Building a Sustainable Street Psychiatry Framework: The Sulzbacher Program in Jacksonville

Abstract Individuals experiencing unsheltered homelessness and severe mental illness face compounding systemic barriers, limiting the effectiveness of traditional clinic-based psychiatric models. This paper outlines the operational framework of the Sulzbacher Homeless Outreach Project Expansion (HOPE), a transdisciplinary street psychiatry program serving Northeast Florida for over two decades. Operating out of a Federally Qualified Health Center in Jacksonville, the HOPE team integrates direct psychiatric care, case management, basic needs provision, and medical trainee education directly in the field. Despite systemic funding challenges, particularly in a state without Medicaid expansion, the program sustains itself through a hybrid financial model. This relies on municipal grants, continuous political advocacy, philanthropy, and specialized medication access programs. Continued funding depends heavily on rigorous data tracking to demonstrate program efficacy to local stakeholders. Clinically, the program utilizes a trauma-informed methodology centered on three core objectives: Relationship, Reconnection, and Recovery. Emphasizing the need to overcome patients' prior negative experiences with healthcare and law enforcement, the model prioritizes building authentic trust and utilizing outreach workers with lived experience. Recovery is defined holistically, focusing on housing acquisition, community reintegration, and social empowerment rather than merely psychiatric symptom reduction. Ultimately, the HOPE framework demonstrates that effective street psychiatry must transcend traditional clinical boundaries to address profound isolation, prioritizing the humanity, dignity, and social reconnection of highly marginalized individuals.