Achieving the Best Client to Staff Ratio

What is the best client/staff ratio for a rescue mission program?

As I have interacted with rescue missions in a speaking and consulting role over the years, this is one of the questions I am asked most often.   It is certainly one of the most important questions as well.   Most rescue mission administrators work diligently to make every donated dollar stretch as far as possible.   Truth is, staff salaries make up the most substantial portion of their budgets.   So they need to know these funds are being spent wisely.   Front-line staff members can feel overwhelmed by many the unmet needs they see around them every day, knowing that a few more qualified people could aka big difference.

So, I would like to take a few moments to set forth a few simple principles that may help answer this question.

A.       Know what you want to accomplish — An emergency shelter with minimal counseling and   scheduled program activities needs a few basic supervisor staff members.     A residential program that focuses on helping participants achieve life-term change by overcoming addictions and deeper inner problems will require much more staff attention.   Sorting through exactly what outcomes you are striving for will not only help to determine how many staff members are needed.     Additionally, it will also help in deciding what type of staff people are needed.     Maybe the type of programs called for social workers and certified additions counselors instead of individuals just finishing Bible School.

B.         Troubled people need lots of attention –   Real and lasting life-change is not something that happens all on its own.   I believe with all my heart only God can produce lasting change in the lives of wounded people.   Yet, I also believe that He does it through people who serve as His representatives to the hurting.   Especially in the first year or so of sobriety,   He uses us to help people in recovery to understand the basics of the Christian life and begin the process of life-long growth.   One-on-one counseling time, group sessions, classes, and corporate times of worship and praise are all ways that God’s Spirit can reach into their lives to bring healing and the power to overcome their problems.   At some rescue mission, many of these activities are outsourced to community agencies and resources. Other have found qualified volunteers to help with them.   But, in more cases, it takes people who are on the payroll to conduct meetings, to teach, and to counsel.

C.         Achieving real, lasting change, is a lot of work –  Troubled people need lots of time to learn, to talk, and sort out the issues of their lives.   This can cause a bit of tension, though, because rescue missions tend to depend on residential program participants   to keep their operations running. Some have even had their program people working full-time in these activities 8-10 hours a day, while offering just a few evening activities. When this is the case, I have to ask “Is the mission there for the client or the client there for the mission? “

I am pleased to say that this is not as common a situation today as it once was.   Most rescue missions have come to recognize that today’s homeless clients need much more help than those who sought out their services a even a decade ago.     Most are truly looking out for the client’s best interests.   Still, for most of them, it may be time to consider actually hiring outside people to do some of the tasks traditionally done by clients.   If a program has been experiencing less than hoped for client success, this step may allow people in their programs to have extra time to do the hard work of early recovery.

D.       Troubled people need individual attention  — One simple “rule of   thumb” that indicates when a program is understaffed is this: does every participant have at least an hour each week in a one-on-one counseling session with a qualified staff member? If this is not happening, it may be better to have a smaller program than to have a building full of people whose lives are barely being impacted.

Every person in a long-term program needs to have one staff member who serves as their primary counselor and advocate.   The next question that follows, of course is, “how many clients can one staff person handle?”   A 1:14 ratio is common in most secular treatment programs.   Additionally, I see and example in our Lord Jesus.   He know He had three short years to invest in the lives of just a few people in whose care He would leave the future of the Church.   He chose twelve.   Could that number be significant?   Someone once pointed out to me that Jesus wasn’t doing case management – and these were pretty stable people to being with.   But, I think the point in all this is that we need to be realistic in how many troubled people one staff member can work with at any one time.

In conclusion, I think it is very important for us to remember the needs of the people who come the rescue mission.   Giving them the time and the attention they need to more from homelessness and defeat to a stable, Christian life ought to be our primary goal.   Whether it means paring back on bed space or increasing the staff budget, the outcome will surely be more lives permanently changed to the glory of God.

Helping the Homeless Who are Mentally Ill (Part 2)

This is the second installment on the topic of helping the homeless who are mentally ill. With a basic knowledge of the issues these people confront, knowledgable Christian workers can make a huge difference in their lives.

A.       Understanding “Dual Diagnosis”  – Up to one-third of today’s homeless adults are mentally ill.   The trend toward “deinstitutionalization” of the mentally ill has meant that our city streets are now being flooded with people who at one time would have been hospitalized for their problems.   As many as half of them are also addicted to alcohol and/or drugs.   Many are “self-medicating” – using addictive substances to cope with their mental problems.   Social service professionals usually do not like working with these “dually diagnosed” people because they can be so demanding and time-consuming.   They can be too destructive and troubled for the typical addiction recovery program.   And, mental health workers shy away from them because they often do not stay sober long enough for treatments to be effective.   So, they end up at an urban mission.

B.       Gaining a Basic Understanding of Mental Illness  – The first step in working with dually diagnosed individuals is to gain a general understanding of mental illness in general; its causes, symptoms, and treatment.   Our staff members must learn how to identify such conditions as schizophrenia, bi-polar disease (manic-depression), and clinical depression so they can know when it is time to make a mental health referral.   The good news is that, thanks to great advances in pharmacological technology, even those with severe mental problems can live a relatively stable life.   Combining the right medication with some simple tools for recovery can help even the most severely mentally ill people to find sobriety and function on a reasonably healthy level.   Because mental illness cannot be treated effectively as long as the active use of drugs and alcohol continues, we do quite a bit when we provide these individuals with a safe Christian environment where they can get off of drugs and alcohol.   Because people with these problems do respond to the Gospel and the work of the Holy Spirit in their lives, we can reach out to them spiritually, as well.

C.       Networking with Local Mental Health Agencies  –   The key to helping the dually diagnosed is good “case management” – long-term support working in tandem with local mental health professionals.   It is vital that we develop contact in local mental health agencies who understand our programs and philosophy.   They can be especially helpful in performing screening of those who we suspect might have mental problems.   I have found that most are very willing to work with a mission program if they know it is safe and well-organized.   In general, mental health workers are glad to know their patients will have the supervision they need in order to stay on their prescribed medications.   It is important to encourage residents to sign a release of information form that authorizes the clinic’s personnel to talk with you about their on-going treatment.

D.       Health Screening Before Starting a Recovery Program is Essential  – Anyone who wants to come into a recovery program should have a thorough medical examination.   Many behavioral problems have a biophysical basis, not related to mental illness.   For instance, such medical problems as diabetes and hypothyroidism can be causes of depression.     Additionally, a health screening is especially important if a person comes to our program with a bag full of pill bottles.   If he is taking mood altering drugs he really doesn’t need, he never actually gets sober.   The truth is, doctors sometimes hand out pills to alcoholics and addicts almost indiscriminately.   Addicts often complain to doctors about the symptoms they know will get them certain types of mood altering medications.   They will talk about how they can’t sleep at night, or how nervous and jumpy they are in order to get drugs prescribed to them.   So, when a person comes to us with a sack full of medications, how do we know whether or not they really need those pills?   It is certainly not appropriate for staff members without medical training to decide which medications a resident should take.   This is another type of situation that is best handled by a psychologist, psychiatrist, or mental health professional in the community who is sympathetic to our ministry, to help us sort this all out.

E.       Adult Foster Care: An Option for   Long-term Care  – Our ultimate goal with most of the addicts in our recovery programs ought to be “working ourselves out of a job.”   We ought always to be looking toward the day when they return to society as employed, sober citizens, relying on God, the church, and the recovering community for their on-going support.   In other words, we truly succeed when they no longer need us.   However, those with mental disabilities – the mentally ill and retarded – might never be able to function in society without on-going supervision and care.   There is a growing trend among rescue missions to minister to these individuals through providing a safe, structured Christian home and by serving as Representative Payee for those who receive Supplimental Security Income (SSI).

By Michael Liimatta, Director of City Vision University  which has an  Addiction Studies program  designed for Christian workers that has a course dedicated to working with addicts who also suffer from mental illness.

See also Helping the Homeless Who are Mentally Ill (Part 1)

Helping the Homeless Who are Mentally Ill (Part 1)

Nearly one in four homeless individuals suffers from a severe mental disability(1).   People with various forms of mental illness frequent urban missions for temporary food and shelter. Some express a desire to participate in long-term rehabilitation and recovery programs.   The most common forms of mental illness among the homeless are schizophrenia and the affective disorders (bipolar and major depression).(2)   Because I have recently received so many inquiries regarding how to best minister to the mentally ill in a urban mission setting, we will dedicate the next few installments of this column to this subject.

A.       Why so many of the mentally ill are homeless  – Over the past thirty years, we have seen a a trend of “deinstitutionalizing” the mentally ill. It was determined that with the proper support and therapy, as well as the right combination of medicines, the mentally ill could function better within society and achieve an independent life.(3)   Theoretically it sounds like a good idea.   The goal has been to give the mentally ill more dignity and independence by placing them in a supportive community setting instead of a hospital.     In too many situations, the mentally ill were released from institutions without proper support networks in place, and as a result, become homeless.   Additionally, the very nature of mental illness causes sufferers to lose the ability to function in a socially-acceptable manner. When their families and other social networks cannot (or will not) support them any longer, they find themselves on the streets.   The latter situation is especially true for those who are referred to as “dual diagnosis” – suffering from both mental illness and drug/alcohol addiction.

B.       We can help the homeless who are mentally ill  
– According to the Federal Task Force on Homelessness and Severe Mental Illness, only 5-7% of homeless persons with mental illness need to be institutionalized; most can live in the community with the appropriate supportive housing options (Federal Task Force on Homelessness and Severe Mental Illness, 1992).   The problem is, so many do not have access to supportive housing and/or other treatment services like case management, housing, and treatment.

The severe forms of mental illness are caused primarily by chemical imbalances that interfere with normal brain activity.   Major advances in psychiatric pharmacology have resulted in highly effective medications that can help mentally ill people live relatively stable lives.   A carefully regulated regimen of proper medications can even allow them to successfully participate in long-term rehab/recovery programs.

C.       Developing a “team approach”  – Few urban missions have medical professionals on their staffs to diagnose mental illnesses and prescribe the proper treatment for the various psychiatric disorders.   Therefore, it is absolutely essential that mission staff members become acquainted with local mental health providers.   In larger cities, there can be a number of options available, which can make it easier to find mental health professionals who share our values.   Even where options are limited, most Christian workers will find that a good working relationship can be established, especially if an effort is made to keep the lines of communication open between the urban mission and the mental health facility.

D.       Knowing when a mental health referral is needed  – Too often, urban mission workers who have not learned to recognize the symptoms of mental illness have become frustrated and discouraged in their efforts to help those who suffer.   Understanding is the key to effectively ministering to those who suffer from mental disabilities.   In upcoming articles, we will look at the most common forms of mental illness – depression, pyschosis, schizophrenia and bi-polar disorder.   We will also discuss the most common medications used to treat these diseases and how urban missions can help those suffering from mental illness to attain a satisfying life.

See also, Helping the Homeless Who Are Mentally Ill (Part 2)


1.       Waxman LD, Peterson K, McClure, M. A Status Report on Hunger and Homelessness in America’s

2.       Fischer P, Breakey W. Homelessness and mental health: an overview. International Journal of Mental Health. 1986;14:6-41.

3.       Stubbs, Pat (1998). Broken promises:The story of deinstitutionalization.1998, September 25.