Street Mental Health Handbook - Care Delivery Across the Spectrum of Homelessness

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.

List of contents

Chapter 1. Trauma.- Chapter 2. Trauma Informed Care.- Chapter 3. Assessment of Mental Disorders.- Chapter 4. Medication Treatment of Mental Disorders.- Chapter 5. Substance Use: Assessment and Guiding Principles for Street Medicine.- Chapter 6. Medication Treatment of Substance Use Disorders.- Chapter 7. Cognitive Impairment.- Chapter 8. Chaos.- Chapter 9. Creating and Running a Street Mental Health Team.- Chapter 10. Psychosocial Interventions.

About the author

Dr. Simon Hatcher is a psychiatrist with Ottawa Inner City Health and a Full Professor at The University of Ottawa. He trained in the UK before working in New Zealand as a psychiatrist in Auckland for 20 years. Since moving to Canada in 2012, he has worked as a "street psychiatrist" as part of a team providing healthcare to people who are vulnerable and housed in shelters, on the streets and in supported housing. He also runs a research program that investigates how best to manage the effects of trauma in underserved populations. He has published over 100 scientific papers and has been the principal investigator in numerous clinical trials, including innovative trauma-informed treatments for the vulnerably housed. He is part of a team that trains other professionals in Narrative Exposure Therapy.
 Dr. Liz Frye is an internationally-recognized expert in street psychiatry and has worked in the field for the past 16 years. With her medical and public health background, Dr. Frye develops strategies for addressing mental health and substance use disorders among unhoused people at a population health level. Dr. Frye previously founded and directed Atlanta’s first street medicine program and worked to integrate behavioral health into the AHN Center for Inclusion Health’s services, including street medicine, in Pittsburgh, Pennsylvania. Dr. Frye holds a medical degree from the University of North Carolina and a Master’s in Public Health from Emory University. She completed residency and a Community Psychiatry and Public Health Fellowship at Emory. Dr. Frye serves as the Chair for the Street Medicine Institute’s Board of Directors and has led the Institute’s annual International Street Medicine Symposium since 2017.
Ms. Kim Van Herk is the Mental Health Team Lead at Ottawa Inner City Health. She is a nurse who has worked for the last 18 years, providing mental health care to people on the streets and in shelters in Ottawa. She has completed her master's in nursing, focusing on improving access to primary care for urban Indigenous women during pregnancy and parenting. She has recently been involved in research examining the emotional and spiritual support needed for frontline workers during the COVID pandemic and the toxic drug crisis.

Summary

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.

Product details

• Authors: Elizabeth Frye, Liz Frye, Simon Hatcher, Kim van Herk, Kim Van Herk
• Publisher: Springer International Publishing
• Languages: English, German
• Product format: Hardback
• Release: 11.09.2025
• EAN: 9783032006622
• ISBN: 978-3-032-00662-2
• Illustrations: Approx. 230 p. 41 illus. in color., farbige Illustrationen
• Subjects: Natural sciences, medicine, IT, technology > Medicine > Clinical medicine; Trauma, Shelter, Psychiatry, Outreach, Mental disorder, Substance Use, brain injury, homeless, SUD, Trauma-informed, Street drug, Adverse childhood events, Street mental health, Vulnerably housed, Context of care