hardhomelessnessmedication-adherencelong-acting-injectablesocial-determinantsharm-reductionschizophreniacommunity-psychiatry
A 42-year-old man experiencing chronic homelessness presents to a community mental health center with worsening auditory hallucinations and disorganized thinking. He has a documented history of schizophrenia and was previously stabilized on risperidone 4 mg daily, but he reports inconsistent medication access over the past four months. He sleeps in a tent near a highway overpass, has no identification documents, no insurance, and no reliable phone. He lost his last supply of medication when his belongings were confiscated during a city encampment sweep two weeks ago. His last psychiatric appointment was five months ago at a different clinic, and he missed subsequent follow-ups because he could not afford bus fare. He is cooperative but malodorous with poor hygiene, and his urine drug screen is positive for cannabis. The PMHNP is developing a treatment plan. Which of the following approaches best addresses the medication management challenges unique to this patient's circumstances?