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An ethnographic study of the homeless poor in New York City suggests that significant changes have taken place in the size and composition of that population during the past 15 years. Among the disenfranchised, the mentally disabled figure prominently, many of them casualties of state deinstitutionalization and restricted admission policies. This paper argues that in the absence of safe and accessible shelter, rehabilitation efforts are doomed to failure. It is suggested that clinicians could play a critical advocacy role for an approach that sees therapeutic and social needs as intimately linked.