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A Novel Resident Experience in a Veteran’s Homeless Center

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Homeless veterans face a number of barriers to accessing mental health care. We developed a novel rotation for psychiatry residents at a veteran community center, which not only offers an… Click to show full abstract

Homeless veterans face a number of barriers to accessing mental health care. We developed a novel rotation for psychiatry residents at a veteran community center, which not only offers an efficient entry point directly into mental health services, but also serves as a unique educational experience for residents. This paper offers a reflection on the educational benefits of the veteran’s homeless clinic and the challenges moving forward. On a given night in 2016, there were about 550,000 homeless people in the USA; at least 20% of those were suffering from severe mental illness and 17% were dealing with substance abuse [1]. The veteran population is particularly vulnerable to becoming homeless and both male and female veterans are overrepresented among the homeless population in the United States [2]. The problem of homelessness among the veteran population has been a major public health concern since the Vietnam era [3]. For men, it is estimated that 13.6% of the homeless adults are veterans, whereas 1.8% of homeless women are veterans [4]. Several factors have been found to significantly increase the risk of homelessness in the veteran population but chief among them are mental illness and substance use disorders [5]. The phenomenon of homelessness in veteran and civilian populations represents an intricate, bidirectional interplay of biological, psychological, and social factors [6, 7]. While psychiatric illnesses such as substance abuse or PTSD place many veterans at risk for homelessness; homelessness itself can increase the risk for mood symptoms, substance abuse, and increased exposure to trauma, which leaves clinicians with a chicken or the egg scenario [8]. Homelessness, regardless of being causative or a consequence of psychiatric illness, complicates the treatment and care of many veterans [9, 10]. Providing optimal care to homeless veterans requires prioritization, navigation of multiple service systems, and care coordination. Psychiatric residents need to have exposure to such formulation complexity to hone their ability to integrate biopsychosocial perspectives. Residents also need to learn about the barriers to health care resources that many homeless people face in order to learn to be effective advocates, team leaders, and change agents. Early career exposure to homeless and other vulnerable populations may help residents begin to develop greater empathy and think about designing and supporting interventions to reduce barriers to care. Only about half of psychiatry residency programs offer clinical rotations specifically serving homeless populations, and only 20% of residents actually end up participating. However, residents that do take part in these rotations have more positive attitudes toward the homeless, are more versed in systems of care, and are more likely to enter public psychiatry as a career [11]. Furthermore, providing residents with opportunities to evaluate homeless patients holds the promise of challenging residents to think critically about the role of psychiatry in public health policy and advancement of equity and social justice in healthcare [12]. The purpose of this paper is threefold: [1] to contextualize and describe a novel psychiatry resident clinical experience in a veterans homeless drop-in center at a community mental health center, [2] to make the case for the homeless center’s added educational value to the resident experience, and [3] to * J. Corey Williams [email protected]

Keywords: psychiatry; center; homeless; health; care; experience

Journal Title: Academic Psychiatry
Year Published: 2017

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