OBJECTIVE: A level-of-care needs assessment was undertaken at Ontario's largest shelter to establish homeless clients' mental health service needs and identify service gaps.

METHODS: A level-of-care planning model was applied to data on 356 men. Assessments included the Colorado Client Assessment Record and a Service Needs and Use Questionnaire.

RESULTS: Among the clients, 32% (N=105) were recommended for weekly support, 38% (N=125) for Intensive Case Management or Assertive Community Treatment, and 9% (N=29) for 24-hour supervision in a residential care facility. Despite on-site health services, half the men did not have their level of service need met.

CONCLUSION: The wide range of unmet specialized mental health needs suggests that interventions of different structure and service intensity may be required for this population. A level-of-care planning model may be a helpful tool for ensuring homeless clients are matched to appropriate services and supports.