When David Carroll meets people who are living in camps, in motels, on the street, or precariously housed, he understands that in most cases he cannot start by asking people directly about their mental health needs or substance abuse concerns. “But I find that most people are willing to talk in a general way about things like anxiety, sleeplessness, or anger,” says David. He is a homeless outreach specialist and PATH provider for The Mental Health Center of Greater Manchester in New Hampshire.
He describes the process of engagement as a nuanced and collaborative relationship building process. He draws upon his training in Motivational Interviewing. “Anyone doing outreach knows that we cannot possibly tell people what they should or should not do when we meet each other for the first time. Building a relationship starts with the very first sentence,” says David.
A typical day of outreach begins at New Horizons, a shelter where he meets with people who are being seen in the on-site Health Care for the Homeless (HCH) Manchester clinic, followed by a visit to another homeless services center immediately before lunch. “We meet up with a lot of people here. There is always a crowd to connect with. Then, in the afternoons we usually head to the camps and the parks. I always go with at least one other outreach worker,” says David.
Twice a week, David conducts outreach with a larger group of other providers. The group may include a nurse from HCH, a case manager from New Horizons, a liaison from the school district, a social worker from the Veterans’ Administration, a housing counselor, or an outreach worker from the teen drop-in center.
“This kind of collaboration in a large group makes our work so much more efficient and results-oriented. It is so much easier to make referrals,” says David. He notes that it is important to have a medical provider on the team. Jake, a nurse from HCH, is often able to open conversations. “’Do you have any mental health concerns?’ is not a good opening line,” says David.
In contrast, many people the team meets tend to be immediately comfortable talking about their medical concerns, like wounds, sprains, or physical ailments. He sees this in part as a reflection of the stigma associated with mental illness. “The initial focus on physical health seems to make people more comfortable, and they are then more likely to talk about mental health or substance abuse concerns. This saves a lot of time that it is normally spent bringing people blankets and sleeping bags,” says David.
“If I was doing this work alone, I am not sure how long I would be doing it. Working with the team, I get all the pieces of the puzzle. Someone else is always going to know more than I do about housing or health care. Their expertise allows me to focus on my strength, the mental health piece that is a component of many complex needs,” says David.
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