Last month we were introduced to Dr. Liz Frye, a resident at the Community Psychiatry Fellowship program at Emory University. Dr. Frye explained how she began working as a psychiatric outreach worker on the United Way of Metropolitan Atlanta PATH team and explained how the program works. This month, Dr. Frye talks about how the program started, challenges encountered, and advice for other PATH programs that are interested in integrating psychiatric services into their outreach teams.
Your program works to link clients with a mental health diagnosis to entitlements like Supplemental Security Income (SSI) or Social Security Disability Income (SSDI). How did you start this program?
Many medical providers are reticent to sign Social Security Administration paperwork in outreach settings or with clients that they have not established a clinical relationship with. Many of the clients we work with are disinclined to engage in conventional clinical services, often because these programs do not serve their needs. We recognized that patients had a number of barriers preventing them from getting into clinics or agencies where they could establish a relationship and have their benefits paperwork signed.
When on outreach with the PATH team, I observe the patient interactions with the PATH providers and myself. I document these observations in their chart and build on my documentation over a period of time. The paperwork that develops from these casual interactions becomes the “documentation” that allows for a disability application or a SSI case.
During this process, clients were very interested, and excited, to know that we could help them with their disability paperwork – and that we could help them right then and right there. This simple act of bringing services that clients most need directly to them was the spark for our work.
What are some of the challenges in providing mental health services and psychiatric care in outreach and shelter-based settings?
Psychiatry has a level of mistrust. One of my goals in this work is to re-build that trust, through actions and on-going engagement. The street credibility that comes from continually working with people experiencing homelessness can help to dispel that mistrust. I recognize that trust is something you develop over time. I know that I am not going to gain the respect and trust of the clients by saying: “I am a psychiatrist and I am here to help you.” This often comes across as condescending. Instead, I introduce myself as Liz and try to get to know the person.
How can other PATH programs learn from your work and integrate more direct mental health and psychiatric care into their outreach?
There are a number of different ways that PATH programs can integrate more psychiatric and mental health services into their work. PATH teams can work with psychiatric residency education programs. Physicians in residency training programs often serve uninsured and underserved populations and have a natural leaning toward working with people experiencing homelessness. If PATH programs are operating in communities with academic training centers that have psychiatry residents, the leaders of the PATH program can meet with the residency program directors and build a collaborative partnership.
Another way that PATH programs can infuse more mental health and psychiatric services into their programs is by inviting local psychiatrists to volunteer or work on a part-time basis to consult with the PATH teams. Many psychiatrists who are interested in vulnerable and underserved populations are looking for places to volunteer their skills, time, and passions. More and more communities are developing models for medical and health care providers to volunteer their time. One example of such a model is the Project Access NOW.
I also encourage PATH programs to work within the “recovery model.” This model asserts that people with mental health diagnoses have hopes and dreams and can enjoy positive meaningful lives just like everyone else. By focusing on recovery, we recognize we can help most when we place our client’s priorities above those of society and ourselves. The goal of the recovery model is to push beyond stigma and stereotypes of mental illness and homelessness, including our own, to achieve the goals of our clients.
Finally, PATH providers are smart, capable, passionate people. Advancing their skills is a natural desire. By collaborating with psychiatric training programs or institutions in local areas, PATH programs can advance their providers’ knowledge and skills. Outreach workers have a great deal of guts to do what they do and it is important to draw on the strengths of their personal experiences. Equally, it is important to draw on the strengths and experiences of the clients we serve.
Are there other PATH programs that are finding creative ways to work with psychiatrists or document disability? Click “add a comment” below to tell your story.
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