Mental Health Challenges in a Shelter Environment

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This case takes place in a shelter for women (and trans females) experiencing homelessness that operates based on a Housing First philosophy. This means that the focus is on providing as temporary as possible shelter for clients while supporting them in their search for more stable, long term housing. No other supports are provided by the shelter (for mental health, addiction, etc.) within the Housing First Model; however, staff can provide referrals to other services (generally M-F, 9-5). The shelter environment is communal living – with shared bedrooms and approximately 20 women staying there at any given time. One other important point about the shelter is that it is often single staffed, and only ever has two staff working. Staff are responsible to provide direct client support, and maintain the safety of those in the building.

Rhonda, who is approximately 55 years old, is brought to the shelter by police one weekend (this is a not her real name). The police officers called ahead from the emergency room at a nearby hospital where Rhonda had just been seen, and medically released. Staff are not provided with information about why she was at hospital, and Rhonda is a new client at the shelter. During the intake process Rhonda appears confused, and is often unable or unwilling to answer many of the questions she is asked. She does not disclose any details about her health history. As part of the process Rhonda disposes of several unidentified substances, and turns in several knives to be stored for her until she leaves the premises. She is informed of the expectations for her during her stay, including safety guidelines and the focus on housing. Rhonda is at the shelter for only a few hours before her behaviour becomes concerning: Signs of mental unwellness, including talking to herself, agitated behaviour and inability to communicate with staff and residents are noted. As well she is found to be not following several rules, including smoking in the house, and turning in her knives upon her return to the house.

Within 24 hours it is decided by staff that Rhonda’s behaviour makes her unsafe to remain in the shelter, due in part to the fact that “her needs are too high” and she is discharged. It is not known where she will go, as she cannot be referred to another shelter because of her mental health status, and as it is a weekend, no referrals are made.

Questions

1. Should staff have allowed Rhonda to stay at the shelter?
2. What should staff think about if allowing her to remain at the shelter? I.e. a safety plan
3. If discharge was unavoidable what kind of community planning or action should take place?
4. Who could or should Rhonda be referred to in the community?
5. Can you identify any structural barriers that are contributing to this situation, or policy changes that need to happen?

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