BHCHP Offers A Robust Array of Behavioral Health Services
Three out of every five BHCHP patients suffer from a serious psychiatric illness and the vast majority of them have a co-occurring substance use disorder. “We meet them wherever they are. They don’t need to be in recovery before they come to us.” said social worker David Clark, the manager for outpatient behavioral health for the Jean Yawkey Place Clinic.
BHCHP’s 30 psychiatrists, psychologists, clinical social workers, licensed mental health counselors, nurse practitioners, and recovery coaches care for about 2,000 patients in BHCHP clinics across the city as well as on the street and in patients’ homes. Medical and behavioral healthcare is integrated — meaning that behavioral health providers are constantly collaborating with medical providers and case managers. Behavioral health care appointments are available on a same-day, walk-in basis.
Patients struggle with a wide variety of psychiatric illnesses, ranging from post-traumatic stress disorder to anxiety to depression to opiate use disorder. “It’s hard for people to stop using substances when the experience of homelessness is so traumatizing. People feel overwhelmed constantly,” said Clark. “For example, how do you feel safe and stable when your humanity is not being recognized?” The behavioral health team offers individual and group therapy, medication management, recovery coaching and therapy to accompany office-based addiction treatment (OBAT).
Director of Behavioral Health Esther Valdez, MD, said that in the 26 years she has been with the program, she has seen the ages people start using get younger and drugs generally become easier to obtain. The types of drugs people are most commonly using have changed too. “Back in the day, we saw more alcohol, heroine, and cocaine use. Now we see a lot of opioids and polypharmacy — the use of multiple prescription drugs.” And today it’s not uncommon to see patients with substance use disorders (SUD) in their 20s, while a couple of decades ago, they tended to be older.
Unfortunately the availability of behavioral health services in Boston can’t keep up with the demand, according to Clark. “We as a city don’t have a strong continuum of care; it can be all or nothing,” he said. If patients can’t be shown to be a danger to themselves or someone else, there’s often nowhere to send them for treatment. Wait lists for programs can be prohibitively long.
Still, the work is incredibly gratifying, said Clark. “Our patients are resilient and strong and creative and I get to play a small role in helping support their goals,” he said. “When someone is able to make a change, it’s so significant and meaningful.” There’s no better feeling than when patients are able to figure out for themselves the best intervention, what’s right for them. “At the end of the day, the patients we service own the clinic. In our clinic, people feel welcomed, seen, listened to. There’s a sense of being recognized.”
Dr. Valdez is just one of many long-term members of the behavioral health team and the constancy of her relationships means a lot to patients, she said. “The longevity of that connection is important to people and something many of them don’t have elsewhere in their lives,” she said.
The rewards of the work can be profound — there’s nothing more gratifying than seeing a patient secure housing or re-unite with their estranged family — but often it’s a simple “thank you,” that means the most. “People are very grateful for what little you can do to alleviate their suffering,” said Valdez.