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Psychiatry in the Streets: Unique Services for People Experiencing Homelessness [PsychiatricTimes.com]

 

“You guys are creeps!” Wilma seethed as the police officer assisted her into the backseat of his car. ”

Her gravelly voice echoes in my mind as I think about our Wednesday night Street Medicine rounds. Wilma, a woman known to many downtown, uniformly refused to leave her portion of sidewalk, even on the coldest of nights, determined to protect the city’s inhabitants from infectious diseases. Upon arriving at the scene, the ambulance driver was initially angry at receiving her 30th call about Wilma and lamented another expensive and fruitless check by our city’s emergency responders. The driver’s anger turned to elation, however, when I held up involuntary commitment paperwork.

The driver had been worried about Wilma and now held the power to force her to go to the hospital. I realized I had risked ruining a relationship with Wilma that freezing winter night. While I may have prevented Wilma’s death—another woman experiencing psychosis died the same night from cold exposure—I felt every bit the creep she accused me of being. On most nights our Street Medicine rounds do not involve such difficult ethical dilemmas, yet the work is always rooted in the ethos of community psychiatry.

Street Medicine, with its mantra, “Go to the people,” has gained national media attention through 2 of its prominent members, Drs. Jim Withers and Jim O’Connell. As a practice, Street Medicine is the “provision of medical care directly to those living and sleeping on the streets through mobile services such as walking teams, medical vans, and outdoor clinics.”1This outreach tradition stretches back to the dawn of contemporary endemic homelessness, beginning in the early 1980s. Teams of professionals and workers who themselves are formerly homeless connect with people sleeping on the streets, methodically engage them, and help them obtain services, shelter, and housing.2 In no small part through Dr. Withers’s cultivation, an international movement has developed. Street Medicine practitioners have united in their passion for working with unsheltered individuals, creating the Street Medicine Institute in 2008. New programs have popped up in cities like Atlanta, in rural communities in Kentucky, and in such distant places as Nigeria and Prague. This initiative has given the practice of street outreach true wings.



[For more of this story, written by Elizabeth A. Frye and Hunter L. McQuistion, go to http://www.psychiatrictimes.co...iencing-homelessness]

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Corinna -- Thanks for your comment. We cast a wide net that includes articles, reports, research related to ACEs science and practice, as well as areas that haven't embraced them yet, to show the status of where the world is in integrating trauma-informed and resilience-building practices based on ACEs science. ACEs science includes the epidemiology of adverse childhood experiences, how toxic stress from ACEs affects the brain, how toxic stress from ACEs affects the body, intergenerational transmission of toxic stress, and resilience research.

When I first started working in New Hampshire's statewide "Homeless Outreach/ Intervention Project in 1996, we had about one outreach worker per county [the most populous county had two.]. One of the other Outreach/Intervention specialists had completed medical school...  he was a welcome addition at our statewide "clinical supervision" meetings, and 'on-call consulting]. My first year, 30% of my case load in my county involved Domestic Violence. Just before the start of the school year, we'd check campgrounds for schoolchildren (Planned Parenthood's general primary care provided free vaccinations for schoolchildren to be eligible to enroll in school).

Once every 5-6 days we'd each take a turn covering the entire state overnight, via a toll-free hotline, an assortment of taxicabs, motels, and gas stations under contract, and those shelters [with vacancies] under contract with the state. The Sheriff in my county sent a 'letter of introduction' for me, to the town Chiefs-of-Police, asking them not to bring 'criminal trespass charges against people in abandoned/vacant buildings for 3-4 days, to give me an opportunity to engage them. Many of us developed collaborative networks with other service providers and those who provided services under contract.

Absent a cell phone, [we ordinarily used pay phones-(to call toll-free answering services), a rarity in many parts of a rural state] my local police department availed me one of their radios for night work-lest I find someone challenged by frost-bite, or other medical emergency.

One Motel owner [under contract], who was a retired police officer, used to let domestic violence survivors park their vehicles 'out back', and register under an assumed name/alias--so their vehicles weren't visible from proximate roadways, etc.

Regretably, state funding cutbacks were such that our director wrote himself out of the 'grant'-and 'group clinical supervision/critical incident stress debriefing was no longer available for us, and I went from covering one county, to two, my third year in the program. The Sheriff in the second county I covered my last year, was kind enough to send a similar letter the first Sheriff had written on my behalf...

My colleagues at the Community Action Agency availed me "fuel assistance certification training" so I could provide propane to people living in camping trailers: one was a 3rd generation elderly property owner-whose house was not habitable, and he'd been selling off parts of the family farm to pay his property taxes-because he hadn't applied for elderly or veteran's property tax exemptions. Another Veteran in a camping trailer [on his family's land] just needed propane to stay warm, and a food basket from the food pantry at our local soup kitchen...

What prompted the initial homeless outreach grant...our NH first-in-the-nation presidential primary would occasionally bring overseas television news crews, one of whom filmed a homeless [tent] campsite in our capitol city that had caught fire that winter-where one person died and the other was seriously burned.

Last edited by Robert Olcott

Not a good algorithm. Antipsychotics increase a person's risk for further psychosis. So giving them to someone who is guaranteed to have an intermittent supply is going to make their problems worse, not better.

way too disease centric, anyway. 

You could just assume the homeless person's problems are all trauma based and you would do them a lot more good. 

Not sure why this image is being shared to this site. It is quite counter to the stuff this site purportedly supports.

In 1999, at the National Conference on Homelessness, in Washington, D.C., during a memorial for our nation's deceased homeless, I began reading the names of New Hampshire residents who had died while homeless. It included the name of one member of our [424 member] State Legislature. I began to weep, and got "choked up", when I started to announce the name of a 17 year old high school student from Portsmouth, who had been working evenings in a restaurant, and died from exposure to the winter cold, while sleeping on a park bench in Strawbery Banke, overnight. I didn't have time to discuss the housing shortage and rental costs in an area within a 60 mile radius of Boston [Massachusetts]-which include a substantial portion of New Hampshire's most populous counties, or a NH AFSC report noting the numbers of Police, Firefighters, Teachers, and even CPAs, who couldn't afford the housing costs in the New Hampshire towns they worked in. ...

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