Rough Sleepers: Among Our Most Vulnerable Homeless People
"Rough sleepers” are those individuals who avoid shelters for a plethora of reasons and sleep on the streets. We have learned that this sub-group of the homeless populations suffers very high crude mortality rates and bears a complex burden of co-occurring medical, mental health and addictions problems that places them at great risk for premature death. Living throughout the year on our city’s streets, this group is exposed to the extremes of violence and weather, including heat waves and frigid cold spells. Rough sleepers are also among the highest users of emergency rooms and hospital beds as well as emergency medical services. Since 1985, our teams have embraced the evolving challenge of providing continuity of quality care to this itinerant and vulnerable population.
Primary Care on the Streets: Meeting Rough Sleepers Where They Are
BHCHP's integrated and multidisciplinary Street Team combs the city’s streets day and night to find rough sleepers wherever they are. Twice a week a doctor from the team accompanies Pine Street Inn’s Overnight Van, and several days each week the team walks the streets of the city, seeking out the men and women who live in alleys and under bridges to offer both urgent and continuous medical and behavioral health care to these individuals whose struggle to survive each day makes access to our shelter and hospital clinics difficult. The Street Team utilizes two internists, two psychiatrists (one from Massachusetts General Hospital and one from Massachusetts Mental Health Center), a nurse practitioner and a case manager. The team works seamlessly to offer fully integrated and co-located medical and behavioral health care to long-term rough sleepers.
The Street Team’s service delivery model includes:
- A doctor accompanies Pine Street Inn’s Overnight Van two night each week since 1986;
- Daytime street rounds three mornings each week since 1994;
- An innovative anchor clinic each week at Massachusetts General Hospital dedicated to the special needs and circumstances of rough sleepers since 2003;
- Daily direct care for rough sleepers admitted to designated street team beds at the Barbara McInnis House since 2004;
- House calls to over 200 chronic rough sleepers who have been placed in low threshold and other housing programs since 2005;