Because of this, evidence-based medicine with measurable clinical outcomes takes a back seat to relationship building, intuition, and tolerance, according to Dr. Christensen. The concept of recovery is impossible without establishing a respectful relationship with each client, he said, noting that "my goal is to get them to talk to me. That’s it. We don’t discuss medication or treatment plans." By building a trusting relationship, the outreach team can begin to help each client establish social, medical, and mental health connections through "open and welcoming doors" via ongoing street outreach, easily accessible walk-in clinics, and extreme tolerance of nonadherence and missed appointments, he said.
Once clients have established a connection to a caring, compassionate community, they can begin to take steps toward healing and recovery, including participating in their own psychiatric care, entering substance-abuse treatment, reestablishing family and social connections, and, ultimately, finding stable housing, Dr. Christensen said.
Psychiatric street outreach and the establishment of a comprehensive, coordinated mental health homes for unsheltered homeless individuals is a complex, often arduous endeavor, as is the establishment and maintenance of funding needed to keep such efforts alive. "The financial aspect can be complicated. Our funding comes from many different streams, mostly in the form of grants from various sources for specific services," Dr. Christensen said. As such, the availability of services necessarily expands and contracts along with the financial support for those services, he said.
Working with homeless populations has been Dr. Christensen’s passion since medical school – in fact, he said, he went to medical school expressly to be able to provide care to the homeless. However, "even if you’re not doing this as full-time work, psychiatrists have many opportunities to link people to services by virtue of our credentials and training," he said. Toward this end, he stressed, "When treating patients in the emergency department or in the inpatient setting, look broadly at the person and not just at the constellation of symptoms in order to really identify what else is needed beside a diagnosis and medication.
"Ask yourself what else might be needed in terms of basic life needs and housing and supports." There are many things psychiatrists can do to not only provide direct care to these individuals, he said, "but also to be advocates for these people who don’t have a voice."
Dr. Christensen had no conflicts of interest to report.