", 
Department of Health and Human Servces 
OFFICE OF 
INSPECTOR GENERAL 
COMMUNITY MENTAL HEALTH CENTERS 
AND HOMELESS PERSONS 
1' . 
S'EVICls
JU 
GffBS BROWN 
Inspector General 
AUGUST 1996 
"d3a  OEI-07-95-0061  OFFICE OF INSPECTOR GENERA 
The mission of the Office of Inspector General (OIG), as mandated by Public Law 95-452
, as 
amended, is to protect the integrity of the Department of Health and Human Servces ' (HHS) 
programs as well as the health and welfare of beneficiaries served by those programs. This 
statutory mission is carried out through a nationwide network of audits, investigations , and 
inspections conducted by three OIG operating components: the Office of Audit Services, the 
, and the Office of Evaluation and Inspections. The OIG also informs 
Office of Investigations
the Secretary of HHS of program and management problems and recommends courses to 
correct them.

OFFICE OF AUDIT SERVICE 
The OIG's Office of Audit Servces (OAS) provides all auditing servces for HHS, either by 
conducting audits with its own audit resources or by overseeing audit work done by others. 
Audits examine the performance of HHS programs and/or its grantees and contractors in 
carryng out their respective responsibilities and are intended to provide independent 
assessments of HHS programs and operations in order to reduce waste, abuse, and 
mismanagement and to promote economy and efficiency throughout the Department. 
OFFICE OF INTIGATIONS 
The OIG's Offce of Investigations (01) conducts criminal, civil, and administrative 
investigations of allegations of wrongdoing in HHS programs or to HHS beneficiaries and of 
unjust enrichment by providers. The investigative efforts of 01 lead to criminal convictions 
, or civil money penalties. The 01 also oversees State Medicaid fraud 
administrative sanctions
control units which investigate and prosecute fraud and patient abuse in the Medicaid program. 
AN 
OFFICE OF EVALUATION  INSPECTONS 
The OIG's Offce of Evaluation and Inspections (OEI) conducts short-term management and 
program evaluations (called inspections) that focus on issues of concern to the Department 
the Congress, and the public. The findings and recommendations contained in these inspection 
reports generate rapid , accurate, and up-to-date information on the effciency, vulnerability, 
and effectiveness of departmental programs. The report was prepared in the Kansas City 
regional offce under the direction of Jim Wolf, Regional Inspector General. Project staff 
include: 
Kaas City  Headquarers 
Dennis Tharp, Project Leader  Wiliam M. Krushat, Branch Chief

Tim Dold, Team Leader  Alan Levine, Program Specialist

Perry Seaton, Team Leader

Linda Paddock, Program Assistant

To obta a  ca the Kaas City regional offce at (816) 4263697. 
copy of thi report  EXECUTIVE  SUMMARY

PUROSE 
To determine the extent that community mental health centers serve homeless 
persons. 
BACKGROUN 
The homeless population is a heterogenous group of men
, women and children who 
have a variety of health care problems, including a high incidence of mental ilness and 
substance abuse/alcohol disorders. 
Community Mental Health Centers (CMHCs) are a major component of health care 
servces for people who are economically disenfranchised and homeJess. The centers 
primary objective is providing mental health servces to persons with mental ilness or 
emotional disturbances. They provide a broad range of servces
, including individual 
and group counseling, psychosocial rehabilitation, therapeutic education, life skils 
training, day programs, and substance abuse counseling and treatment. CMHCs 
also 
tyically provide case management, medication management, and arrangements for 
residential servces. 
This report is based on a mail survey of 50 community mental heath centers and 86 
homeless shelters. Fifeen of the 50 centers had received special grant funding to 
specifically engage in outreach servces for homeless persons with mental ilness (e. 
the Projects for Assistance in Transition from Homelessness (PATH) grant program or 
the Access to Community Care and Effective Servces and Supports (ACCESS) grant 
program.) We also conducted on-site visits with two CMHC mental health care 
managers and five directors of homeless shelters to supplement information from the 
surveys. 
This study was requested by the Assistant Secretary for Planning and Evaluation as 
part of a broader effort to look at mainstream Federal programs 
addressing homeless 
persons. 
FININGS 
Communty Mental Health Centers Perform Outreach to Homeles
; Persons 
All centers with PATH and/or ACCESS grants report that they conduct outreach by 
sending staff or volunteers off-site to areas where homeless persons with mental ilness 
may congregate. However, only 50 percent of those centers which did not receive any 
PATH or ACCESS funding perform outreach.  Nearly all of the centers' staffs that conduct outreach go to emergency homeless 
shelters. Outreach staff visit and provide referrals at transitional shelters, street 
locations, soup kitchens, drop-in centers, parks, depots, and campgrounds. 
Approximately one-fourth also may go to county jails, public libraries, river banks 
psychiatric hospitals, churches, restaurants, and shopping malls. 
Centers Receive Referral from a Varety of Sources

Although 21 percent of the centers' homeless clients with mental ilnesses are self-
referrals, the majority of homeless clients are referred from emergency shelters 
hospital emergency rooms, police, state psychiatric hbspitals, and the jail/court system. 
Only 17 percent (15 of 86) of the homeless shelters report that they do not refer their 
clients to the CMHCs for mental health servces. 
A Majority of Shelters Rate their Relationship with Communty Menta Health 
Centers as Positive; Some Problems Do Emerge, However 
Over 69 percent of the homeless shelters rate their relationship with the local mental 
health center as either satisfactory or excellent. However, 20 percent believe that the 
quality of mental health servces at the centers is unsatisfactory or poor. They cited: 
weakness in providing immediate crisis intervention servces; not enough individual 
therapy; shortage or lack of assignment of case managers and therapists; and clients 
being given standard prescribed medication without really being listened to. 
Centers Provide Referral for Other Health Cae and Social Servces 
Most centers report providing referrals for other health care servces such as substance 
abuse servces, inpatient psychiatric servces, medical outpatient servces, and referrals 
for medical assistance benefits/entitlements and programs such as Aid to Families with 
Dependent Children and Food Stamps. 
Centers Cite Barers in Providig Servces to Homeless People, Especialy Difculties 
in Contiuity of Cae and Avaiabilty of Servces in the Communty 
Community mental health centers report that they face barriers in tryng to serve 
homeless persons, especially since many of those persons with mental ilness are also 
substance abusers. Over one-half of the homeless shelters also responded that clients 
have problems accessing center services. Barriers include the clients' inability or 
unwillngness to follow through on a plan of care and shortage of necessary servces 
for homeless persons with mental ilness. 
OPPORTUIE 
FOR IMROVEMENT 
Overall, community mental health centers and homeless shelters seem to be 
coordinating their efforts to help homeless people. However, there are stil 
opportunities for improvement. We recognize that resources are limited and that not  all services that are needed can be provided within current funding levels. We offer 
the following suggestions to centers wishing to re-examine and prioritize their 
programs for serving homeless persons with mental ilness. 
Improve Communication and Inormation Sharg with Homeless Shelters 
Communication and information sharing could take the form of periodic meetings to 
discuss problem areas, beneficial activities, statistical reporting techniques, and the 
joint monitoring of homeless persons with mental ilness. Centers which do not 
engage in outreach activities could do so; those centers which already do could 
develop even more assertive outreach programs. Also, community mental health 
centers could work with homeless hotlines in their service area to provide urgent care 
or crisis intervention for those needing immediate attention. 
At the Federal level, the Substance Abuse and Mental Health Servces Administration 
(SAMHSA) could be instrumental in supporting further research on the topic of 
homeless persons with mental ilness and their difficulties in obtaining appropriate 
mental health care and counseling.

Offer Comprehensive Servces to Address 
Indidual Needs 
Counseling servces could be offered to specifically address individual needs. These 
could include: substance abuse counseling (since many clients have a dual-diagnosis of
mental ilness and substance abuse) and physical and/or 
sexual abuse counseling. 
Centers could provide more intensive case management to members of this 
population. CMHCs could also work with housing programs to develop a variety of 
housing options. 
AGENCY COMMNT 
We received formal comments from the Administrator of SAMHSA and the Assistant 
Secretary for Planning and Evaluation. Both agreed with the findings in the report. 
The Administrator of SAMHSA emphasized the need to work more 
closely with
shelters and housing providers and for more research on homelessness and mental 
ilness. Copies of the full text of their comments are included in Appendix A.  . .. . . . . . . .  .. . . . ... . 
. . . . . ..  ..  ..  ..  ..  ...   ...   ...   ...   ....   .... .  ....   ....   . ..  . ... .  ...    ....    ....    ....    ....    ....    ... .  . .. .  . .. .  ....    ....    ....   ....    ....    ...   ..  ..  ..  ..  ..  . . . . . 
 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
TABLE  OF CONTENTS 
PAGE 
EXECU SUMY 
INODUCTON. . 
. . . . . . . . . . . . 1
FININGS. . 
. . . . . . . . . . . . . . . . . 4
Outreach. . . . . . . . . . . . . . . . . . . . . 
Screening Protocols. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Referral Sources.  . . . . .. . . . 5
Relationships with Shelters. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Health Care and Social Servce Referrals. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Servce Barriers. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
OPPORTU 
FOR IMROVEMENT. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
AGENCY COMMNT. .  . . . . . . . 9
. . . . . . . . . . . . . . . . . . A-

APPENDIX A . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  INTRODUCTION

PUROSE 
To determine the extent that community mental health centers serve homeless 
persons. 
BACKGROUN 
The homeless population is a heterogenous group of men, women and children. They 
include long term street dwellers, residents of homeless shelters and temporary living 
quarters, the economically disadvantaged, single men and women, families with 
children, as well as runaway and castoff youths. Homeless individuals have a variety of 
health care problems, including a high incidence of mental ilness and substance 
use/alcohol disorders. 
Community Mental Health Centers (CMHCs) are a major component of health care 
servces for people who are economically disenfranchised and homeless. The centers 
primary objective is providing mental health servces to persons with mental ilness and 
persons with emotional disturbances. They provide a broad range of mental health 
servces, including individual and group counseling, psychosocial rehabilitation 
therapeutic education, life skills training, day programs, and substance abuse 
counseling and treatment. CMHCs also typically provide case management 
medication management, and arrangements for residential servces. 
Public Law 102-321 , the Alcohol, Drug Abuse and Mental Health Administration 
Reorganization Act, mandates a vigorous Federal leadership role in mental health 
servces delivery and policy development. The Act significantly 
increases the attention 
and resources devoted to the mental health servce needs of children and adults. The 
Center for Mental Health Servces (CMHS) in the Substance Abuse and Mental 
Health Servces Administration (SAMHSA) works closely with other Federal agencies 
whose programs and policies affect the lives of persons with mental ilness. The 
CMHS also works closely with State and local governments and the private sector to 
assure continuity, integration of servces, and access to comprehensive systems of care. 
The CMHS provides national leadership to (I) ensure the application of scientifically 
established findings and practice-based knowledge in the prevention and treatment of 
mental disorders; (2) improve access, reduce barriers, and promote high quality 
effective programs and servces for people with, or at risk for these disorders, as well 
as for their families and communities; and (3) promote the rehabilitation of people 
with mental disorders. It also composes and retains a listing of all community mental 
health centers. While having no direct administrative control over mental health 
center servces, the agency compiles statistical information on the facility location 
telephone numbers, servces available, and years of operation of all centers 
nationwide.  The Stewart B. McKinney Homeless Assistance Amendment Act of 1990 authorized a 
new Federal grant program to deal with the needs of people who are homeless and 
have serious mental ilnesses. The program--known as Projects for Assistance in 
Transition from Homelessness (PATH) --funds community-based outreach, mental 
health, substance abuse, case management and other support servces, as well as a 
limited set of housing services. Each year, the PATH program distributes about $30 
milion through formula grants to each State and U.S. territory to provide 
services to 
people with serious mental ilnesses, including those with co-occurring substance use 
disorders who are homeless or at risk of becoming homeless. In many States
, PATH 
funds are the only Federal dollars available for outreach services within the mental 
health system. 
Beginning in fiscal year 1993, the Department of Health and Human Servces (in 
collaboration with the Departments of Housing and Urban Development
, Labor 
Education, and Veterans Affairs) provided Access to Community Care and Effective 
Servces and Supports (ACCESS) grants to nine 
States. This innovative 
interdepartmental demonstration project integrates housing, treatment and support 
servces for homeless persons with mental ilness. The ACCESS initiative flows 
directly from the work of the Federal Task Force on Homelessness and Severe Mental 
Illness and is founded on the assumption that the integration of fragmented servces 
wil substantially contribute to ending homelessness among persons with severe mental 
ilness. 
METHODOLOGY 
The inspection focused on the extent of outreach and servces provided by community
mental health centers to the population of homeless persons with mental ilness. 
There are approximately 3 000 community mental health center providers nationwide. 
However, we focused on 569 centers that had previously received Federally funded 
construction grants, a subset of the "1995 Mental Health Directory" issued by the 
Survey and Analysis Branch of the Center for Mental Health Servces. Since Federally
grant-constructed centers constitute only a fraction of community mental health 
centers nationally, our findings would not be considered representative of all centers
only those which received Federal funding.
We purposefully excluded mental health centers located in cities with populations of 
000 or less because most rural centers do not have homeless shelters in their 
service area. From this revised universe, we selected a random sample of 75 centers. 
In addition, we also selected two - three homeless shelters in the 75 cities in which the 
community mental health centers are located. 
We mailed surveys to 75 CMHCs, and received 50 responses. In addition, we sent 
surveys to 180 homeless shelter directors and received 86 completed surveys. Due to 
incomplete response rates, we did not always receive a returned survey from centers 
and shelters in the same area. The survey document did not make a distinction
between access to mental health servces by homeless persons with serious mental ilnesses and access by those homeless persons with mental health needs but who do 
not have a serious mental ilness. 
We received surveys from: 
15 CMHCs with PATH and/or ACCESS grants. 
11 CMHCs that are located in cities receiving PATH or ACCESS grants. 
24 CMHCs which had no PATH or ACCESS funding. 
The inspection team analyzed the responses to the survey 
questions. These responses 
were quantified to determine such issues as the number of mental health centers that 
provide outreach servces, the quantity and type of referrals for mental health care 
treatment and counseling for homeless persons with mental ilness, and the extent of 
barriers that prevent access to servces. We also conducted on-site visits with two 
CMHC mental health care managers and five directors of homeless shelters to 
supplement information from the surveys. 
The characteristic center in our sample was a moderate to large-sized multi-servce 
center established in 1971 with a budget of $8. 8 milion, and seeing an average of 
000 undupIicated persons/users annually. There were about 224 homeless 
nearly 5 
persons with mental ilness served annually out of a self-reported (estimated) 2 
000 
homeless persons in each servce area. While homeless persons with mental ilness
comprise about 4-5 percent of the centers' average user population , approximately 
only I percent of the average center s annual budget goes toward operating costs for 
servng homeless persons and conducting homeless outreach. 
This study was requested by the Assistant Secretary for Planning and Evaluation as 
part of a broader effort to look at mainstream Federal programs addressing homeless 
persons. This report is one of two related national reports on health care servces for 
the homeless. A companion report addresses the extent that Federally-funded 
Community Health Centers serve the homeless population. 
We conducted our review in accordance with the  Quality Standard for Inspectins 
issued by the President's Council on Integrity and Effciency.  FINDINGS
Community Mental Health Centers Perform Outreach to Homeless Persons
All centers with PATH and/or ACCESS grants report that they conduct outreach
sending staff or volunteers off-site to areas where homeless persons with mental ilness
may congregate. However, only 50 percent of those centers which did not receive any 
PATH or ACCESS funding report performing outreach. Nearly all of the centers 
staffs that conduct outreach go to emergency 
homeless shelters. Outreach staff visit 
and provide referrals at transitional shelters
, street locations, soup kitchens, drop-
centers, parks, depots, and campgrounds. Approximately one-fourth also may go to
county jails, public libraries, river banks, psychiatric hospitals, churches, restaurants
and shopping malls. 
The most frequent outreach activity is a mental health 
assessment. This is followed by 
offering information on mental health servces available to shelter residents
, providing 
general health care services, providing food/clothing, and conducting mental health 
training for shelter staff. Outreach services also cited by mental health centers include 
referrals to public assistance entitlements , housing assistance, psychiatric referrals, and
transportation to psychiatric or medical appointments.
While our respondents reported a varied practice among community mental health
centers in providing outreach, 32 percent of the centers conduct daily outreach and 10 
percent conduct weekly outreach. Twenty-two percent reported a variety of 
responses: that they either perform outreach as needed
, on a biweekly basis, or 2-
days per week. 
Centers Adapt Screenig Protocols to Address Homelessness Issues 
Nearly one-half (48 percent) of the mental health centers surveyed report they have 
adapted treatment and screening protocols to specifically meet the needs of homeless 
persons with mental ilnesses. As part of this effort, emphasis is made to obtain the
homeless status during the initial intake process. For instance
, over three-fourth' s (76
percent) of the centers indicated they identify the housing/omeless status of new 
clients. Centers also perform comprehensive psychosocial assessments and discuss the
housing status in the screening process.
Of the centers reporting treatment recipient figures, nearly five percent of the mental 
health user population were homeless. From survey data, centers present a picture of
For purposes of this inspection, we defined outreach as: "an initial, continuing, and
persistent effort to establish a trusting relationship essential in engaging, 
connecting, or
reconnecting homeless individuals to needed health
, mental health, social welfare, and
housing services. , "

homeless persons with mental illness that they serve. Some of the 
more interesting
factors of the homeless client are noted in percentage data: 
Centers Receive Referral from a Varety of Sources

Although 21 percent of the centers' homeless persons with mental ilnesses are seJf
referrals, the majority of homeless clients are referred from emergency homeless 
shelters, hospital emergency rooms, police, state psychiatric hospitals, and the jail/court
system. Whle 17 percent, or 15 shelters, indicated they do not refer to centers, the
majority (or 83%) of the homeless shelters surveyed said that they refer their clients to 
the centers for mental health services. In addition, the shelters also refer to hospital 
emergency rooms, substance abuse counseling, homeless outreach counselors 
psychiatric social workers, medical clinics, hospital inpatient/outpatient, volunteer 
psychologists, and private psychologists and psychiatrists. 
A Majority of Shelters Rate their Relationship with Communty Menta Health 
Centers as Positive; Some Problems Do Emerge, However 
Over two-thirds (69 percent) of the homeless shelters rate their relationship with the 
local mental health center as either satisfactory or excellent. Only 13 percent report 
poor working relationships. (Eighteen percent did not respond or indicated that it was 
not applicable.

As a function of this relationship, two-thirds (67 percent) of the homeless shelter 
respondents report they receive positive comments about good or excellent quality of 
care from homeless persons with mental ilness that were referred to 
community
mental health centers. Homeless shelter directors said they receive a diversity of 
comments from homeless people depending on the client's wilingness to receive help. 
One shelter director said  The comments are highly subjective and entirely anecdotal. 
Many clients like their individual case workers but are frustrated by the slow 
incremental changes in their lives." A homeless shelter director noted 
(Clients)...appreciate the case management support.(They) feel that staff really care  about their needs/issues...(They) appreciate the opportunity to receive services in a 
non-threatening setting." Another director indicated that "Clients are grateful to 
know they are not unique or strange... .Appreciate transportation..(The program 
is)...very effective in working through crisis and long-term depression. 
However, 20 percent of homeless shelters believe that the quality of mental health 
servces at the centers is unsatisfactory or poor. They cited: weakness in providing 
immediate crisis intervention services when homeless people are most vulnerable and 
wiling to accept help; not enough individual therapy to address their problems; 
shortage or lack of assignment of case managers and therapists; and clients being 
given standard prescribed medication without really being listened to. 
Other concerns enumerated by homeless shelter directors follow: 
Center appointments are given too many days ahead and the client may need 
immediate servce or may no longer be at the shelter on the appointment day. 
It takes too long to get an appointment...Clients cannot understand 
forms.....Clients cannot afford the sliding fee scale..... 
Clients do not understand why their cases are closed...
Clients do not receive 
any follow-up servces once placed in housing....Clients do not know where to 
go or who to ask for help when they start to decompensate. 
Centers Provide Referral for Other Health Cae and Social Servces 
Most centers report providing referrals for health care servces. The main referral is 
to detoxification or other substance abuse servces, followed by inpatient psychiatric 
servces. Common referrals also include 
medical outpatient servces provided at such 
locations as free health clinics and public health clinics. The least common referrals 
are for dental servces at Community Health Centers, residential servces, emergency 
room treatment and services, and medical inpatient treatment. Centers also provide 
referrals for health care benefits/entitlements: , " 
Ninety-four percent of the centers link those who qualify with assistance administered 
by the Social Security Administration. Centers also offer a full-range of other public 
assistance referrals: 
88 percent offer Food Stamp referrals.
80 percent refer clients to the AFDC program.
70 percent refer clients to the WIC program, if applicable.
64 percent refer homeless persons with mental ilness to general
assistance.
24 percent refer to State disability, unemployment compensation 
housing agencies, legal assistance, and food banks. 
Centers Cite Barers in Providig Servces to Homeless People, Especialy Difculties
in Contiuity of Cae and Avaiabilty of Servces in the Communty 
Although 64 percent of community mental health centers conduct an outreach 
program, centers report that they face barriers in trying to serve homeless persons 
especially since many of those persons with mental ilness are also substance abusers. 
Barriers include the clients' inability or unwillngness to follow through on a plan of 
care and their unwilingness to go to a mental health center for servces. Another 
obstacle listed by many centers is the shortage of necessary servces for homeless 
persons with mental ilness. 
Over one-half (58 percent) of the homeless shelters reported that clients have 
problems accessing the centers' servces. Most of the items cited are well-known 
obstacles among the homeless population: lack of affordable transportation; lack of 
information about center servces; and an unwillngness to go to a center for mental 
health servces. 
Another problem identified by homeless shelters is that community mental health 
centers often target their services to those most in need and may not accommodate 
persons with mental health needs who are not among the most seriously impaired. In 
addition, centers may find that one problem is that once the client's appointment day 
arrives, homeless persons have often moved on to another location or shelter. 
Also, homeless persons with mental ilness located in cities which share State or county 
lines often find themselves positioned out of the appropriate center s jurisdiction or
service area. One shelter responded  Ilinois residents cannot be seen in an Iowa 
mental health center except for emergencies....." The non-evening, non-weekend hours 
of some centers were also noted to impact homeless persons with mental ilnesses.  OPPORTUNITIES FOR IMPROVEMENT

Overall, community mental health centers and homeless shelters seem to be 
coordinating their efforts to help homeless people. However, there are stil 
opportunities for improvement. We recognize that resources are limited and that not 
all services that are needed can be provided within current funding levels. We offer 
the following suggestions to centers wishing to re-examine and prioritize their 
programs for serving homeless persons with mental ilness. 
Improve Communcation and Inormation Sharg with Homeless Shelters 
Communication and information sharing could take the form of periodic meetings to 
discuss problem areas, beneficial activities, statistical reporting techniques, and the 
joint monitoring of homeless persons with mental ilness. Centers which do not 
those centers which already do could 
engage in outreach activities could do  so; 
Also  community mental health 
develop even more assertive outreach programs. 
centers could work with homeless hotlines in their servce area to provide urgent care 
or crisis intervention for those needing immediate attention. 
At the Federal level, SAMSA could be instrumental in supporting further research 
on the topic of homeless persons with mental ilness and their difficulties in obtaining 
appropriate mental health care and counseling. 
Offer Comprehensive Servces to Address 
Indidual Needs 
Counseling servces could be offered to specifically address individual needs. These 
could include: substance abuse counseling (since many clients have a dual-diagnosis of
mental ilness and substance abuse) and physical and/or 
sexual abuse counseling. 
Times for such sessions might need to be flexible to deal with the clientele 
inconsistency in keeping appointments. In addition, counselors could pro actively work 
with the homeless client, stressing the importance of continual therapy to achieve 
progress. 
Centers could provide more intensive case management to homeless persons with 
mental ilnesses. These servces could be provided on an ongoing basis in order to 
engage homeless persons with serious mental ilnesses into mental health services 
obtain housing, entitlements and mainstream servces on their behalf
, and help them 
establish residential stability. 
Centers could work with housing programs to develop a variety of housing options. 
However, providing housing is not enough. Many homeless persons with mental ilness 
need intensive, on-site support to maintain their residential stabilty. Centers could 
provide supportive services to homeless individuals in their housing to help them 
achieve that stability.  AGENCY COMMNT 
We received formal comments from the Administrator of SAMHSA and the Assistant 
Secretary for Planning and Evaluation. Both agreed with the findings in the report. 
The Administrator of SAMHSA emphasized the need to work more closely with 
shelters and housing providers and for more research on 
homeJessness and mental 
ilness. Copies of the full text of their comments are included in Appendix A.  APPENDIX A  """"
DEPARTMENT OF HEALTH & HUMA SERVICES  Public Health Service 
Substance Abuse and Mental 
Health Services Administration 
Rockville MD 20857 
JUL I 6 /99 
DATE: 
TO:  Inspector General, DHHS 
FROM:  Administrator, Substance Abuse and Mental Health Services Administration 
SUBJECT:(cid:1) OIG Draft Report: "Community Mental Health Centers and Homeless Persons 
OEI-07-95-00061 
Attached are the Substance Abuse and Mental Health Services Administration s comments on 
the subject Offce ofInspector General draft report. We appreciate the opportunity to review the 
report. We believe it provides valuable information about the extent to which Community 
Mental Health Centers serve homeless persons and look forward to receiving the final report. 
If you have any questions regarding these comments, please contact Nancy McGinness on 443-
1155. 
Nelba Chavez, Ph.  COMMENTS OF THE SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES 
ADMINISTRA nON ON THE OFFICE OF INSPECTOR GENERAL DRAFT REPORT 
COMMUNITY MENTAL HEALTH CENTERS AND HOMELESS PERSONS 
OEI-07-95-00061 
Thank you for the opportunity to review and provide comments on the subject draft report. It is 
lear that all 
responsive to our earlier concerns and recommendations. We were not surprised to 
of the community mental health centers (CMHCs) in the study that received PATH or ACCESS 
funding also provided outreach, while only fifty percent of those that did not receive this funding 
provided outreach. Both the ACCESS and PATH programs have encouraged CMHCs to work 
more aggressively with the homeless population. 
We agree with the suggestions about the need for better communication between CMHCs and 
shelters, more assertive outreach to people in the shelters, more intensive case management and 
counseling for persons who are homeless and more housing resources. If the CMHCs are going 
to have an impact on reducing homelessness, they wil need to work more closely with shelters 
and housing providers. 
We also agree that there is need for more research on homelessness and mental ilness and that 
the Substace Abuse and Mental Health Services Administration could be valuable in supporting 
these knowledge development initiatives. The Center for Mental Health Services (CMHS) has 
fuded a number of research and evaluation studies on homelessness. The McKinney Research 
Demonstration Program, which was funded between 1990 and 1993, examined the effectiveness 
of different approaches to providing mental health treatment, housing, and related services to 
homeless adults who have severe mental ilnesses. The Dual Diagnosis Treatment 
Demonstration Program, funded jointly with the Center for Substance Abuse Treatment (CSAT) 
between 1993 and 1995, identified and evaluated integrated approaches to treating homeless 
people with co-occuring mental ilnesses and substance use disorders. The ACCESS Program is 
a 5 year demonstration program, initiated in 1993, to identify effective strategies for creating 
inediate 
integrated service systems so that people who are homeless and mentally il will have 
access to mental health and substance abuse treatment, health care, housing and income supports 
and entitltements. Finally, CMHS and CSAT will support in the fall of 1996 a new knowledge 
development program to document homelessness prevention models for individuals with serious 
mental ilnesses and/or substance use disorders. As the findings from these programs are 
published, they are. providing importnt information regarding effective services and service 
delivery to people who are homeless and mentally ill.  DEPARTMENT OF HEALTH &. HUh\AN SERVICES 
Office of (he SeCrelary

-.T
h.."  Washington
, D.C. 20201 
JUL I 7 
'996 
TO:(cid:1) June Gibbs Brown 
Inspector General 
FROM:  Assistant Secretary for Planning and Evaluation 
SUBJECT:(cid:1) Comments on the OIG Draft Report: "Community Mental Health Centers and 
Homeless Persons," OEI-07-95-00061 
Thank you very much for the opportunity to review the above referenced report. Knowledge 
about the extent that community mental health centers (CMHCs) serve the homeless and how 
such servces can be improved is highly important. 
The report represents a major improvement over the Erst draft. We are pleased to see included in 
, rather than illness and homeless focused language used in describing 
the report: people focused
the population; a definition of outreach; and the note that the survey questionnaire did not make 
distinction between persons with serious mental ilness and those who do not have a serious 
mental ilness. Most importantJy, we were pleased to see the analysis of the outreach data by 
looking at centers' receipt of Projects for Assistance in Transition from Homelessness (pATH) 
As a 
or Access to Community Care and Effective Services and Supports (ACCESS) funding. 
the 
result of the inclusion of the PATH and ACCESS analysis we are better able to see that both 
ACCESS and PATH programs have encouraged CMHCs to work more aggressively with the 
homeless population. 
We appreciate this opportunity to review this draft GIG report. We believe it provides valuable 
information about the extent to which CMHCs serve homeless persons and look forward to 
receiving the final report.