Overcoming service barriers for homeless persons with serious psychiatric disorders

Objective: To help homeless persons with comorbid psychiatric and substance use disorders gain access to community set-vices, in 1993 the Center for M ental Health Services implemented the five-year Access to Community Care an d Effective Services, or ACCESS program, in 15 cities. One aim of the progr am is to encourage collaboration between agencies serving the multiple need s of this population, This study examined the extent of linkages between ag encies in the 15 demonstration cities. Methods: One respondent from each of the 1,060 community-based programs in the 15 cities rated the extent to wh ich his or her agency was linked with each of the other agencies in the loc al community in 1994 and again in 1996. Overall, there were 20,801 potentia l pairwise linkages, Linkages were classified into four types: a mutual tie , in which both agencies send and receive clients; a unidirectional tie, in which one agency sends and the other receives; an attempted tie, in which one agency sends but the other agency does not confirm receiving; and all u nattempted tie, Results: In 1993, and 1996, of the 20,801 pairs of potentia l service linkages, about a third were in place, while the remaining two-th irds were absent. Overall, linkages showed a slight but significant increas e between 1994 and 1996. More than half of the linkages changed in type, in dicating fluid service systems. Conclusions: Linkages between community age ncies serving homeless persons with comorbid psychiatric and substance use disorders are not extensive. However they increased slightly under the fil st two years of the ACCESS program, and there are good reasons to anticipat e greater improvements in the future.