As healthcare providers, it’s easy to focus mainly on your patients’ physical health. After all, it’s easier to see and measure conditions like blood pressure and diabetes. Lately, mental health awareness has become less taboo and more topical, yet it deserves a more prominent focus in healthcare.
Like mental health, homelessness is an issue that is not discussed enough. Although homelessness has decreased overall during the last decade, over half a million Americans struggle to find stable housing. When we aid those in need, we often cater to the more obvious, physical needs — food, clothing, and shelter. Meeting the psychological needs of the homeless is just as important to their wellbeing, and in some instances, these mental health issues are the reason they are struggling to begin with.
According to the Maryland chapter of Health Care for the Homeless, at least 25% of the homeless population experiences mental illness, and a large number struggle with addiction. “Of all the causes of homelessness, one is mental health issues, either innately or as a result of addiction,” says Steve Wienner, owner and pharmacist-in-charge of Mt. Vernon Pharmacy in Baltimore, MD. For 20 years, Mt. Vernon has offered 340B services alongside Health Care for the Homeless. A few years ago, a Mt. Vernon location opened up within the same building as the Health Care’s Baltimore clinic, making access to care simpler and quicker for the patients who need it. Providing medication to the homeless has challenges just like caring for any other customer, but these are not the usual hurdles. “Curiously, the challenge is not financial,” Steve observes. “The clinic we work with covers the copay in many instances. A lot of people assume the be-all and end-all to compliance is money, yet this is a prime example of how finances have nothing to do with it. It’s a completely different narrative.” Medication adherence may not be easy, but it’s all the more difficult when your patient has no home address or phone number to be reached by.
At the other Mt. Vernon Pharmacy location, pharmacist Shivas Patel works closely with the Health Care for the Homeless clinic to address the issue of patient compliance, along with other needs they may have. From annual vaccinations to supportive insoles to addiction therapy, Shivas and the other Mt. Vernon staff members ensure that the homeless patients receive the care they need. Mental health is one of Mt. Vernon’s greatest concerns, so Shivas has had to approach adherence differently with the homeless:
“There are a lot of factors behind homelessness and mental health issues. It’s not an easy thing to categorize. You have to talk to them in person to know the reason why they’re at the clinic. It’s a common misconception that homeless people just don’t want to work, can’t find jobs, are addicted to drugs — these are all stereotypes that aren’t necessarily true.”
Because these patients don’t have a reliable source of contact, Health Care for the Homeless has an outreach program that goes and checks all the locations a patient has noted that they may be found. When they are located, the clinic staff members bring them to the pharmacy to pick up their prescriptions. Adherence is key for maintaining a healthy balance and making sure their medications are effective, especially for psychotherapeutic drugs. Along with compliance, Healthcare for the Homeless offers a range of services for individuals who need psychiatric care.
Combined with Mt. Vernon’s pharmacy services, homeless patients who seek behavioral and/or psychiatric care may receive it at the Health Care for the Homeless Clinic. Meredith Johnston, Director of Psychiatry, and her team offer assessment, referral, individual and group therapy, and ongoing support groups for those who have achieved sobriety from substance use disorders. Carlton, one of the recipients of these services, was diagnosed with depression and anxiety after reaching out to one of the mobile clinics for help. Health Care for the Homeless provided him with various services that have shown him healthier ways to manage his mental state. Now, Carlton is clean from heroin for the first time in 20 years, and he actively relies on strategies like meditation and support groups to maintain his sobriety and health.
“Behavioral and physical health are entangled with substance use. So we treat all of those things as one.” – Jan Ferdous, Director of Behavioral Health
Like Shivas, Meredith asserts that communication is key in finding solutions for their patients. “Working with the homeless requires patience, creativity, and a sense of humor,” she explains. “Knowing each other face-to-face helps.” Communication with local providers is also a helpful tool for pharmacists who wish to reach out and offer their care to the homeless population within their community. “This all works best when there is a strong collaborative relationship between pharmacists and providers,” Meredith affirms. “Getting to know each other’s systems and an open communication of tweaks to be made make the workflow smoother.”
Independent pharmacists are in an opportune position to offer healthcare to their local homeless population. They develop strong relationships with their patients, and they are devoted to their communities’ overall wellbeing. “It’s the right thing to do because you’re a healthcare provider,” Steve concludes. “Regardless of how challenging it may be, this is the right thing to do.”
For more information on how to begin helping the homeless population in your area, Steve encourages pharmacists to reach out to their local health departments and providers who are 340B-eligible. Visit the National Health Care for the Homeless Council website to learn how your pharmacy can proactively assist the homeless in your community.