Main Street Psychiatry

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It was a cold, rainy day when doctors found Alvin on the streets of Oakland, imprisoned for months, off his psychiatric medication and committing suicide.

Main Street Psychiatry

“I have reached my wits end. I’m tired of being promoted. I’m tired of not taking drugs, it’s illegal.

Royal College Of Psychiatrists

Alvin became a dark statistic: one of nearly 3,000 homeless people in Oakland and one of 45 percent reported mental or physical health problems.

When psychiatrist Aislinn Bird, MD, MPH and her team found Alvin on the street on a gloomy day, he became another statistic: one of 14 percent of homeless people. In San Francisco and Alameda counties receive health services.

Bird is a psychiatrist at LifeLong Medical TRUST, a provider of physical and mental health care to homeless people in downtown Oakland, and the founder of StreetHealth, part of Alameda County Health Care for the Homeless. Every morning of the week, doctors and social workers visit the homeless camp, distributing essential items such as clean shoes and granny bars, as well as medication for depression, anxiety and nightmares. People don’t always agree, but the team comes every day to help, hoping to build enough confidence that people will go to the clinic.

“StreetHealth came along, it’s a match made in heaven,” Alvin said of his first relationship with Bird. “They saved me and I did everything I could to get to the hospital.”

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At the TRUST Clinic, Aislinn Bird (right), MD, MPH, psychiatrist, and Kate Benham, MD, Fellow in the Public Psychiatry Fellowship, examine the medications they bring to visit homeless camps.

Bird and the TRUST clinic are an example of a public psychiatric service. Homeless people living on the streets of the Bay Area are the most visible of public mental health needs – but also the tip of the iceberg.

Christina Mangurian, MD, MAS, co-founder and director of the UC San Francisco Public Psychiatry Fellowship at Zuckerberg San Francisco General Hospital, says, “Public psychology is mental health care in a safety net.” “So think of it as a system where uninsured people or people with public insurance like Medicaid can get mental health care.”

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As Bird, a colleague and others work every day to care for the mental health of those in need, across the country the demand for these types of services continues to grow.

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There is growing recognition that mental health care can be the key to improving overall health outcomes and can be a gateway for people to get the help they need.

Mangurian spoke of increasing attention to the need to address health issues. But he noticed the difference in access to care. “As mental health care becomes scarcer, people with access to it may seek care in the private sector. “But for the victims, especially the poor and the needy, public services must be expanded to provide the care these people need.”

One problem is that there are too few psychiatrists who can care for the most vulnerable. 40% of psychiatrists work in private practice, receiving only money. The rest — the number of psychiatrists working in the public sector and the insured population — declined by 10 percent from 2003-2013, according to a National Medical Council report. Director of the Institute.

[F] Or the poor, especially the poor and needy, the public sector must expand to provide the care that people need. Christina Mangurian, MD, MAS Professor of Psychology

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Some of the reasons for the low reading rate include heavy file requirements, limited sharing of information that can facilitate better maintenance and higher aging rates.

And of course there are wages, especially in areas with high living costs, such as coastal areas.

“So why would a psychiatrist choose to work in the public sector when they could work elsewhere for $50,000 or $100,000 a year?” Mangurian said. “They do this because they seek meaning in this work and because they are dedicated to social justice and equal care for all residents.”

His path to public psychology began across the coast from Oakland in East Palo Alto, where he worked as a college elementary school teacher. There he saw young students suffering from oral problems, obesity, malnutrition and the consequences of poor health care. He decided to go to medical school for manual care, thinking he could become a family doctor.

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During a psychology rotation at the VA in Long Beach, where he worked with people with severe and chronic mental illness, he discovered how for this population, psychologists often have one mind. Doctors and their advocates. He also found that many barriers to health care are ubiquitous, from poverty to a lack of integrated care in hospitals.

“Unfortunately in medicine and in society there is stigma and judgment of people with mental health symptoms. So I went to a psychiatrist to make sure I got the treatment that patients needed in other medical fields. But also to connect them to cases. Management and housing . help. I really like the broad spectrum that you can do as a psychiatrist,” he said.

Her interest led her to a one-year fellowship program, which she graduated in 2017. During the program, fellows are placed in clinics where they gain experience working with homeless people, such as homeless people or children in child care. Bird was assigned to the TRUST clinic, where he got a job after his career.

During his three years at the clinic, he founded the StreetHealth team and worked to raise awareness of PTSD among homeless people in Oakland. Like all psychiatrists, Bird has patients who often miss their appointments. But for his patients, most of whom are homeless, the only time they don’t seek help is because their tents are flooded in the rain, they don’t have cell phones or emails to get reminders, or they’re extremely scared. Enter a building after everyday life on the streets. .

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The most common diagnosis he sees in his patients is PTSD. Mental illness isn’t the main reason most people are homeless, it’s the lack of affordable housing, but the daily trauma of living on the streets really exacerbates behavioral problems.

For some, accessing a health center is the first step in managing the situation. A few days after meeting Bird on the street, she was happy to see him in the waiting room of the clinic. Now he sees her regularly, he swallows his medicine and moves to a shelter.

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One of Bird’s patients, accompanied by Reverend Preston, lived outside Oakland for many years, sometimes only a few blocks from the clinic. A longtime priest, ordained minister and now 62 years old, Pastor Preston has long struggled with depression and PTSD.

Pastor Preston now regularly visits the TRUST Clinic for mental and physical health care after meeting StreetHealth when he was homeless. He told other victims on the street to try the clinic.

Mental Health Poster Images

“If you’re depressed and you don’t know what’s going to happen, talk about it,” he said. Hours from now, it might bother you. “

StreetHealth persuaded him for help. They hooked him up with a program to get free teeth, and his new teeth gave him a “high” that he was finally able to get into the clinic. He now comes to the clinic several days a week for psychotherapy, primary care, treatment and haircuts.

He now tells people he sees in pain on the street to try the clinic, even if they just went to the bathroom for free.

Treating PTSD in patients is important – but so is recognizing that it is a major problem.

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When Bird was a colleague at the clinic, he saw a lot of trauma among his patients, but there was no systematic screening for PTSD for the homeless. Diagnosis focuses on depression. He went on to develop a PTSD screening process that helps maintain and monitor progress.

Psychiatrists are preparing to go to San Quentin State Prison this year. In addition to classes and medical work, fellows also visit public health organizations, including state prisons, behavioral courts and police vehicles.

“We’re really trying to give people the tools they need to start looking at things in public health. I’m asking them to start using

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