Magazine article Clinical Psychiatry News

Hospital Program Targets Homeless

Magazine article Clinical Psychiatry News

Hospital Program Targets Homeless

Article excerpt

For all intents and purposes, Phil looked like a hopeless case.

The 43-year-old homeless man had been in and out of treatment programs in the Rochester, N.Y., area. In addition to alcohol and substance abuse problems, Phil, who has schizophrenia, also had lost a leg due to a previous illness.

He had been arrested numerous times and often suffered from frostbite during the region's cold winter months.

"One day 6 months ago, he hit all three emergency departments in one day," said Linda Morgan, Ph.D., grant program director at Unity Health System, a Rochester hospital. "We said. 'This is not working.' He was not taking his medications, and he was living on the street." This was true even though he was receiving government aid in the form of Social Security Disability Income; he was just letting the money pile up without spending it.

The staff at Unity enrolled Phil in its new program for homeless mentally ill patients, the Integrated Model Program based on Assertive Community Treatment (IMPACT). The program, which is funded by a 3-year, $1.6-million grant from the Substance Abuse and Mental Health Services Administration (SAMHSA), aims to help patients such as Phil cut through red tape and get the help they need.

Dr. Odysseus Adamides, the program's psychiatrist, said he appreciates the way it makes patient intake go much more smoothly. "By going through IMPACT, they can come to me unofficially before they are an enrolled patient," he explained. "They can see me, I can do a review, and they can get a bridge script very quickly. Then they consent to treatment and within a week we can arrange a follow-up and intake at a regular site."

IMPACT allows patients to have access to whatever level of treatment they need, whether it be day treatment, partial hospitalization, or outpatient care. Best of all, Dr. Adamides said, it frees him from having to worry about how treatment will be paid for. "It's refreshing because I can just be a doctor. I don't have to worry about managed care or insurability."

Today, Phil is living on his own and participating in day treatment. He has been off illegal drugs for 2 months and is shopping for a group home. Phil's case manager has an unusual method for getting him to participate in the treatment program: If he is there and ready to go when the team members show up at his door in the morning, they give him one of his favorite things--a pack of cigarettes. …

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