Homeless Veterans

I remember my first encounter trying to help someone who was homeless or displaced. One

day on my way to class, as an undergraduate, I was stopped at a light where a middle-aged gentleman was holding up a sign, ‘Vietnam veteran, homeless and hungry, anything helps.’ I had just returned from my second overseas deployment. As a member of the military we are taught to look after one another. Here at this stoplight was an above-the-knee amputee on crutches. I couldn’t drive by and continue on with my day like I didn’t just see someone in need, so I stopped and talked with him. As a veteran who has benefitted from the VA Health System, I talked with him about ways to get him help. What ensued was a 6-month long relationship, where we would talk routinely (him by calling me on a payphone and meeting up) and I would try to help connect him with veteran services. During this time, I was able to help him gain some stability, but we unfortunately lost touch (I stopped receiving calls and stopped seeing him in his usual spot). I never got a chance to know if he regained housing.

I didn’t know street medicine existed prior to starting medical school, but when I learned what TBSM did I had to take part. Providing medical care to those who have nothing or next to it. What could be more important and impactful as a medical student? In the four ensuing years I have had the privilege to serve and treat members of the homeless community and see some of them become stabilized. Being a veteran, I tried to leverage my background to identify and connect veterans to Veterans Affairs. I have learned so much from the people I have met while being a member of TBSM and have had the opportunity to see TBSM grow into what it is today. The students who volunteer their time as leaders and student providers are some of the brightest, most-humble, and kindest people I know. Being a member of TBSM has been one of my most valued and proudest experiences in medical school.

The veteran I tried to help prior to medical school, unlike some of his homeless veteran peers, was already connected to the VA. He had a service-connected disability and received benefits from the VA. He had a house and rented several storage units. As I got to know him better, I learned that he was evicted from his house due to failure to pay his mortgage, and his house was in foreclosure. When asking him why, when he had a stable income, he said he had to pay fines due to issues with the storage unit complex, but he was now locked out of them too! I ended up going to the storage unit facility one day to ask about what was going on with his units. The management talked at length about him and his units, how he collected and put garbage in his units (literally not figuratively) and was living in them. They talk about how they had warned him and tried to work with him, yet he kept disobeying the facility’s policies. After several times, they started sending him fines. After he did not stop and did not fully pay the fines, they locked him out of his units. He would have to pay the fines before having access to his possessions and then afterwards he had to relocate his property. Complicating his situation, since at the time he lost his housing, he had no address and was not receiving his disability income – making him unable to pay the fines. Just prior to losing touch, I tried to help him get reconnected with the VA to get his income and in an effort to resolve the fines and regain access to his property.

I didn’t realize it at the time, but looking back, it is likely he had an underlying mental health disorder that was either undiagnosed or untreated. So many homeless individuals, like him, have an undiagnosed or untreated mental health disorder. The National Coalition for the Homeless estimate 20-25% of homeless individuals suffer from a severe mental health disorder. While volunteering at the street medicine clinic, I have seen many homeless patients with mental illness in the clinic, more than I would like to count. A complicating and unfortunate factor for many of these individuals, who lack stable housing and income, is that they go without the very thing that may offer them the ability to regain housing and an income – medication and therapy. Many of the medications for severe mental health disorders have risks, and follow-up (which can be especially challenging) with these individuals who initiate therapy is critical. In addition, it often takes special effort and time to build trust and rapport with these individuals before the topic of treatment can even be broached with them. All of these barriers to care regrettably complicate our capacity to treat these individuals.

While a member of TBSM, I have seen TBSM grow from just one street run to having a clinic, outreach runs, and most recently a mobile unit. Partnering with community organizations has been vital to street medicine’s growth. I have had the privilege to be involved in building some of these community relationships that have positively affected our patients. As a result of this effort, we have improved our capacity to treat members of the homeless community, including those with mental health disorders – but there is still a way to go in helping this sub-population. I look forward with eager anticipation as future leaders continue to build upon the progress of their predecessors, to find new and innovative ways in overcoming the barriers to caring for this population.