Safety, Trust, and Treatment: Mental Health Service Delivery for Women Who Are Homeless

Women with serious mental illnesses who are homeless and have histories of substance abuse, poverty, social dislocation, ruptured relationships, and/or experiences of abuse and trauma can encounter barriers to fully engaging in formal treatment and related services. Many local public mental health systems are often ill-equipped to accommodate these women's unique behavioral and physical service needs. This article proposes an innovative approach to providing mental health services that are sensitive to the intersecting identities and associated difficulties these women experience. Based on our evaluation of a federally funded program for homeless women with behavioral and mental health concerns, we highlight four key principles that can optimize and promote the recovery outcomes of these women: (1) peer support, (2) flexible services and resources, (3) supportive program leadership, and (4) gender-sensitive services provided by women. We provide case vignettes highlighting how each of these treatment principles fosters trust and helps to create safe psychological and physical spaces for women clients. We conclude with clinical and programmatic recommendations for implementing these principles in non-traditional behavioral health care settings.