Happy New Year from the Maryland Early Intervention Program!
We look forward to developing and sustaining relationships with consumers, providers, and those in our community. This year let's continue to work together to increase understanding and our ability to identify and treat early signs of psychosis!
December 2016 Spotlight: Homelessness and Serious Mental Illness
The US Department of Housing and Urban Development reported that in 2015 more than half a million people experienced homelessness with nearly 175,000 of them unsheltered. Based on a brief survey, 60% of these unsheltered individuals were reported to have a serious mental illness (SMI). A disproportionate percentage of the population with SMI lives unsheltered (HUD, 2015). Of the homeless individuals in our country with SMI, approximately half self-medicate, placing them at further risk for addiction and poor physical health. When psychotic symptoms are not effectively managed, individuals are at a higher risk for hospitalization, arrest, victimization, and even suicide (National Coalition for the Homeless). The EIP would like to highlight this important topic and touch on some of the resources available to help individuals experiencing SMI and homelessness in our community.
Street Medicine: Unique Services for People Experiencing Homelessness
Street Medicine, with its mantra, "Go to the people," has gained national media attention through two 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 (Psychiatric Times)." Teams of professionals and workers, who are often formerly homeless, connect with people sleeping on the streets, methodically engage them, and help them obtain services, shelter, and housing.
Given the disproportionate percentage of the population with SMI that lives unsheltered, community psychiatrists have now joined the Street Medicine teams. Aimed at breaking down barriers, street psychiatrists provide diagnostic assessments, medication management, and therapy in the streets, under bridges, in the woods, and even at McDonalds. Psychiatrists who participate in Street Medicine are experts in establishing rapport, understanding human behaviors and motivations, and employing motivational interviewing and cognitive behavioral therapy for psychosis. The Street Medicine system of care also focuses strongly on interdisciplinary care, and the street psychiatrists collaborate closesly with primary care, inpatient units, emergency departments, homeless shelters, and other providers of services to connect homeless individuals to care. Community psychiatrists within Street Medicine attempt to bridge the gap between people on the "outside" and people on the inside of the systems of care by advocating within established systems to help providers deliver better care to marginalized individuals.
Maryland Resources for Homeless Teenagers
There are a number of excellent programs in Maryland to help homeless teenagers. These programs provide shelter, as well as other resources, such as counseling and job training. Below is a list of some of the programs as well as the resources they provide:
City Steps Program:
- This program includes multiple programs that serve homeless or unstably housed youth age 14-24. They provide housing, counseling, job training, case management, help for teen parents, and help with transitions to adulthood and independent living.
- St Anne’s Center-Grace House
- This program, targeted specifically to pregnant teens and young mothers, provides housing, an accredited high school, nursing care, parenting classes, life skills training, child care, individual and family counseling, and social and cultural activities.
- Hearts and Homes for Youth
- Separate Boys and Girls homes for youth ages 13 to 17. Provides housing as well as life skills building, college prep and educational advocacy, counseling, and career development.
- Youth Empowered Society (YES) Drop-In Center:
- Founded and run by formerly homeless youth and their allies, YES works to end youth homelessness (for youth ages 14 to 25) in Baltimore by (1) providing urgently-needed direct services to youth experiencing homelessness, (2) developing the leadership and employment readiness of youth who have experienced homelessness, and (3) engaging in system-level reform.
- Loving Arms Inc (YES Emergency Shelter):
- Provides, food, shelter, and clothing, in addition to individual, group and family counseling for youth between 14 and 18. They also provide mediation and support services for homeless youth who are not residing at their shelter.
Project Jump Start
Project Jump Start is an interdisciplinary student-run organization at University of Maryland, Baltimore that has been helping individuals facing homelessness in Baltimore since 2005. This organization meets the immediate needs of Baltimore's homeless through weekly meal distributions and compassion. Unlike many charitable organizations, Project Jump Start goes directly to the clients. Acknowledging that many homeless individuals do not access the shelter system or other programs, this group instead goes directly to the street to provide assistance.
Interested in volunteering? Project Jump Start meets every Tuesday and Friday at 5:30pm in the Lower Level of the SMC Campus Center. The SMC Campus Center is located between the HS/HSL library and the School of Nursing on the University of Maryland, Baltimore campus. Food drives are typically the jumping in point for new volunteers, which is an easy way to get involved and a good place to meet similar-minded people.
Treatment Engagement of Individuals Experiencing Mental Illness and Homelessness
Individuals living with serious mental illness can often be difficult to engage in ongoing treatment, with high dropout rates. Certain populations of people have historically exhibited particularly poor engagement, such as young adults experiencing a first episode of psychosis, individuals with coexisting psychotic and substance use disorders, and those who are homeless. In a recent review article, Drs. Dixon, Holoshitz, and Nossel outline how various evidence-based, recovery-oriented treatment techniques have been shown to enhance engagement in individuals who are homeless.
While homeless individuals can face many barriers to engaging in mental health treatment in traditional settings (e.g., complex medical and mental health needs; substance use; mistrust of helping professionals), they also may have strengths that can be harnessed in treatment, including well-developed street skills and knowledge of the services system. Assertive outreach to homeless is an evidence-based practice that has been adapted for homeless individuals and is based on these potential strengths. Assertive outreach involves making contact with homeless individuals on their terms -- where they live -- rather than at an agency setting. It takes a multidisciplinary team approach to provide case management, mental health and substance use treatment, crisis intervention, employment support, and family services to individuals in the community. Research suggests that the primary elements for engagement within assertive outreach is persistence and consistency, therapeutic alliance, support beyond medications, flexibility, and a team decision making process.
Critical time intervention is another evidence-based practice focused on helping homeless individuals engage in treatment, with a particular focus on periods of transition, such as the transition from the hospital or shelter to housing. Critical time interventionists provide time-limited intensive case management using a phase-based approach with decreasing intensity over time. The model includes practical assistance, advocacy, and motivational enhancement to strengthen individual's long-term ties to services and supports.
Overall, evidence-based treatment models that have been successful engaging homeless individuals in treatment have an explicit focus on the development of a positive working relationship, meeting clients where they are, persistence, practical assistance, and flexibility in approach.