Psychiatric assessment and rehabilitation for adults with severe and persistent mental illness who have exceeded the capabilities of district level resources; typically who have been treatment refractory and are struggling in their home environment. We offer recovery-orientated service, integrating individuals' wishes and goals through a wellness framework. Patients are supported in developing the skills and supports necessary to live successfully and satisfactorily in the community and in a living environment of their choice. Patients are offered in-depth inter-disciplinary psychiatric assessment to identify needs with relevant interventions. Outreach is offered subsequent to discharge with time limited follow-up and consultative services.