by Dr. Samantha A Stewart
With homelessness on the rise in Los Angeles, particularly on the Westside, now is the time for innovative approaches to address the health – both physical and mental – of people living on the streets. Venice Family Clinic approaches homelessness as a health issue and mobilizes integrated street outreach teams comprised of health care and social work professionals. Our mobile teams visit encampments and public places to deliver health care and supportive services.
As a member of our outreach team in Pacific Palisades and Malibu, I see firsthand how street outreach effectively bridges the gap between people experiencing homelessness and traditional systems of care. We address the complex needs of the homeless who face a life expectancy of only 48 years, at least 25 years less than someone with housing. In many cases we treat people for tri-morbidity—addiction, mental illness, and a major medical illness—along with the trauma of living on the street.
Venice Family Clinic has worked with the Westside’s local homeless population since our founding, and we have delivered our primary care services through street outreach for nearly a decade. As a psychiatrist, I know the tremendous need for mental health care among this population. Now, thanks to the Clinic’s partnerships with St. Joseph Center, The People Concern and others, we provide mental health and psychiatric services, medical treatment, case management, and access to temporary and permanent housing. This mix of services has made our street outreach more impactful than ever.
Mental Health in Focus
The mental health component of our street outreach program is critical given the prevalence of mental illness among people experiencing homelessness. If left untreated, it can lead to self-inflicted violence, poor overall health, and substance use or addiction. For others, homelessness can cause depression and anxiety. Trauma is also pervasive among this population and might stem from past tragedies, loss, war-related service, domestic violence, and rape—not to mention the poverty and everyday stresses associated with homelessness. Our teams are trained in trauma-informed care best practices. We interact with the homeless in ways that acknowledge and are sensitive to past traumas while avoiding potential triggers or causing flashbacks.
As a clinician, I also know how important it is to identify the right mental health interventions. I assess and screen individuals for psychiatric treatment. One of the most serious mental illnesses we see in our outreach is schizophrenia. For the most severe cases, we are seeing success with long-acting, injectable anti-psychotics. Dosing is only needed monthly, making it ideal for anyone who has trouble with pill regimes or lacks access to clean drinking water.
This was true for our patient “Rick,” a 45-year-old gentleman who has resided at the base of the Palisades for years. A restaurant on PCH gives him a daily breakfast and neighboring businesses have given him odd jobs in exchange for snacks and sundries. Rick is schizophrenic and was nearly mute when we first met him. He avoided eye contact and reacted to things that weren’t there. Over the course of eight months, our team established a relationship with him. After multiple assessments and evaluations, we introduced the idea of a long-acting, injectable anti-psychotic medication. Rick accepted, and we noticed rapid and positive improvements in him. He started to interact with our team in new ways and demonstrate emotional range. He ordered his own breakfast!
The relationships our teams build in the field with homeless individuals like Rick are critical to their long-term care. As trust is gained, more individuals and families visit the Clinic’s or our partners’ facilities for additional health care, therapy or substance use treatment. They see the same familiar and friendly faces of providers they already know from our outreach; this continuity leads to better care and health outcomes.
Addressing mental illness is a key first step to getting off the streets. My team and I are encouraged by Rick’s progress on his psychiatric medication. Recently, his case manager helped him obtain a California I.D. card. For someone who had been lost to the streets for so many years, this I.D. was a profound first step to a new life. It allowed Rick to register for Medi-Cal to access additional health care. Now that he has found mental stability through his medical treatment, he has come to trust our team and is open to taking the next step in stabilizing his health. Our team will help get Rick on a waiting list for safe, supportive housing.
Venice Family Clinic is the Westside’s largest community health center, providing comprehensive, high quality and compassionate care to over 27,000 people annually regardless of income, immigration or insurance status.
Dr. Samantha A. Stewart is the Venice Family Clinic Director of Psychiatric Services and a proud member of the street outreach team.