This article summarizes the dramatic changes in public policy through which public mental health systems are attempting to meet the housing and community support needs of persons with severe and persistent mental illnesses, including those who are homeless. It traces the historical approach to meeting these needs through defining people principally as patients and providing some combination of psychotropic medications, outpatient therapy, and structured, supervised quasi-institutional settings such as group homes, shelters, and segregated single-room-occupancy, or board-and-care facilities. A transition phase in public policy has emphasized defining these individuals essentially as service recipients who need greater or lesser amounts of community support services to avoid institutionalization. This policy focus, while less institutionally oriented than past policies, did little to alter the kinds of housing approaches planned for them. An emerging set of values and policies, which represents a paradigm shift in the field, now focuses on these persons first as people and as citizens, with rights, responsibilities, and needs like those of all citizens. Implications of this new set of policies for mental health systems are discussed.



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