From mobile medicine to mental health: Helping the homeless take the next step

by John Gilvar, manager Mobile Medical Program

First Person ImageThe connection between physical health and mental health is hard to miss at Public Health’s Mobile Medical Van (MMV).

Our homeless clients may come with a specific medical issue, but they also may need psychiatric medications. The challenge, over the years, has been getting them the mental health treatment they need. They would leave the MMV with a psychiatric referral, but it seemed like very few of them were ever getting to an appointment.

How to get beyond one percent

The staff and managers for the van decided to keep track of how many clients who get a referral actually attend at least one appointment where mental health treatment is provided. If we kept track over time, we’d be able to see what reforms are making a difference.

Mobile Medica Van nurseWhen we first counted, as a baseline in 2009, only 1% of clients received the mental health treatment they needed.

We started asking questions, and the MMV team learned about the challenges clients face in navigating the way to timely treatment. The appointments might be several weeks in the future, and often the first appointment wasn’t actually for treatment, just an orientation to the clinic. So, it would often take six to eight weeks for a client to get medications.

We discovered: In our health system, you have to be really organized, and plan months in advance to get treatment. That’s a recipe for failure for many of our clients.

Recipe for success

A homeless client who’s in need of psychiatric medications may find it tough to stay organized. They typically don’t have family support – a parent or sibling to keep track of appointments and how to get there. Instead, the clients may be living in their cars or in the woods.

Armed with this data, the MMV team created a new partnership, so they could refer clients to HealthPoint primary care clinics – and the clinics would be ready to get the clients quickly into treatment.

Incrementally, we found these steps helped:

  • bringing HealthPoint social workers onto the MMV team
  • speeding up the appointment time (often next day, instead of waiting up to six weeks)
  • making a personal introduction of client to staff at the HealthPoint clinic

When a social worker makes that personal introduction, it helps clients overcome the fear of going into an office, when their clothes are dirty and they don’t know anyone.

Huge impact

By 2014, approximately 20% of clients received mental health treatment at HealthPoint, which is a 20-fold increase over the 1% baseline from 2009. We use this as a quality measure, to track how well the team is performing.

And it pays off for clients, who are getting their psychiatric prescriptions and a connection to mental health treatment, which help them stabilize their lives.

In 2015, the MMV team is using the same model to develop a new quality measure – this time for chemical dependency treatment referrals.