Mental illness and substance use disorders are central factors contributing to street homelessness for many individuals which often prevent them from getting the support they need. Our psychiatric services are essential for these homeless individuals to work with our outreach program and move towards permanent housing. To learn more about outreach psychiatry, we sat down with Joanna Fried, MD, the Medical Director for the Manhattan Outreach Consortium (MOC), to discuss the work of psychiatric providers, the program’s evolution and the future of psychiatric outreach in New York City.
What does it mean to be the Medical Director for MOC?
I oversee all the clinical operations of the medical and psychiatric providers working for MOC. It also means I get involved in areas like incident review, [helping on] challenging clinical cases where a higher level of intervention is needed, and advocating with other agencies or hospitals. It’s being involved in systems level interventions that trickle down to improve the clinical services on the ground.
Can you tell us about the clinical services on the ground?
MOC currently has about 100 hours a week of psychiatric services. Every team has one or more psychiatric providers attached to them. Generally, each team has two and a half days a week of psychiatric services available. There are seven psychiatric providers in Manhattan and there are also Janian psychiatric providers working with Breaking Ground’s outreach program in Brooklyn and Queens and with BronxWorks’ homeless outreach team in the Bronx.
Our psychiatric providers are able to go out in the field to engage, evaluate, and treat people. If someone doesn’t show up for an appointment, our providers can be flexible in terms of being able to see that person. We can figure out creative ways to get people medication or services if they don’t have insurance. We are able to develop a lot of work-arounds that a more rigid traditional system wouldn’t be able to.
How did psychiatric services like this become part of outreach?
It was part of the original set-up; from the very beginning of outreach there were going to be psychiatric services available for all clients. Every client needs to have a psychiatric evaluation to put together a housing packet. So the psychiatric providers can help the teams determine what kind of housing someone is eligible for, what kind of services we should be pursuing.
From the beginning to now, has the role of psychiatric providers changed significantly, or does it feel similar?
Overall, I think the work hasn’t changed substantially because all outreach clients still needs a psychiatric evaluation for their housing packets. We still really strongly encourage providers to get involved, engage clients who are difficult, and help the team do risk management around high-risk clients. We have tried to really work as providers to think expansively about how we treat, be more creative and proactive in our follow-up, really outreach to people, and focus on treating people by seeing that as part of the housing process. Treating somebody’s psychiatric symptoms is going to make them more likely to tolerate the housing process and remain in housing successfully. I think now that CUCS is leading MOC, the clinical role is going to evolve, it’s going to expand what we’re able to provide to the outreach teams.
What is it like working with the outreach teams?
It’s incredibly rewarding to work with outreach because you’re a member of this team working to provide something concrete that somebody needs, such as moving somebody from the street into an apartment and helping them reintegrate into a community.
What are some of the cases that you’ve helped with that you’re proud of?
Part of what’s really nice about my role is that I have the leadership role, but I also spend two and a half days actually doing clinical work with the outreach teams. I’ve been doing that for eight years. There are people who I’ve worked with long term, in a way I would not have been able to in a traditional setting. I can visit someone at their transitional site, or on the street.
I’ve had clients I’ve worked with for a year or two, doing weekly therapy, treating their symptoms, getting to know them, and seeing them transform by reconnecting to family, reducing their substance use, and getting their anxiety and depression under control. What’s been really gratifying is to do that work not just in a vacuum but with a team of people who are also engaged in that work.
Any thoughts on the future of psychiatric outreach in New York?
I’m really excited that CUCS is taking the lead, it’s a really nice opportunity to think about how to innovate, change, and grow. I’m excited about working to better integrate the psychiatric and primary care services we can provide to clients. It’s about working to provide the same level of care that you would want for yourself or your family to people who are disconnected from resources. Continuing to really refine and improve the care provided to people who are disconnected and disenfranchised is exciting.
It’s thinking about how CUCS can expand the services we provide to people to really help them. It’s not about just moving out of homelessness but moving into recovery, reaching goals, getting reintegrated in the community, and developing a home that’s beyond just an apartment to live in.