Am J Psychiatry 1992; 149:951-957
Copyright © 1992 by American Psychiatric Association
Psychiatry and the homeless mentally ill: a reply to Dr. Lamb
D Mossman and ML Perlin
Department of Psychiatry, University of Cincinnati College of Medicine, OH.
Homeless mentally ill persons are highly visible subjects of ongoing public
discussion and potent symbols of a host of contemporary social problems.
They present psychiatry with a scientific challenge that calls for further
elucidation of the sources of their mental illness and for fashioning
possible solutions to their problems. They also present a moral challenge
that requires psychiatrists to acknowledge the cultural, political, legal,
and economic context of the mental problems of the homeless in the course
of deciding what should be done to help them. H. Richard Lamb has proposed
a program of aggressive outreach and psychiatric hospitalization for the
homeless mentally ill. The authors believe that his proposal misconstrues
the problems and needs of homeless mentally ill individuals; it would also
needlessly infringe upon their freedom, further stigmatize them, and
probably not help them. The authors offer an alternative understanding of
the plight of the homeless mentally ill which places their problems within
a larger context of social trends and domestic issues that society has been
reluctant to confront. Psychiatrists can help the homeless mentally ill by
championing their liberty rights and by focusing public discourse on the
broad national need for improved access to medical and psychiatric care.
