Three Things To Read This Week
From wound care to flu shots to long-lasting injectables that treat schizophrenia, street medicine programs improve public health and safety.
1. Street Medical Teams In Los Angeles Offer Long-acting, Injectable Antipsychotic Medication To Unhoused People Struggling With Mental Illness.
Dr. Susan Partovi directs the Substance Use Disorder Integrated Services team, which focuses on what she describes as the “small sub-group of people who won’t accept housing because of their mental illness” even though “housing definitely saves your life.”
The team, which includes an addiction specialist, a psychiatric pharmacist, and a social worker, often has to make multiple contacts before a person agrees to accept medication.
As Steve Lopez reports for the Los Angeles Times, success requires that “you get to know people, their routines, their histories, even their pets. [When a] connection [i]s made, [that’s] the first step in building trust.” When people decide to take medication, it often isn’t effective to prescribe a month long supply of pills. That’s because “people often lose their daily medication … Or they forget to take it. Or it gets stolen, or swept away in storms or street-cleaning sweeps. [Thus,] a month-long dose can up the chances of turning things around.”
Then, as Dr. Partovi told the Los Angeles Times, “once you treat their delusions and their irrationality … the ‘word salad’ dissipates, patients express themselves more clearly … [and] they start to realize …. Oh, I do need resources,” That’s why, as Lopez reports, when the team “administers medication that lasts a month and can help stabilize patients — with their consent — they’ve got a chance.”
2. “Street medicine providers say the most important aspect of their relationship with patients is trust.”
That’s because, as Ciara McCarthy reports for the Fort Worth Star-Telegram, “the majority of their patients have had a negative experience with an institution in their lives, be it time in prison or jail, the foster care system, or the healthcare system.” In Fort Worth, building that trust means that:
“The street medicine team does most of its work [outside] where their patients live… They carry medical gear in their backpack… The team typically is on the road treating patients for two shifts a day, five days a week… The team includes a mobile health coordinator, a nurse, a community health worker, and a social worker. Together, the group works to get patients as much medical care as they can provide on site, as well as linking them to other service providers throughout Fort Worth and more advanced medical care as needed. The team is also regularly joined by new doctors who are training at [a] residency program…”
The approach is already working. Ronald Northern, 49, who is experiencing homelessness and lives at one of the sites where the Fort Worth street medicine team regularly visits, credits that team with why he stopped needing frequent trips to the emergency room and has even been able to start working: “Without them, I wouldn't be able to cure these ills that ail me and move around and do the things that I have to in order to get myself back in standing in society.”
3. “People who are living outside, who are experiencing homelessness care about their health — but it’s just difficult to get to doctor’s offices.”
That’s what Dr. Mary Kathryn Orsulak told Edwin Garcia with Davis Health News. Twice every week, Orsulak works with patients in homeless encampments around Sacramento. “The goal of this clinic,” Dr. Orsulak said, “is to decrease the barriers to health care, to literally meet people where they're at, to bring care to them.”
Orsulak is part of Wellness Without Walls, “a mobile unit delivering clinical services … to unhoused communities in Sacramento County.” The program, which received funding from the U.S. Centers for Disease Control, is a partnership between Sacramento County Health and the medical and nursing schools at the University of California at Davis. The mobile team provides “comprehensive primary care services such as mental health care, medication, flu shots, wound care and physical exams [and] screen for sexually transmitted infections, provide HIV testing and treat substance abuse disorder.”
In addition to providing primary care, Wellness Without Walls organizes the provision of wraparound services for the unhoused people that the team treats. For example:
“veterinary care”
“medication delivery to the mobile clinic”
Legal services including addressing homelessness related citations delivered through a UC-Davis law school clinic; and
“The [UC-Davis] nursing school is opening a complementary mobile outreach program to care for refugees and other underserved groups, offering smoking cessation classes, hearing tests, and eye care services.”
