Wendy Georges (second from the left) leads a planning session for the new TRUST Clinic (Photo: David Modersbach)

By Alvin Tran

Alameda County has new plans in store for its homeless population – it intends to open an integrated medical clinic in downtown Oakland.

The TRUST Clinic is one of the county’s newest projects and involves the collaboration of several agencies including Alameda County’s Health Care for the Homeless Program, Social Services Agency and Behavioral Health Services.

But unlike other clinics in Alameda County, TRUST will be one of just two which will offer integrated health services, including primary care, behavioral health, case management with housing assistance, and medical-legal partnerships.

“This clinic is a very innovative idea. It’s not something that’s being done in very many places,” said Dr. Michael Boroff, a clinical psychologist who will be working at the clinic. “It embraces the integrated health care … with medical and mental health and all of these different aspects of services combining and working together as a team.”

“I’d be hard-pressed to identify the population who needs these services more than the homeless population that we’re going to be serving,” Boroff added. And that population is large — more than 4,000 people in 2011, according to a report by EveryOne Home, an advocacy group.

Wendy Georges, the TRUST Clinic Manager, said many homeless people deal with a variety of health and behavioral problems. Homeless individuals might have mental illness and substance abuse issues, they may have difficulty keeping track of their medical appointments, and might struggle in social settings.

The TRUST Clinic is intended to be a place where people can get a variety of services for up to 24 months. The hope is that during this time, patients will achieve financial and housing stability and be prepared to transition to other permanent clinics in Oakland.

“What we’re hoping to do in the TRUST Clinic is to address all of those problems across a spectrum — stabilize their health, stabilize their mental health, offer effective substance abuse and interventions for addiction, provide legal advocacy to people so that they can successfully transition off of (General Assistance), get on to insurance which will then increase their access to medical care, mental health care,” Georges explained.

While many homeless individuals are current recipients of General Assistance, also known as welfare, Georges said that many of them are still unable to obtain adequate health services. TRUST will help enroll individuals in other areas of assistance.

“If they get on to Social Security, Supplemental Security Income — SSI — or SSDI, they’ll have access, automatic access, then to Medi-Cal and, in some instances, to Medicare,” Georges said.

But when more people become insured, there will be other challenges to face.

According to Georges, more than 56,000 people in Alameda County will become eligible for health insurance once President Obama’s Affordable Care Act takes full effect in California.

“The demand outweighs the supply,” Georges said, adding that the current community clinic system in Alameda County will continue to be overburdened with patients from the safety net population –- a population in need which lacks health insurance.

This is where the TRUST Clinic comes into play. Georges describes the clinic as the “safety net for the safety net.”

“By redirecting the homeless population to the TRUST Clinic we relieve the burden on our community health network and enhance an already inadequate safety net system in Alameda County,” Georges explained later in an email. “Our clients/patients already have difficulties gaining access to the system and fitting in even when they do. We are establishing the (clinic) with just such clients/patients in mind, so truly to function as a safety net for the safety net.”

While the bricks and mortar clinic opens in 2013, Alameda’s homeless population does not have to wait until then to begin receiving the TRUST Clinic’s integrated health services. Starting Tuesday staff members of the clinic, including a nurse practitioner and a clinical psychologist, began offering part-time, interim mental health services at two locations in Oakland.

“We’re going to start with mental health and we’re going to begin this building up process, get our mechanisms in place,” Georges said. “It’s a little bit of a practice run for a ramp up to full scale services.”

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.