Care built on trust, delivered where people are

Plain language

What is street-based mental health care?

Street-based mental health care — or street psychiatry — is mental health care delivered outside the walls of a clinic: psychiatrists, nurses, social workers, and peer specialists going directly to people experiencing homelessness, wherever they are — on sidewalks, in encampments, in parks, in shelters, and in drop-in centers.

For many people living unsheltered, traditional mental health care is out of reach. Appointments, waiting rooms, insurance cards, and fixed addresses all assume a stability that homelessness takes away — and past experiences with institutions often leave people wary of seeking help. Serious mental illness and substance use disorders are common among people living unsheltered, yet they are the least likely to be connected to care.

Street-based mental health care turns the model around. Instead of waiting for people to come to care, care goes to them.

How street-based mental health teams work

Street-based mental health care is relationship-first medicine. Teams typically:

• Lead with engagement, not paperwork. The first visits may be a conversation, a pair of socks, or simply showing up again next week. Trust is the foundation every treatment plan is built on.
• Work as interdisciplinary teams. Psychiatrists and psychiatric nurse practitioners work alongside social workers, nurses, case managers, and peer specialists with their own lived experience of homelessness or mental illness.
• Deliver real treatment in the field. Psychiatric evaluation, medications — including long-acting injectables — therapy, and treatment for substance use disorders can all happen on the street or in a mobile clinic.
• Practice harm reduction. Teams meet people at their own goals, reducing risk and building toward recovery rather than demanding it as a precondition for help.
• Connect the dots. Street teams work hand-in-hand with street medicine, housing providers, hospitals, and legal and social services, so that mental health care is one strand of a larger path toward stability.

Street-based mental health care, street psychiatry, and street medicine

A few closely related terms are worth untangling. Street-based mental health care refers to all mental health care delivered on the street, across professions and credentials. Street psychiatry is similar, with a more specific focus on medical interventions — psychiatric evaluation, medication, and treatment of substance use disorders. Both belong to street medicine, the broader practice of delivering health care to people living unsheltered, built on the principle of going to the people (see the Street Medicine Institute). Street-based mental health care is the mental health arm of the street medicine movement.

Where care happens

• Sidewalks, parks, and encampments
• Shelters and transitional housing
• Drop-in centers and soup kitchens
• Mobile clinics and outreach vans
• Supportive housing, as people come indoors

Curious to go deeper? Explore the growing body of peer-reviewed research on street psychiatry, much of it authored by members of this Coalition.