Mercy Care: A street-level approach to mental health treatment
By Misty Williams
The Journal-Constitution
The evening light fades as Dr. Liz Frye approaches the young homeless woman sitting on the stoop of Central Presbyterian Church downtown.
Across the street, the Gold Dome glows orange.
Schizophrenia runs in the family, 27-year-old Kreshendalea Cheney says, and she battles the illness too.
A year and a half, that’s how long Cheney has spent on the streets — her child in state custody, her belongings stolen, her mental illness gone untreated.
“I just don’t have any help,” Cheney says. She smiles, but her eyes glisten with tears.
This is how Frye and the Mercy Care team spend every Wednesday night — treating the physical and mental ailments that afflict Atlanta’s homeless. The stretch of Washington Street, directly across the street from the Capitol, is always their busiest.
“They get more frequent care a lot of times than the people I see in clinic,” Frye says. “A lot of times for people who are really acutely ill, we’ll see them every week.”
An estimated 4,800 people live in Atlanta’s homeless shelters or on the streets, according to the latest data available. More than 60 percent have a serious mental illness or substance abuse disorder or both.
For many, visits from the street medicine team are the only times they come into contact with doctors.
‘Not dying on the street’
A light breeze takes the edge off the 90-plus degree summer day.
The six-person Mercy Care team traipses single file along the street gutter to the first destination of the evening, Exit 248D off of the Downtown Connector. Or rather, under Exit 248D.
Beneath the freeway overpass lie piles of old blankets and towels, gravel littered with cigarette butts, a worn copy of a children’s book called “Monkey Me and the School Ghost.”
Anthony Shea, 53, is encamped next to a massive concrete pillar. He’s been seeing the folks from Mercy Care for four or five months.
The St. Louis native has lived on the streets of Atlanta for three years now. The team checks his blood pressure and inspects a rash that appears to be clearing up.
“They make sure I’m not dying on the street,” says Shea, a self-described “hard head.”
An alcoholic, Shea’s been sober for two months, he says, and is down to a pack of cigarettes every few days.
Substance abuse is common on the streets, experts say, and often goes hand-in-hand with psychiatric disorders as people try to self-medicate.
‘Mobility is the last thing they have’
On these Wednesday outings, the conditions Frye sees run the gamut — schizophrenia, bipolar disorder, traumatic brain injuries.
“We see a lot of depression,” Frye says. “We see a lot of PTSD.”
People have been raped, held at gunpoint, suffered violent attacks in jail or prison. She prescribes anti-depressants, anti-psychotics and sleep aids, on the spot when needed. Some people agree to come to the clinic for follow-up visits.
Often, the physical care these individuals receive provides Frye an opening to broach their mental health.
One member of the team specializes in treating problems with people’s feet, such as fungus from their shoes and socks being constantly wet.
“It’s one of the most vulnerable places you can touch someone,” says wound care specialist Tim Porter-O’Grady, as the team packs up from their second destination of the night on the edge of The Bluff, an area near downtown known for drug dealing, prostitution and blighted homes with boarded-up windows. “Mobility is the last thing they have.”
If people feel comfortable enough to have a doctor look at their feet, they typically feel comfortable enough talking about mental health issues, he says.
‘The most vulnerable’
The sun is rapidly descending as the group makes its last stop of the night at Central Presbyterian across from the Capitol building.
Four team members hover over a man with flashlights as Porter-O’Grady works on his feet, cleaning and clearing out pus.
Frye sees her opportunity and sits down next to the man, talking quietly while the rest of the group packs up.
The Mercy Care street medicine team has operated for two years now. Frye says she would do street medicine every night if there were money to fund it. There isn’t.
“It never quite seems to escape my mind that we are providing services for some of the people in this community who are the most vulnerable . . . right across the street from a place that could really decide to change that if our legislators wanted to,” she said.
This article was reported and written as part of the The Rosalynn Carter Fellowships for Mental Health Journalism at the Atlanta-based Carter Center.
HOW WE GOT THE STORY
Over the past six months, health care reporter Misty Williams has interviewed dozens of mental health providers, health care experts, hospital executives, lawmakers and individuals who live with mental illness. She has also reviewed hundreds of pages of state and federal data on the numbers of individuals who deal with mental illness and substance abuse issues and spending on mental health services, as well as key studies on mental health prevalence and treatment across the nation. Over the course of her reporting, Williams visited a local peer respite center, NAMI support group and behavioral health centers. She and staff photographer Hyosub Shin also rode along with a street medicine team who brings mental health care to Atlanta’s homeless population. Williams also traveled to Oregon to explore the impacts of Medicaid expansion on creating better access to mental health care there.
The AJC's "A Hidden Shame" series from 2007
The U.S. Justice Department investigated the state’s mental health institutions after a 2007 series of stories in The Atlanta Journal-Constitution, “A Hidden Shame,” brought to light the abuse and deaths of dozens of patients.
“We were not treating people with the dignity and respect they deserved,” said Frank Berry, commissioner of the state Department of Behavioral Health and Developmental Disabilities, at a meeting of mental health advocates, providers and experts earlier this year. “People need easy access to care.”
Under the five-year agreement, the state has created dozens of new community-based services, such as crisis stabilization units and case management teams to help individuals live healthy, productive lives in their own communities instead of being locked away in institutions. But Georgia's mental health system remains inadequate, advocates and experts say.
The big question is how to grow the system set up under the settlement agreement to help not just the 9,000 people it targets but the thousands of others who lack access to care, said Thomas Bornemann, who heads the mental health program at the Atlanta-based Carter Center.
“We know there’s a lot more people with mental illness out there who need services that aren’t available to them,” Bornemann said. “That’s going to be an ongoing challenge.”
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