Photo credit: Flickr
By Mario D. Zepeda
The largest barriers for at-risk homeless population in Boston involves coping with mental and medical health in the community, creating a need for outreach work to help them.
North Suffolk Mental Health Agency in Chelsea provides outpatient, community-based, support and counseling services to individuals struggling with mental illnesses. The Community Support Program (CSP) targets Boston area clients who are homeless and are high emergency room utilizers.
Case Management for Homeless
Evett Ruiz, a CSP outreach worker, meets with clients discharged from inpatient hospitalizations, shelter, and detoxification centers.
She meets with clients face-to-face on a weekly basis to discuss goals focused on completing housing applications, referrals to outpatient treatment, applying to government benefits, and linking to day treatment programs.
“Clients who are at-risk and homeless in the community have difficulties staying motivated. They aren’t able to think about their future, career, or housing. They are thinking about their next meal and where they are going to stay at,” said Ruiz as she described the common attitude among her homeless clients.
She indicates this population is constantly on the move and frequently bounces from different service providers. Outreach workers like Ruiz meet clients at their homes, in shelters, and hospital settings to help them connect to resources through weekly case management.
Outreach workers balance a client caseload of up to 25 people. On average, outreach workers meet with 10-12 clients face-to-face each week.
Ruiz helps clients complete applications for public housing at more than 120 local housing authorities. “We have all these clients who are homeless and applying. But when housing authorities finally reach back to clients, they have outdated numbers and addresses. They miss their opportunity. They don’t get notified,” said Ruiz.
She submits these housing applications, but explained that most of her homeless clients hardly follow up on their status and often lose their position on the waiting list due to not having stable mailing addresses.
Ruiz helps clients to receive priority housing status by obtaining documentation on their medical and mental health history from their health care providers.
Although there has been a rise in new housing construction in Boston, very few are aimed towards low-income residents. Ruiz explained that low-income housing is designed to meet the needs of residents earning wages close to the poverty line. Not having low-income housing limits the opportunities for homeless to be housed.
“How can we have this population that we can’t house? The biggest issue we have is helping clients seek suitable housing needs. There are no low-income housing opportunities for these clients,” said Ruiz.
Outreach workers aim to help clients during their lowest moments can help them become stronger and resilient. “We want to let them know that somebody cares. To make a small impact in people’s life. Homeless need something that will always be there,’ said Ruiz.
Ruiz explained that client’s medical and mental health history impact their ability to afford housing. “They can’t pay their bills, they lose their housing, and lose their valuables. This can cause someone to fall in to a deep depression,” she said, as she expressed common issues within her clients.
Ruiz’s clients often struggle with forms of depression and anxiety that prevent them from becoming stable in the community. “This can lead to substance abuse, a way of forgetting. Losing touch with reality,” she said as she described mental health triggers that impact clients.
Inessa Gevorkian, another CSP outreach Worker, explained that most of her clients are dual-diagnosis, as they have both a mental illness and substance abuse disorder.
Gevorkian said she visits clients to conduct CSP in-takes in emergency rooms, psychiatric admissions, crisis units, therapy sessions, and court settings.
She explained that a common issue among her homeless clients is the availability of having information on housing resources. Most of her clients feel discouraged completing housing applications as they can be challenging to fill out.
“Housing applications are difficult. Wait lists are 7-15 years. Clients don’t have the capacity; they don’t have the support that they need. Housing authorities cannot connect all priority clients,” said Gevorkian.
She indicates that an increase in state funding for homeless housing programs are necessary. “I don’t think there’s enough emphasis on housing, substance abuse, or considerations for homeless. These areas need to have more resources,” said Gevorkian.
She explained that CSP makes it a priority to link homeless clients to medical and mental health providers. “Our program is designed to promote independence, bring down high risk behavior, and help clients become stable in the community,” said Gevorkian.
Rebecca Douarin, an outreach worker, helps her homeless clients get admitted into shelters. She explained that the strict shelter admission hours provides issues and limit what homeless can do for the day. “You have to be out at a certain time and in at a certain time. People feel scared to go to shelters. Clients report it’s dangerous and you can get your things stolen,” said Douarin.
She explained that it’s difficult for homeless to find a shelter at night due to overcrowding or no space. “Some people can’t stay in shelters because of their mental health illnesses,” said Douarin. She said she would like the state to increase programming for transitional/rooming houses. She argued that clients can become stable in the community by having supportive housing opportunities. Clients can benefit from having their individual rooms and participating in group therapy.
Outreach workers speak more on issues facing those who are homeless.