Why Behavioral Health Care Matters

Several years ago, while staying at the Woods Mullen Shelter, which is operated by the Boston Public Health Commission, Jane got connected with BHCHP’s care and began weekly therapy sessions with social worker David Clark. A woman in her sixties, she was estranged from her family, grieving the loss of her partner to overdose, and had recently transitioned out of street homelessness. She was in dire need of a supportive space where someone would listen to her story and help her process the traumatic incidents she had experienced in life.

Working with David, she gradually regained her inner voice and felt like her life was worth fighting for. She began repairing her relationship with her daughters and applied for housing. When her application was denied in the first round, she firmly stood her ground to appeal her case and won. David marvels at her self-advocacy skills and shares, “Just having a safe space where she didn’t have to justify her existence, Jane was able to just grow and bring out what was deep within her.” Housed now and done with her therapy, she was recently seen outside our doors with her church members, offering food and other essential items to people living on the streets. Reflecting on her transformation, David continues, “People experiencing homelessness are amazing people. They are not a category. When they come to therapy, their soul, essence, and strength come out because we have the gift of time and space to help them find the calm and piece together a different narrative.”

Jane’s story demonstrates the power of therapeutic relationships and how behavioral health services are essential in reshaping our patients’ lives. Since 1994, BHCHP has been offering high quality mental health care to our patients, and over the years, as the number of unhoused and demand for this service have increased, our team has also expanded in size and offerings. In 2007, behavioral health became fully integrated within our primary care services when the program adopted the patient-centered medical home model. This led to the creation of multidisciplinary teams providing comprehensive care for the whole person, including physical and mental health, a strategy that has been effective in enhancing collaboration and coordination of care for the medically complex population we serve.

Whether we are meeting our patients in a clinic, on the streets, or in our medical respite facility, they can easily access the diverse services offered by our behavioral health team. Our offerings include individual and group therapy, psychiatric care, substance use disorder treatment, domestic violence support, low-threshold interventions such as the SPOT Drop-in Program and the CCiR Mobile Clinic, and more. Our work is guided by trauma-informed care and community access principles, with the primary goal of improving our patients’ quality of life. This laborious and meaning-filled challenge falls upon our skilled and dedicated team made up of psychiatrists, licensed social workers and mental health counselors, psychiatric nurse practitioners, and one psychologist who specializes in child and family care. We are also delighted to host graduate students for their clinical internships and to receive invaluable support from AmeriCorps fellows with a variety of programmatic and administrative needs.

Like Jane, there are many others who have found tremendous benefit from their engagements with our mental health professionals. Take the example of Lisa and Zoe, a mother-daughter duo who were staying at a family shelter when we first met them. At age four, Zoe witnessed a violent incident which resulted in her mom getting hurt and dad being sent away to jail. Frightened and confused about what had happened, she became more agitated when questions about her dad’s disappearance were ignored. Lisa, on the other hand, didn’t feel equipped to explain the reality to her young child. When Zoe’s school noted that she was acting out and needed emotional support, she began seeing our psychologist Rachel Harrington-Levy.

Over the course of a year, using the technique of play therapy, Zoe made immense progress with navigating her difficult emotions. She was better able to identify how she was feeling and in turn respond in a more productive manner. Lisa, who was also working with her own mental health clinician, gained new insights into how the traumatic incident was impacting her daughter, enabling her to have more empathy with Zoe and support her accordingly. The pair have now moved into their own apartment and Rachel is helping Zoe adjust to this new environment and establish feelings of safety so that she can continue to learn, play, and grow happily, as any child should. When asked about how we determine the success of a behavioral health intervention with children, Rachel replies, “For younger kids, if they can learn the language to talk about their feelings and tell somebody their feelings, it allows them to have some agency and get the support they need. Success is if a child can have a strong emotion but then use a coping strategy to manage by themself or seek the support of an adult who can help them. This is what we want because it allows them to function effectively, so they can stay in their classrooms, build good relationships with other kids, and express themselves in a healthier manner.”

With respect to adults, the question about patient success brings forth a mix of answers, but the underlying value remains consistent. “If I can help a patient change their behavior or accomplish mutually agreed upon goals, whether that’s complete abstinence or reducing use or simply improving their symptoms, that’s progress,” says Emily Gregonis, a psychiatric nurse practitioner who sees patients across multiple sites including respite, outpatient clinic, and outreach. Emily was drawn to BHCHP’s work because of its key emphasis on reducing barriers to health care for those experiencing homelessness. Working directly with many individuals who are dealing with substance use disorder, often co-occurring alongside other issues such as depression, anxiety and PTSD, she credits the use of community access strategies as instrumental in reducing mortality rates and providing a grace period for her to put together an intervention that can sustain her patient’s health in the long term. Furthermore, she shares, “I find it important to recognize and celebrate our shared humanity while doing this work. There is certainly a patient-provider relationship, but I make sure to convey to my patients that we are also two humans on the same level interacting with each other.”

Mental health care is complex, and when you add on the trauma of homelessness, the path toward healing is more winding than usual. No matter how daunting the work may be, our staff consistently go above and beyond to support our patients. The demand for high-quality care is constant—and it’s the meaningful progress we witness every day, whether big or small, that continues to inspire and drive us forward. Georgia Thomas-Diaz, a veteran mental health counselor who has been with BHCHP for nearly 25 years, adds, “It takes a village to support an unhoused patient because they have lost everything in the world, sometimes even their own respect and dignity. We are there when they hit rock bottom and it means a lot to them when they realize that they matter in the world. I don’t take their appreciation of our services for granted, ever.”

We are deeply grateful to our entire behavioral health team for their tireless dedication to our patients. And we truly hope that you—our BHCHP community of donors—realize the impact of your generosity on the lives of patients and our staff. We could not do this critical work without your support—thank you for making it possible. To learn more about this topic, please visit www.bhchp.org.