For Dan Bradford, the most rewarding
part of his work with Carolina's Program for Psychiatric Outreach
to the Homeless is the incredible improvement he glimpses in some
of his clients' lives.
Bradford
|
"The successes can
be quite profound," said Bradford, who directs the program. "That's
what keeps me going."
Bradford, a Robert Wood
Johnson Clinical Scholar and clinical instructor in the School
of Medicine's Department of Psychiatry, volunteers each week at
the free psychiatric clinic the program operates at the Inter-Faith
Council (IFC) Community House. The outreach program is based within
the psychiatry department's Division of Social and Community Psychiatry
-- and is the area's first and only free psychiatric clinic.
"They're in great
need," Bradford said of the clinic's clientele. "They also have
fascinating stories."
While only 4 percent of the
general U.S. population has a serious mental illness, between
20 and 25 percent of people who are homeless are chronically mentally
ill, the National Resource Center on Homelessness and Mental Illness
statistics indicate.
In 1995, UNC Hospitals'
Department of Psychiatry, the IFC and the Orange-Person-Chatham
Area Mental Health Program recognized a community need to provide
outreach services to homeless people with psychiatric and substance
abuse disorders.
"The homeless may not
necessarily have residency in our community and because of their
mobile nature, don't have Medicaid," said John Haggerty, associate
professor of psychiatry, director of the Division of Social and
Community Psychiatry and director of departmental N.C. Area Health
Education Centers program training. "They really need a service
that's available to them because they are often excluded from
most forms of public service."
The Program for Psychiatric
Outreach to the Homeless began with one psychiatric fellow, Michael
Golding, holding clinic every other week in the evening with occasional
help from medical and social work students and other trainees.
Clients received psychiatric evaluations, medications when needed
and referrals to the local mental health center, but the capacity
of the clinic to address broader needs and make referrals to other
agencies was limited.
Bradford took over leadership
of the the University's program in 2000 and worked to expand it
to fill the community's need for more comprehensive psychiatric
outreach. Currently, eight volunteer resident psychiatrists, two
volunteer faculty psychiatrists and two pre-medical student volunteers
work with the program. A full-time social worker was hired after
the program received a $5,000 grant from the Carolina Center for
Public Service in 2000 and in 2001 a $121,000 grant over three
years from the Kate B. Reynolds Charitable Trust.
Clinic hours begin at 7
p.m. every Thursday. At least two, and sometimes three, psychiatrists
see patients each week. Out of the pool of 10 volunteer psychiatrists,
most volunteer once a month.
In the past year, physicians
have provided a total of 217 hours of volunteer service for 98
unduplicated clients. In addition, Bradford spends about five
hours per week performing administrative tasks like writing grant
applications, obtaining medication samples and working with collaborating
agencies.
The Orange-Person-Chatham
Area Program has been particularly important to the shelter's
work, Bradford said.
"The program has been
just terrific, and our relationship with them is critical," he
said. "They've worked with us to streamline referral procedures
and helped us to identify potential funding sources."
Patients are also sometimes
referred to other Carolina physicians for psychiatric and general
medical needs, providing them with access to the resources of
UNC Hospitals and the School of Medicine.
In addition to providing
service to people who are homeless in Chapel Hill and Carrboro,
the program is also committed to two parts of the University's
mission: education and research.
"Psychiatric residents
are provided with an opportunity to learn about the unique challenges
and rewards of working with this vulnerable and underserved population,"
Bradford said.
Shane Boosey, a third-year
resident in psychiatry, works as the resident liaison to the shelter
to recruit other trainees as volunteers. He has volunteered at
the shelter for a year and a half.
"The residency program
is very challenging, and we don't have very much time," Boosey
said. "This is one area where I feel like I can give back to the
community.
"If, by going to a
shelter once a month, I can help someone get medication, get connected
with a substance abuse group or get an appointment with a mental
health center, then that's a way I've made a difference."
He organized an update dinner
for shelter volunteers and hopes the event will give volunteers
a better idea of how their individual work is helping to achieve
the overall research and treatment goals of the clinic.
With approval from a campus
Institutional Review Board, the program has also conducted studies
to evaluate treatment interventions. Bradford said the purpose
of the research is to measure outcomes and make evidence-based
decisions about what works and what doesn't in providing care
to the homeless population.
"Some patients can
do well just by being identified, but there are some folks that
are not able to make that transition without a lot of help into
ongoing care," Bradford said.
The program hopes to expand
services over the next year to treat some clients on a longer-term
basis and also to extend outreach to the unsheltered homeless.
Attaining more funding will be necessary before the clinic makes
this expansion. Bradford added that the outreach program will
continue while the Rosemary Street shelter undergoes renovations
in the next few months.
"I would say the most
challenging thing is keeping the program afloat," Bradford said.
"It's a struggle every six months or so to know where the money
is going to come from."
|
