Intended for healthcare professionals

Rapid response to:

Practice What Your Patient is Thinking

Three forms of identification and a letter from God

BMJ 2017; 359 doi: (Published 25 October 2017) Cite this as: BMJ 2017;359:j4669

Rapid Response:

Reconstruct the cycle: homeless psychotics call for GP's help

The efforts Burridge has made to improve medical services for the homeless are encouraging and worth praising (1). Homeless people are of course one of the disadvantaged groups in society, yet it is even more so for homeless psychotics. They are powerless to resist the natural disasters and intentional harms; they do not even know what to do. The problem is that they will threaten the stability and security of society if proper and timely measures cannot be taken.

Therefore, we believe that providing medical and other services for homeless psychotics brooks no delay. However, the reality is that the relief management system in most countries follows the principle of voluntariness, which doesn’t apply to people who are not able to ask for help by themselves. With high mobility, recurrent diseases and lack of care, homeless psychotics make the relief work stick in a vicious cycle--the more we shelter, the more psychotics are on the tramp.

One of the reasons of failure is that mental disorders in the homeless have not been treated well. As Burridge has done, GPs play an important role in helping homeless psychotics. Although the number of psychologists is extremely limited, GPs know how to deal with mental disorder. For example, the British community mental health system is composed of GPs, nurse practitioners, social service workers(2). Can we improve the effectiveness by the cooperation of GPs and other social organizations? Fortunately, the answer is affirmative and it has been practised in China. In June 2014, Dongguan has introduced GPs to street relief work. Some GPs joined the public social work service center and carried out the program called street-corner dawn(3). Through daily patrolling, follow up and record, homeless psychotics get timely primary care and relief. Up to last year, the program has helped 23 homeless psychotics return to their families and society.

The pity is that this program only covers four districts of the urban area in Dongguan due to human and financial constraints. It is also urgent to change the way of GP training in mental health(4). We hope that more GPs can take the initiative to have access to local relief work and dedicate their knowledge and energy generously, because it will set a positive example for other people and groups, so a new and virtuous cycle will form at last.

Competing interests: None declared

1 Stan Burridge. Three forms of identification and a letter from God. BMJ 2017, 359: j4669. doi: 10.1136/bmj.j4669 pmid: 29070597.
2 Evans L, Green S, Sharma K, et al. Improving access to primary mental health services: are link workers the answer? London Journal of Primary Care 2014, 6: 23-28. doi: 10.1080/17571472.2014.11493409 pmid: 25949709.
3 Yangcheng Evening News. The homeless psychotic killed people on the street, and the financial support is just a drop in the bucket. 2016.
4 England E, Nash V, Hawthorne K. GP training in mental health needs urgent reform. BMJ 2017, 356: j1311. doi: 10.1136/bmj.j1311 pmid: 28302682.

Competing interests: No competing interests

01 November 2017
Zhijie Xu
resident doctor
Cadet Brigade, Naval medical university
No.800, Xiangyin Road, Yangpu distict, Shanghai, China