How mobile psychiatrists can help the unhoused
Story at a glance
Mental health services are typically accessed through clinics and hospitals.
People who have unstable housing conditions may not have adequate access to psychiatric treatments.
Street psychiatrists are a growing group of mental health professionals who are working with community groups to reach people in need in cities around the U.S.
A growing area of psychiatry, called street psychiatry or street medicine, has developed in the U.S. in several metro areas like Boston, Oakland and Los Angeles. Adjacent programs like one in Portland sends responders who are trained to help in non-life-threatening mental health and behavioral health issues to relevant 911 calls.
One of the few ways people can get psychiatric treatment is to go to the emergency room or department at a hospital. A patient might get prescribed medications during an emergency room visit, but once they leave there aren’t follow ups for when the medication runs out.
Seeing a patient in a clinical setting is also different from seeing them in their daily environment.
“You are seeing two different versions of the patient,” psychiatrist Shayan Rab, who leads the team of psychiatrists and psychiatric nurse practitioners, told the L.A. Times. “When we work with an individual on the street we see how an individual is living in the community, what the realities of their environment are like.”
The goal is to get people into residential programs, but the first critical step is knowing where they are through the outreach and social worker teams. Rab’s psychiatry team in L.A. collaborates with teams of outreach workers, social workers, nurses and substance abuse counselors from L.A. county’s Homeless Outreach and Mobile Engagement (HOME) program.
People who are unhoused and are experiencing homelessness are particularly vulnerable to mental health illness, as well as food insecurity and other needs.
“These vulnerable and disengaged individuals struggle with securing appropriate food, clothing, and shelter due to their mental illness,” the HOME website states.
“In addition, they may have critical deficits in hygiene and communication, and are generally highly avoidant of services. They are unable to live safely in the community and require specialized mental health services to secure and sustain housing.”
Street psychiatrists fill a gap for this group of people, who are less likely to access services especially if they are far from where the services are located.
“I would argue that few populations bear greater psychological burden than homeless people yet given the magnitude, there are very few resources for treating them,” street psychiatrist Katherine Koh with the Boston Healthcare for the Homeless Program and Massachusetts General Hospital told the L.A. Times.
Some individuals may really need help and want to find shelter but may still take some convincing to enter a care facility.
“I was at my wit’s end. I was tired of getting high. I was tired of not being on my medication, not being normal,” a person named Alvin told the University of California San Francisco. Another person told the university that getting dental care gave him the “super self-esteem” he needed to finally go to a clinic to get treated for post-traumatic stress disorder (PTSD), and he later found housing.
Rab notes that street psychiatrists can follow up and give medication support to their patients, sometimes also helping them get housing. By engaging with people in need where they are and bringing psychiatric services to them, it increases the chances that these patients can get the care they need.
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