How this team provides mental health care to the homeless during the coronavirus pandemic
Dr. Anthony Carino, the Director of Psychiatry at CUCS, sat down with Yahoo Life to explain how the coronavirus has impacted the homeless population and how his team continues to provide proper care to those with pre-existing mental health conditions.
Video Transcript
ANTHONY CARINO: Homelessness is a devastating problem in the US, and in particular, in New York City where we have about 63,000 New Yorkers in a shelter at any one point in time, and 4,000 New Yorkers that are staying on the streets. Only about 43% of people with mental health conditions are able to get effective care in the US under usual circumstances, and that number goes down with more severe mental illness.
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Hi, my name is Dr. Tony Carino. I'm the Director of Psychiatry at Janian Medical Care. Our mission is to serve the highest needs individuals that have the poorest access to psychiatric and mental health care. The majority of the people that we are treating have severe and persistent mental illness. I work in particular on assertive community treatment teams and intensive mobile treatment teams, which we refer to as clinical swat teams. So we go out into the community, locate people, establish a relationship, and provide for them really effective talk therapy, medication, case management support.
So people experiencing homelessness have multiple barriers to care. One of the challenges that's a potential barrier is stigma. Stigma for the experience of homelessness, stigma for mental health conditions, and stigma for addictions as well. We've seen this really escalate with COVID-19. Individuals experiencing homelessness don't have a capacity to isolate. They're oftentimes in congregated care situations such as in shelters. They don't have individual bathrooms or eating spaces, and they also have a lot of the medical comorbidities that we see are associated with poor outcomes with COVID-19, and so we've had to work really hard to decrease the risk to this population.
We moved really actively to break up our team of clinicians into half of the team going on-site and treating people, whereas the other half of the team was working remote providing primarily telepsychiatry. Those teams then switch every two weeks to decrease exposure and spread to the patients that we serve. Things that we could do remote, we did remote, but we still had to have some face to face encounters. Quarantine in isolation is not good for individuals with trauma, and a lot of the folks that we work with have a history of trauma, but it's really been a whole community effort between the psychiatrist, primary care, and the social workers to try and boost access to people. Sometimes that might involve providing people with smartphones. There's platforms where there is an iPad that's cleaned off. There's also what's called a clean telehealth room.
People are aware of the rising psychiatric symptoms that are occurring with COVID-19. And in this population, we're seeing more people via telepsychiatry and remote in these targeted visits than before. They need mental health right now. So many of the people that we work with, once they get a little bit of stable footing are the first to say, how do I give back? How do I support others that are experiencing homelessness? This population is experiencing the city and people around them in a very specific way, so folks are aware that people walk past them, that might not treat them like a person, and they respond to that. And in time, they respond to when people do connect with them with a sense of humanity.
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