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Integrating Primary and Mental Health on Street Outreach
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Jake Hull, RN, is part of Manchester, New Hampshire’s integrated primary care and mental health street outreach team. The team is the result of collaboration between The Mental Health Center of Greater New Hampshire, a PATH grantee and the Manchester Health Care for the Homeless program. Jake shares his thoughts on strengths of the team’s integrated approach to health care and street outreach.

“My partner and I strive to make sure that we gain a sense of trust and respect from the people we are working with on outreach calls. We need to do this right away. Many people may not be willing to reveal anything to us immediately, especially if it is the first time we see them. We can always plant a seed for future outreach or visits to the clinic. The goal is to be welcoming, honest, open, and friendly so that people will feel comfortable coming to our clinic,” says Jake Hull, RN. He works with the Health Care for the Homeless (HCH) program in Manchester, New Hampshire. His partner is David Carroll, homeless outreach specialist and PATH provider with The Mental Health Center of Greater Manchester (MHCGM).

David and Jake are a part of an integrated primary care and mental health street outreach team. They work closely with other service providers to build relationships with people experiencing homelessness, mental illness, and substance use disorders. Their community health approach integrates both primary and mental health care.

The integrated primary care and mental health team was created through a partnership between HCH Manchester and the PATH program at MHCGM. Both providers had observed that health care questions are often a fruitful way to start outreach conversations. If a person wants to talk about mental health concerns, Jake will step away and allow David to address those issues with privacy.

“It is always great to have another set of eyes. David and I take turns recognizing things the other one doesn’t,” says Jake. “Working with David is really helpful. He can clarify if we are seeing Schizophrenic behaviors, acute delirium, or other mental health issues. He understands baseline behaviors related to mental health. He can facilitate rapid in-house referrals for people who are in danger of harming themselves more quickly than I can,” says Jake. While Jake can make referrals to the mental health center, David’s in-house status offers a faster response time.

Recently the team worked with a woman who was facing imminent eviction. While she was unwilling to discuss anything related to mental health, Jake’s primary health care background offered inroads for her to discuss her concerns about losing consciousness. During his interactions with her, he learned she had a primary health care provider and was able to make a connection. “My discussions with her about her physical health opened up avenues that enabled her to feel comfortable talking to David about mental health issues,” says Jake.

Jake also notes that he feels safer conducting outreach as a team. The two men once encountered a situation with a young group of men by the river who were using. The young men became aggressive. Together, they felt safer backing out of the environment, and leaving with an offer to meet the group at a different time.

Currently Jake is working with a woman who has recently been housed. While her medical needs are being addressed, Jake has observed that she misses the routines and community the shelter offered. He has been collaborating with others on his team to address her need for social connectedness. He hopes to bring David into the process so that he might help to address any mental health issues she has.

In addition to their outreach work, David and Jake work together to reflect on where they have been and to review their plans for outreach. “We see very sad, emotionally rough situations. But we know we are making a difference. Sometimes talking about what we have encountered is helpful. I know that building trust between outreach workers is something that needs time to develop,” says Jake.

To learn more about the integration of primary care and mental health services, read the PATH Spotlight: Integrating Mental Health and Primary Healthcare.

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