Street Mental Health Handbook

This book grounds the work of street mental health within the lived realities of the people it serves, emphasizing the importance of trauma and context of care, and how these factors shape the experience of homelessness and engagement with mental health care. With the rise in homelessness has come a growing movement of street medicine—healthcare delivered directly to individuals who live on the streets, in encampments, or within emergency shelters. While physical health services are relatively well-integrated into street medicine models, mental health care remains underdeveloped and poorly resourced. There is a pressing need for guidance, reflection, and solidarity in this space. The authors have nearly fifty years of combined experience working in street-based mental health services across North America. Much in this field has not yet been formally researched or codified; many insights have been gained through trial, error, and the wisdom of those served. The authors’ goal is to share what they have learned in a way that is honest, grounded, and helpful. The opening chapters discuss the individual, collective, historical, and structural traumas that are common in the vulnerably housed population and how these should inform engagement, diagnosis, and treatment. Subsequent chapters explore the complexities of and practical strategies for conducting mental health assessments and prescribing medications on the street. The authors discuss the importance of building and working in teams to adapt to the chaos that street medicine clinicians and their patients frequently encounter. The book closes with a discussion of psychosocial interventions for individuals experiencing homelessness, emphasizing their potential effectiveness despite implementation challenges. Chapters emphasize harm reduction and include case studies and dialogues to aid understanding. The primary audience of Street Mental Health Handbook is front-line clinicians—physicians, nurses, outreach workers, social workers, and others—who are new to the field of street mental health or are seeking to deepen their understanding of it. For those already embedded in this work, the authors hope it will serve as a practical and reflective guide that acknowledges the unique challenges and rewards of working with people who are homeless and living with mental illness.