & World Report list of "America’s Best Hospitals." MGH is a founding member of the Mass General Brigham healthcare system.