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Independence and chats over coffee
BMC offers a haven of last resort to mentally ill substance abusers
By David J. Craig
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Alisa Lincoln (SPH'92) (right), an SPH assistant professor of social and behavioral sciences and a MED assistant professor of psychiatry, and Peggy Johnson, a MED assistant professor of psychiatry, oversee a new safe-haven shelter in Boston for the chronically homeless. Photo by Vernon Doucette |
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Among the homeless, those with serious mental illnesses and drug or alcohol problems are the most difficult for clinicians to reach.
But a new shelter run by Boston Medical Center (BMC) takes a progressive approach: it provides chronically homeless people with a safe home without requiring that they immediately change their lives in drastic ways. While residents are offered counseling and medical care, for instance, they aren't forced to use those services. And while drugs and alcohol aren't allowed on the premises, residents don't face repercussions if they come home under the influence.
The safe haven, at an undisclosed Boston location, opened last October with a $1.8 million, three-year grant from the federal Substance Abuse and Mental Health Services Administration (SAMHSA). It's a collaboration among the Primary Care Clinic of BMC's section of general internal medicine, the School of Public Health, the Boston Public Health Commission, the Massachusetts Department of Mental Health (DMH), and Vinfen Corporation, with each organization contributing staff.
The project follows the recent discovery by MED researchers that there exists “a major gap in services” in Boston for homeless adults who have both substance abuse problems and serious mental illnesses, says Alisa Lincoln (SPH'92), an SPH assistant professor of social and behavioral sciences and a MED assistant professor of psychiatry. She is principal investigator of the SAMHSA grant and oversees the shelter.
Based on a model for transitional housing created by the U.S. Department of Housing and Urban Development, the safe haven is the only one of its kind in the Boston area that serves men, Lincoln says. She will assess how well the shelter assists its residents. The four women and three men currently living there were chosen with help from DMH outreach workers; most had been homeless for 10 years or more.
“These are the most marginalized, disenfranchised, and severely mentally ill homeless people, and those least connected to any social or clinical services,” says Lincoln. “Some of them have been banned from every existing shelter in the city. They're people of whom we've heard it said: ‘You'll never get them to stay in a shelter.'”
Four months into the project, that presumption seems dead wrong. Seven of the eight original residents remain, a new person is being coaxed in, and residents have become steadily more communicative with clinicians and with one another, says Peggy Johnson, a MED assistant professor of psychiatry. Co–principal investigator of the grant, she visits the safe haven two days a week and oversees its clinical staff. “That these people are off the street and beginning to have conversations with us is unbelievably exciting,” she says.
Allowing the residents independence is the key to getting them to talk to the primary-care physicians, addiction counselors, psychiatrists, and other clinicians who regularly visit the shelter, say project organizers. Many residents were booted from other shelters in part because they are easily frustrated by rules and tend to be suspicious of authority figures. The only rules at the safe haven involve basic safety: no violence or aggressive behavior, no overnight guests, and no drugs or drink. The multifloor house is staffed around the clock with mental health and substance abuse counselors, but residents have their own bedrooms, which they can lock, and are free to come and go as they please. They're invited to help prepare meals and attend weekly house meetings, but they don't have to. And while organizers want the residents to make the transition into permanent housing within a year, there's no limit to their length of stay.
“From the points of view of the clinicians, it's been a challenge to give up our sense of control and to let the clients set the pace,” says Johnson. “But it's important, because the whole idea is to engage them by being undemanding. Sometimes my psychiatric assessment of a person is sitting down with them for a cup of coffee. There's nothing formal about it, but I've been able to learn a lot about people that way. This certainly isn't medicine as usual.”
6
February 2004
Boston University
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