How do you prevent recurrent homelessness for people who suffer from severe mental illness? Dr. Alan Felix, a Columbia University Medical Center psychiatrist believes he has found an answer. "There is a critical time when homeless people leave public shelters and try to enter life in the community," said Dr. Felix. "If you help people through that difficult time, you can usually prevent them from winding up back on the street."

With funding from the National Institutes of Mental Health, Dr. Felix has developed a groundbreaking psychosocial intervention, called the Critical Time Intervention Program, at a men's community shelter in Washington Heights, New York.

The Critical Time Intervention Program provides assistance and support for people who are homeless while they are at the shelter and after they leave. "We believe that when people go from an intensive treatment program at a shelter back into the community, there is a very big change. You need to provide them with services that help them manage that transition," said Dr. Felix.

Under the program, a team of case managers, a psychiatrist, and a psychiatric nurse go to the shelter to conduct psychological and medical evaluations and help those who are mentally ill get back on medication. The case managers focus on helping people with the nonmedical areas of their lives, such as finding supportive housing or receiving entitlements (i.e., social security or Medicaid).

Once an individual has found supportive housing and left the shelter, the Critical Time Intervention Program continues to work with them. "When people get their own room after having been in a shelter, we help them decorate it," said Dr. Felix. "Something as small as that gives people a sense of dignity and self respect, a feeling that they belong in the world again."

The program is comprehensive: it includes support groups that focus on medication and housing, for example. Case managers also refer people to other resources and programs, such as New York City psychosocial clubs, (e.g., Fountainhouse), literacy classes, and GED programs.

According to Dr. Felix, at a given time there are about 75 to 90 people in his program. The program averages about 4 housing placements a month. "Not everyone who goes to the shelter who is mentally ill is willing to fully participate in this intervention. Some do return to being homeless or stay at the shelters because they are unable to live on their own," he explained. Dr. Felix and his colleagues published a study in the American Journal of Public Health (February 1997) in which they revealed that the program reduced homelessness by a third compared with programs that did not work with people after they left shelters.

Felix remembered one patient with schizophrenia who was initially very disorganized, strangely dressed, and did not take medication. "He thought he was a lawyer and wanted legal pads to write cases down. So we gave him legal pads. Slowly, he got to know us and feel more comfortable with us. We then told him he'd have to take his medication in order to get more legal pads."

Ultimately, the team got him into a housing program and he stayed on medication. The team has kept in touch with him; he is still living in supportive housing and is involved in vocational rehabilitation. Said Dr. Felix: "To me that's a real success story."