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Taking psychiatric help to the street

Taking psychiatric help to the street
Photo by Getty Images
Taking psychiatric help to the street

Last August, New Haven made the national news in a way no city wants when 72 people were poisoned by an illicit synthetic cannabinoid called AMB-FUBINACA. All over the New Haven Green, people who had ingested and/or inhaled the substance fell to the ground, convulsed, and lost consciousness.

Among those who rushed to help them was Emma Lo, MD, a fourth-year resident in Yale School of Medicine’s psychiatry program and volunteer with a street medicine team.

Ambulances, police, and EMTs were scattered all over the green when she arrived. She knelt to aid a man who had just fallen and was seizing. After a moment, she recognized him as a former patient of hers at the Connecticut Mental Health Center (CMHC), where she had completed a residency rotation. Thinking that he was suffering an opioid overdose, she sprayed the emergency antidote naloxone up his nose. It didn’t work. “I felt very helpless. I wanted to save him, but we didn’t know what was going on,” Lo says.

Luckily, nobody died. But stunned city government and health care officials developed a strategy for avoiding a repeat of that awful day. A number of the overdose victims were homeless, so the official response included creating one of the few street psychiatry teams in Connecticut and hiring Lo to spearhead it. “We’re developing a program that can be scaled up if it’s proven to be effective,” says Jeanne Steiner, DO, medical director of CMHC and associate professor of psychiatry at Yale School of Medicine.

Lo has shown a deep concern for people experiencing homelessness ever since she began volunteering to help them as an undergraduate at Haverford College. “In New Haven, we’re lucky to have a wealth of resources for people who live on the street, but there’s a gap for people who are chronically mentally ill,” she says. “There are clinics that offer mental health care but until now there was nobody going out to provide care where the people are.”

While national experts estimate that about 25 percent of the homeless population suffers from severe mental illnesses, those who care for them say nearly all have some sort of mental disorder. “Some are homeless because of mental illness, and some are mentally ill because of the stress and trauma of homelessness,” says Philip Costello, an advanced practice registered nurse who is the clinical director of homeless health care outreach for New Haven’s Cornell Scott-Hill Health Center.

Lo had been volunteering on Costello’s team for two years as they provided basic medical care for people experiencing homelessness—in parks, at soup kitchens, at shelters, and on the street. Costello says Lo has a low-key style that breaks down the barriers of distrust that many homeless people have for police and health care professionals alike. “These people are so marginalized and they only warm up to somebody who has the persona to be sensitive, genuine, and patient—and Emma is all of those things,” says Costello.

Lo credits the residency program’s practice of setting aside time for special projects with helping her get to where she is today. She crafted her own residency rotation with the street medicine team. Now, thanks to her, street psychiatry is an elective rotation for other residents.

Her journey is part of a major new emphasis in the psychiatry residency program—where social justice and health equity are increasingly baked into the curriculum. Residents interact with patients and community leaders throughout New Haven’s neighborhoods. To raise their awareness, the residents even try to buy healthy meals with the $2.10 per meal that the government provides for food assistance. “We’re exposing the residents to structures in the community that affect health so they better understand the issues their patients face, can help provide more comprehensive patient care, and can advocate for change,” says Robert Rohrbaugh, MD ’82, professor of psychiatry and residency program director.

“Every resident could benefit from this experience,” Lo says. “It has taught me so much about understanding people—not just their physical and mental health but their whole environment, the social determinants of health. Ultimately, you’re learning empathy.”