Staff of the Outreach and Engagement Project (O&E) at the Connecticut
Mental Health Center (CMHC) in New Haven can claim a number of successes.
Not the least of these victories is that both city and state officials
agreed to fund the program after a six-year federal grant ended in 1999.
The Substance Abuse and Mental Health Services Administration funded the
project, then called ACCESS, in 1993 as part of a multicity demonstration
effort to determine the effects of service integration on care for homeless
people with mental illness.
Frequently, the end of federal funding for a demonstration program results
in the end of services and a staff left with no resources to implement the
lessons learned. The O&E Project is one of only three of the original 18
ACCESS demonstration projects still in operation.
The project, in fact, has expanded because of support from the Connecticut
Department of Mental Health and Addiction Services (DMHAS) and the city of New
Haven and now has a budget of over $1 million.
Project Director Deborah Fisk, who was one of the first three outreach
workers, described an evolutionary process in which staff tried different
approaches to persuade homeless people to seek treatment for mental illness
and to access supportive services.
They faced issues that had received little attention in the literature
about outreach to this population.
"We had problems related to professional boundaries and
ethics," she said. "We would approach a client in a soup kitchen,
not realizing that we were `outing' him as a user of our services to the other
Staff were giving their own money to clients because of the level of
Today more than half of the O&E staff are recovering from mental
illnesses, including addiction disorders. Many of these staff members, who are
called peer specialists or workers, have also been homeless.
Fisk initially was skeptical about adding a peer specialist to the team,
but did so because it was a condition of the grant. She recognized the power
of the concept when she heard a homeless woman tell the peer specialist,"
I want to be like you. What do I have to do to get a job like
Integrating peer specialists into the team and other aspects of the program
brought new challenges.
"Workplace discrimination is pervasive against people with mental
illness," Fisk said. It can even occur at a setting such as a community
mental health center.
Peer specialists told about instances of overt discrimination, such as
being the only team member expected to make coffee and of being excluded from
routine social events such as lunch gatherings.
They also talked about more subtle problems. "I feel cut off from
both groups," one specialist told Fisk. "I'm alone in the
A peer specialist might find herself in a professional role at a meeting
with her therapist or former therapist.
Fisk advocates open discussion and exploration about these issues and
recognizes the need for training staff about them.
She and other staff members began to publish articles about various issues
concerning the employment of peer specialists and providing outreach in
journals such as Psychiatric Rehabilitation Journal.
Staff also established closer relationships with city officials and
agencies providing relevant services. Two new programs resulted from the
New Haven funds a project that provides subsidies for homeless men and
women to enter housing that is "substance free."
A second program, jointly funded by the DMHAS and New Haven, provides a
range of services, including outreach, case management, and vocational
services, through a multidisciplinary team to people with substance abuse
Fisk herself has gone through an evolutionary process in terms of her
career in mental health services.
She began as a night attendant doing custodial work and bed checks at a
public psychiatric hospital and joined the CMHC 18 years ago as a psychiatric
aid in the inpatient unit.
Fisk took particular satisfaction in helping people cope with the trauma of
acute illness and hospitalization and watching them gain hope. She has since
earned an M.S.W. and is working toward a Ph.D. ▪