Homeless people are among the most vulnerable to the coronavirus. Lo of Yale Psychiatry is making sure they still receive care in the midst of the pandemic.
Homeless people are among the most vulnerable groups of people affected by COVID-19. Homeless people on the streets tend to fall into the higher risk category for severe illness from COVID-19, as they are more likely to be older male smokers, with many medical co-morbidities and – in pre-COVID-19 conditions – were 10 times more likely to die. than the general population.
This means that providing care to the homeless is even more vital in the midst of a pandemic. To address this need, Emma Lo, MD, assistant professor of psychiatry and attending physician for the street psychiatry program at Connecticut Mental Health Center (CMHC), continued her work even in the face of the challenges presented by staying at the scale. of State. -the order of the home and social distancing.
Street psychiatry is the mental health component of street medicine, and providers conduct outreach activities to the unsheltered homeless people who live on the streets, in parks, under bridges and in camps, explained. Lo. The aim is to improve access to mental health care, as well as engage those who are unlikely or unable to engage with traditional systems due to various structural barriers, she said. CMHC’s street psychiatry team also provides therapy, medication and even groups to rough sleepers, and connects people to social services for their basic needs.
But the COVID-19 pandemic has forced Lo and his team to change the way they approach their work.
“Every encounter or situation with a patient has a flavor of COVID-19,” Lo said. “The pandemic has affected all aspects of care – from the way care is delivered, to the services available, to the medications available, to the decision-making behind sending someone to hospital. Our patients are deeply affected by this crisis, both because of their inherent vulnerabilities and because of the services that have changed. “
Homeless patients are unable to follow recommendations made by the Centers of Disease Control and Prevention, Lo said, because it is nearly impossible to stay 6 feet away in shelters or other public spaces. Access to hand washing or hygiene is limited. Homeless, they cannot isolate themselves at home and do not have access to face masks.
“Our patients are not only stressed about contracting the virus, but they bear the burden of the quits very immediately and personally,” Lo said. “The anguish of this uncertain future and the threat to their very selves only describes the emotional turmoil experienced by many of our clients, and we have already seen exacerbations of mental illness linked to these devastating side effects of COVID-19. for the society.
Providing care to the homeless during a pandemic
When the CMHC street psychiatry team deployed over the past few weeks, patients were approached 6 feet away. The team members first explain the precautions to be taken, “which goes against the pretty intimate bond we try to make with people in normal times,” Lo said.
The team then screens a patient for symptoms before starting conversations, and there is a protocol in place in case someone tests positive. They distribute student-made hygiene kits containing homemade alcohol wipes and flyers showing how to prevent the virus and what to do if a person is showing symptoms.
In addition, the team’s outreach hours have been reduced from five to seven times a week to once a week for two hours. This makes it difficult to find people with whom they are usually in regular contact, especially since the majority of them do not have a phone.
“We take the position that we need to be public health ambassadors – especially now – and prevent our high-risk population from contracting the virus, which would be devastating,” Lo said. “In the meantime, we recognize that mental health problems don’t just stop during a pandemic and can, in fact, be exacerbated during these difficult times. We ultimately know that our friends on the streets are extremely vulnerable to the physical, social and economic impact of the pandemic, and we need to protect them by shifting our reach, but most importantly by making sure not to abandon them during the times. where they probably need us the most. “
Lo thanked partners of the street psychiatry team, including the Homeless Health Team at Cornell Scott-Hill Health Center, which provides primary care, emergency care and mobile COVID-testing. 19 for the homeless, as well as the Outreach and Engagement Team, which manages case management. and housing services for people experiencing homelessness. Both programs are still operating during the pandemic with adjusted services.
In addition to working both on-site and off-site at CMHC, Lo provides consultations at ShelterOne, medical respite for homeless people who test positive for COVID-19 and who have no safe place to recover and isolate yourself. Lo said the shelter can accommodate up to 40 patients.
She helped design the organization’s behavioral health protocols, which aim to prepare the respite center for possible behavioral health emergencies, “as well as create a unique opportunity for people to connect to treatment. mental health if they weren’t already, ”she said.
“When designing this protocol, we noted the need for a psychiatrist, so I volunteered to serve as a psychiatric consultant with the other psychiatrists on our team,” Lo said. “After that, our licensed clinical social worker and program manager got heavily involved in helping the team plan discharge and coordinate care.”
Since ShelterOne opened, Lo has provided telehealth consultations to patients staying there, via donated tablets. Lo said that while there hasn’t been a great demand for consultations, she has found it useful to have a video platform to find out what the patient looks like in case the street psychiatry team from CMHC would meet with them again in the future. Yale psychiatry residents and public psychiatry fellows also volunteered to help with the consultations, Lo said.
“ShelterOne patients certainly feel marginalized and are being denied treatment, employment and shelter due to a history of COVID-19, even though they are now medically cleared,” Lo said.
COVID-19 exacerbates discrimination against homeless people
Lo said that such patterns of discrimination against the homeless are unfortunately not unusual, but “they are only magnified during times like these when the poor do not have the luxury or choice to. protecting myself during “stay at home” orders, and that makes me incredibly angry and sad for our society.
One such case occurred at Union Station in New Haven, a place where homeless people could sit during the day and most of the night. Under the statewide shelter-in-place order, the station quickly became one of the only public places available to the homeless. Lo said that while usually incredibly cooperative, the station recently cut its hours and denied entry to anyone except ticketed passengers.
“This leaves the homeless with nowhere to go even for temporary shelter, during rain or cold, which is heartless and tragic at a time when the homeless are most vulnerable,” Lo said. “Having a place to sit indoors is very little to ask for in these difficult times.”
“I have seen a lot of fear and disgust come from the public who view the homeless as dangerous and contaminated, which is not only empathetic and false, but also counterproductive to the mission of protecting everyone,” Lo said.
Lo said that if she and her colleagues advocate and work with the City of New Haven to design alternatives, such as a makeshift reception center and hotels for the homeless homeless, “the solutions will not come. fast enough to keep people from having to sleep unprepared outside in the rain and cold. “