What You Need to Know about Street Medicine Movement and Homeless Healthcare

A large challenge for many people experiencing homelessness is accessing healthcare. Often, these individuals use the emergency room when the health problem is already advanced. This leads to undue morbidity and strains the limited resources of care providers.

In the last decade, a movement known as “street medicine” started to send care providers out to individuals experiencing homelessness instead of forcing them to seek care. It was a radical idea when first introduced. Now, national street medicine organizations make “house calls” to provide care for individuals where they sleep.

Rapid Growth of Street Medicine

Jim Withers, MD, is often regarded as the father of the street medicine movement. In the early 1990s, while on faculty at Mercy Hospital in Pittsburgh, he realized he wanted to reach out to provide health care services for homeless people in his community. He partnered with a formerly homeless man he knew, Mike Sallows, who, for six years, had been helping homeless people on the streets of Pittsburgh. To fit in, Withers dressed like a homeless person rather than a doctor. Thus he began a nighttime journey with Sallows to camp sites under bridges, in parks and on the streets.

By exhibiting care, understanding and compassion to people experiencing homelessness, he broke through barriers and created connections and trust. He delivered early interventions, from wound care to basic treatments for skin conditions. Other people from the hospital joined him to help and expanded care beyond the basics, addressing social needs, legal aid and housing issues.

A few dozen new street medicine programs began to appear, inspired by the work of Withers, who eventually created the Street Medicine Institute as a means of training other providers to meet the needs of people experiencing homelessness.

However, programs have expanded significantly. Now more than 60 programs exist in the United States. There are also programs in 14 other countries. Annual conferences held by the Street Medicine Institute draw hundreds of providers from around the globe who are interested in reaching out to communities in need.

Current Shifts in Street Medicine Approach

The street medicine movement is still establishing its place in the medical community. Up-and-coming leaders in the movement have diverged from the initial vision of Withers. They are advocating for a more formalized approach to providing care to a wide variety of underserved populations in addition to individuals experiencing homelessness.

The leaders believe street medicine should become its own subspecialty due to the unique needs of these individuals. Creating a subspecialty would ensure providers were specifically trained to deal with all of the issues which could arise. However, specialization could also create additional barriers for people who want to give back.

The source of funding for street medicine may also change in the coming future. Many proponents of these programs have begun turning to hospitals for financing. This is because providing care on the street reduces the use of the emergency room as a primary care facility by individuals experiencing homelessness.

One hospital reported savings of $3.7 million in a single fiscal year due to reduced emergency department visits and admissions after a street medicine team organized in the community. This particular street medicine network did more than deliver care on the street; it also included eight medical clinics at soup kitchens and shelters, as well as a hospital consultation service.

Massive Need for Mental Health Services

As street medicine expands, it is evident many teams do not have all the resources they need to deal with the health needs of individuals experiencing homelessness. In particular, mental health services remain lacking.

Mental illness, including substance use disorders, are prevalent in this population. Many people face long wait times for psychiatric evaluation and then experience delays in the prescription process. As a result, they may go long periods without medications, which can interfere with their housing placement process.

To address mental health needs, Sheryl Fleisch, MD, faculty member at Vanderbilt University Medical Center, founded a street psychiatry program in 2014. Once a week, she and medical residents visit various encampments in Nashville to hand out supplies and engender trust.

The care providers also have one-on-one meetings, during which they distribute a week’s worth of medication at a time and discuss progress. This way, individuals rarely miss appointments and are relieved of any anxiety associated with coming to regular office visits.

Potential for Multidisciplinary Collaboration

Already, many street medicine teams do more than provide healthcare. These teams work with individuals to secure Medicaid or Social Security Disability, as well as connect people to housing opportunities. Many street medicine teams distribute clothing, food and beverages as a way to address immediate need and build trust.

Street medicine offers new opportunities for collaboration between service providers working to end homelessness. Population health leaders have shown that healthcare delivery requires addressing the social determinants of health. In the future, these teams may include more social workers and other professionals capable of handling the complex nature of social and physical health among people experiencing homelessness.