Taking Behavioral Health Care to the Streets

When you picture a psychiatrist’s office, what do you see? Probably a couch, inside a nice warm and private room, perhaps with some book shelves and tissues. If you ask Dr. Eileen Reilly, an esteemed psychiatrist and beloved member of BHCHP’s Street Team, and a mainstay of caring for Boston’s homeless population for over 30 years, she’d say a park bench or a coffee shop would work just fine for her patient visits.

For our patients on the Street Team, fearfulness and paranoia are common. Many people experiencing homelessness have endured unspeakable trauma and talking to a psychiatrist about that can trigger more trauma. They might be in denial or defensive about their own mental illness and have negative assumptions about psychiatric care.

When you meet Eileen, you can understand how her soft spoken and caring demeanor is appealing to our vulnerable street patients. She says her initial engagement with patients is very casual and conversational. “How are you doing today?” “Is there anything I can do for you?” she might ask someone sitting on a park bench. Eileen calls engaging those living on the street an art, for behavioral health care in particular, and says you have to, “know when to back off and know when to be pushy. And the longer you do it, the better you get.”

She may offer them a warm cup of coffee, or pair of socks as ways to engage. Our patients respond to her gentle and friendly overtures that help Eileen to earn their trust. It may take weeks, months, or even years until patients are comfortable enough to completely open up and receive psychiatric care, but the hope is that those she sees on the street will eventually accept treatment and may one day be housed,.

Our good fortune to have Eileen’s tremendous expertise on our street team began in 2002, when BHCHP and Massachusetts Mental Health Center (MMHC) collaborated to write a 3-year grant to embed behavioral health care into our Street Team primary care, allowing us to offer our street patients the same integrated behavioral health that was already available at our many clinics. Eileen’s presence had an immediate effect on improving our care for our street patients and, 16 years later, we couldn’t imagine our Street Team without her.

Eileen works for the Massachusetts Department of Mental Health (DMH) and divides her time between BHCHP’s Street Team, working for DMH at the Pine Street Inn and St. Francis House, and her office work at MMHC. The rest of the Street Team, led by Dr. Jim O’Connell, is comprised of three doctors, another psychiatrist, a nurse and nurse practitioner, a benefits coordinator, an addiction recovery coach, Mass. General Hospital psychiatry residents, and a couple of volunteers.

How does she get strangers on the street to open up to her about deeply personal and often traumatic experiences? Eileen stresses that consistency and gentleness are key, along with providing for a patient’s basic needs. She shared a story about an older woman who, day after day, sat on the same bench at South Station. Whenever Eileen approached her, asking how she was or if she needed anything, the woman would hold an umbrella over her face, refusing to speak. After several attempts, Eileen got an idea.

“Can I get you some lunch?” Eileen asked.

“Hamburger, French fries, and a coke,” the woman said suddenly. Eileen got her the meal and the two began to build a relationship, allowing Eileen and the rest of the Street Team to better meet her needs.

Eileen and other members of the team often bring hats, gloves, scarves, and even gift cards for McDonald’s or Dunkin Donuts to help engage the people they meet on the street. These items or funds to purchase them are given to us by BHCHP’s generous donors. They may seem incidental, but they can be lifesaving to folks on the streets.

“That’s a really good way to engage people, because most people on the street need a new pair of socks and would appreciate a gift card, especially when it’s cold or wet outside. Then they can go in and have a cup of coffee, be able to buy something with the gift card. They are always very grateful.”

Luckily, Eileen has an impressive resume working with Boston’s most vulnerable neighbors. As a college senior, Eileen volunteered one day at the Pine Street Inn clinic where she assisted none other than Barbara McInnis, the nurse who also trained Dr. Jim O’Connell, and for whom the Barbara McInnis House medical respite facility is named. Eileen wasn’t sure she would return the second day, but Barbara’s compassionate and compelling manner inspired her. That began Eileen’s lifelong career in caring for homeless individuals, which included founding Women’s Lunch Place and she went on to earn her medical degree and did a residency in psychiatry.

For people living on the street, complicated behavioral health issues can include schizophrenia, major depression, bipolar disorder, substance use, and anxiety disorders. For many of our patients, existing behavioral health issues lead to their life on the streets and the harsh realities and traumas of homelessness exacerbate their condition.

Eileen says she loves being on the BHCHP Street Team, working directly in the community, the camaraderie and variety of the settings and, ultimately, helping to relieve her patients from suffering.

According to Eileen, the best part of her job is, “when I go out to the MMHC waiting room and see someone who’s been out on the street for 20 years sitting in the waiting room, because I know they are off the street, in housing and they’re waiting to see me as an office patient.”

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