Yale Psychiatry resident launches program to assist homeless veterans at VA

A screening program at the West Haven campus of the VA Connecticut Healthcare System is connecting some homeless veterans with housing and clinical services to assist with their cognitive and functional impairments.

The clinic, Screening Program to Identify Needs Due to Geriatric Syndromes (SPRING), was launched last year by Adam Mecca, MD, PhD, a fourth-year resident with the Yale Department of Psychiatry.

Mecca became interested in helping homeless people when he was an undergraduate student at the University of Florida. Now that he’s at Yale, he has started a program that is connecting up to eight veterans a month with services for housing, mental health assistance, and functional needs like medication monitoring.

“The goal is to provide them with assistance to maintain independent housing,” Mecca said. “We have lots of people wanting to see us now.”

The program screens veterans who seek help from the homeless service at the VA, where between 800 and 1,000 people annually turn when they have either lost their home, or are in imminent danger of doing so.

Most of the veterans who seek help are men between 50 and 65 years old who have become homeless for the first time. Some suffer from dementia and other medical problems, while others lack social supports.

The age demographic is of particular interest to Mecca, who is studying geriatric psychiatry, and last year received scholarships from the American Association for Geriatric Psychiatry (AAGP) and the Geriatric Mental Health Foundation (GMHF) to support his work.

Mecca and his team reach out to veterans who are seen at the VA service and ask if they would be screened by SPRING. He said most people appreciate the assistance.

Our goal would be to see every person who comes in with housing difficulty.

Adam Mecca, MD, PhD, fourth-year resident, Yale Department of Psychiatry

Studies show many older adults who are homeless suffer from severe mental illness and have higher rates of functional impairment. Depending on the situation, some veterans undergo a brief screening by the SPRING team, while others are put through more extensive testing to determine their level of impairment.

The results of the brief screening are shared with the veteran’s clinical providers so they know how the veteran performed on the tests. Those who receive more thorough testing are frequently referred for more extensive laboratory screening or imaging to assess their cognitive function.

Home-based primary care services and physical and occupational therapy can be ordered, and referrals can be made to a geriatric psychiatrist or physician, or the neurobehavioral clinic at the VA.

With both screenings, assessments are done to determine why the veteran is homeless. Attempts are then made to help the person find housing.

More data must collected before Mecca and his team can say how many housing situations have been improved, but he said the program has definitely improved people’s access to clinical services.

Mecca’s collaborators in the clinic include his wife, Marcia Mecca, MD, assistant professor of medicine (geriatrics) at the VA, and Theddeus Iheanacho, MBBS, DTM&H, assistant professor of psychiatry, who has connected SPRING to the homeless clinic at the VA, where Iheanacho is an attending physician.

SPRING has been funded by the Hartford Foundation and by a VA Innovations grant. The team submitted three posters and an oral presentation to the AAGP annual meeting in March, and was invited to attend. The meeting is in Washington D.C.

Mecca said he hopes to draw more attention to the clinic so more veterans can be helped.

“Our goal would be to see every person who comes in with housing difficulty,” he said.

This article was submitted by Christopher S Gardner on February 10, 2016.