Mobile Health Vans Care for Alameda’s Homeless

By Alvin Tran

Alameda County Mobile Health Services Unit van, set up to treat patients in downtown Berkeley. (Photo: Alvin Tran)

The walking wounded wander the streets of Alameda County.

They are people who are homeless and live day to day in public parks and shelters. They are people in need of support for mental health issues and drug and alcohol addiction. And says Addie Brown, they are also one of the most difficult groups of patients to treat.

Brown would know. She oversees the operation of the Mobile Health Services Van headed by the Alameda County Health Care for the Homeless Program (ACHCHP). The van travels throughout Alameda County serving approximately 160 homeless individuals each month. A team of healthcare providers, including nurse practitioners and social workers, provide no-cost primary care and support services, such as counseling and testing for sexually transmitted diseases.

“Over the years, we’ve saved a lot of lives. A lot of clients come with conditions that would have gone untreated had we not gone out there. We’ve been able to help them with their medical issues and getting them hooked up to the appropriate clinic, or doctor, or specialty care,” Brown explained.

Reggie Evans came to the van to get treated for his allergies. As a street vendor who sells homemade jewelry on the streets in downtown Berkeley, Reggie said he often encounters passersby who ignore and discriminate against him for being homeless. But on the van, it’s different. “They’re not snotty. They don’t judge you,” Reggie told me.

But despite the mobile team’s success in treating the homeless over the years, there has been a growth of patients with untreated mental health conditions and drug and alcohol addiction.

Not altogether surprisingly, Brown says these patients often fail to follow through with their medical referrals and go on with their lives — untreated.

“Those are the hardest clients to work with and the hardest clients to get a positive outcome with because of their struggles with mental health and substance abuse,” Brown said.

Gerald Walker, a mental health specialist from Alameda County Behavioral Health Services Agency, counsels mentally ill patients and helps them seek proper treatment. Walker began working for the van on a part-time basis in 1991 to help patients with mental illnesses. While he cannot treat them, he can refer them to the appropriate care.

“Part of our job is to teach them to become better patients,” Walker said.

He described the van’s mentally ill patients as “treatment resistant individuals,” because it is up to them to decide if they want to get treated for their conditions.

“They haven’t come to a point where they want to admit that they have a mental illness,” said Walker. “It’s almost impossible to treat someone who is telling you that the problem does not exist.

Even with the current challenges, Walker remains optimistic and points to Alameda County and the state of California’s current push to combine behavioral health care and primary care in treating patients.

“We are a few steps ahead of many others because we … realized that this has been a problem for a really long time. We’ve been putting systems together that can address that,” Walker explained.

Still, the systems do not support all patients equally.

“In Alameda County right now, we have a pretty strong system of care for people that have a serious mental illness,” said David Modersbach, Director of ACHCHP. “That could be something like schizophrenia or very severe depression or other sometimes organic mental illnesses. However, persons that have a low acuity mental illness such as depression, anxiety, personality disorders — these mental illnesses don’t qualify them for low cost care.”

Modersbach calls these patients the “walking wounded” because they don’t have access to support services and care that other community members “take for granted.”

To address these patients, Modersbach said his team is working with Alameda County Behavioral Health Care Services to explore expanding the current mental health services being offered.

Part of this potential expansion includes adding psychiatrists and licensed clinical social workers to the Health Services Vans so they can directly treat mentally ill patients.

“What we would like to do is have a system where we’re able to provide some sort of treatment for people at the places where homeless people are,” Modersbach explained.

While ACHCHP and Behavioral Health Care Services are still in the planning stage of the expansion, Modersbach said he remains optimistic and hopes to see the expansion happen in early 2013.

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  • trueamericans

    HCHP sounds like a nice program. Maybe they should keep things more the same since the clients are comfortable as well as getting their needs met (for the most part). Got to remember that it’s social work and not all of the problems can be solved. However, if the program invites major changes, their chemistry, without a doubt, will change also. The statement by the clients who said, “They’re not snotty. They don’t judge you,” illustrates the very fabric of the program’s “good nature” and essence of their work. Yet, they are willing to risk losing this goodness for just some bodies with credentials who most likely be “snotty.” Just keep the compassionate staff that you have with BA, MA in the field of social sciences (no BS needed), and your program will stay real. Value what their hearts have to offer and the goodness will resonate!

    • FNP

      You have a valid point in your response to the lack of judgemental tone that the client spoke about. Manyh of the clients that we see on the van have substance abuse and mental health issues that keep them from following thru and doing what they need to do to be healthier. Often times though, what the majority of people we see are lacking is mental health and S/A treatment, so that is why the push is to have mental health and other professionals who are experts in these fields to come on board. We also would like to provide legal counseling to folks, as many of the clients seen often have legal issues also. Ultimately as you said, in social work, not all problems get solved, but this would be a good start.

      • trueamericans

        I understand the need for specialists not just in health care but in almost every profession. And
        yes, integration sounds good, of course; however, whatever happened to the
        village/community model? Are there not outpatient mental health programs in the
        neighborhood? What about AOD services? How
        much space do you have on the van; 40 or 50 feet of space? That comes to
        approx. 300 sq ft or less of functional space for your van operation. Wow, most
        barbershops have more space than that and they don’t have to deal with most of
        the problems (gossips, yes, but not case management, HC or therapy). How many staff do you have on the van? I can
        imagine having a couple of medical staff, a couple of social workers, and a
        driver… but if you want to add a MH therapist/psychiatrist then your program is
        going to require a lot more. How will the program deal with the flow of clients
        –particularly when clients are being emotionally charged, difficult clients
        that may take hours (not minutes) to thoroughly assess, and client’s
        confidentiality, not to mention clients that may come in with bedbugs, lice,
        scabies, and other contagious conditions. To provide property care to not just the
        homeless but anyone, space and time are needed. Have you seen the number of patients that have
        been misdiagnosed with Bi-polar?

      • trueamericans

        I understand the need for specialists not just in health care but in almost every profession. And
        integration sounds good, of course; however, whatever happened to the
        village/community model? Are there not outpatient mental health programs in the
        neighborhood? What about AOD services? How
        much space do you have on the van; 40 or 50 feet of space? That comes to
        approx. 300 sq ft or less of functional space for your van operation. Wow, most
        barbershops have more space than that and they don’t have to deal with most of
        the problems (gossips, yes, but not case management, HC or therapy). How many staff do you have on the van? I can
        imagine having a couple of medical staff, a couple of social workers, and a
        driver… but if you want to add a MH therapist/psychiatrist then your program is
        going to require a lot more. How will the program deal with the flow of clients
        –particularly when clients are being emotionally charged, difficult clients
        that may take hours (not minutes) to thoroughly assess, and client’s
        confidentiality, not to mention clients that may come in with bedbugs, lice,
        scabies, and other contagious conditions. To provide property care to not just the
        homeless but anyone, space and time are needed. Have you seen the number of patients that have
        been misdiagnosed with Bi-polar?

  • trueamericans

    I understand the need for specialists not just in health care but in nearly all professions. And, yes, integration sounds good of course; however, whatever happened to the village/community model? Are there not outpatient mental health programs in the neighborhood? What about AOD services? How much space do you have on the van; 40 or 50 ft of space? That comes to approx 300 sq ft or less of functional space for your van operation. Wow, most barbershops have more space than that and they don’t have to deal with most of the problems (gossips, yes, but not case management, HC, or therapy). How many staff do you have on the van? I can imagine a couple of medical staff, a couple of social workers, and a driver…but if you want to add a MH therapist/psychiatrist then your program is going to require a lot more. How will the program deal with/how has your program been dealing with the flow of clients -particularly when clients are being emotionally charged, difficult clients that may take hours (not ninutes) to thoroughly asssess, and client’s confidentiality, not to mention clients that may come in with bedbugs, lice, scabies, and other contagious conditions? To provide proper care to not just the homeless but anyone, space and time as well as compassion are needed. Have you seen the number of patients that have been misdiagnosed with Bi-polar? And still, you’ll probably come back and say that the program can do a better job than other agencies, that’s why there’s a need to push this forward…..that’s what you’re expected to say and that’s what they always say.