In Boston, ‘street psychiatrists’ are meeting patients where they sleep
On a winter morning in downtown Boston, a psychiatrist kneltbeside a man trying to keep warm in South Station, layers of worn clothingwrapped around his body. There was no exam room, no clipboard, no appointment time.
“Do you want a pair of socks?” Dr. Katherine Koh, a psychiatrist at Mass General Brigham, asked.
For people living on the street, this is often where mental health care begins.
“Street psychiatry flips the usual model,” Koh said. “Instead of asking people to come to us, we go to them.”
Koh is part of an emerging trend in homeless care in Boston focused on delivering mental health care directly to people, wherever they may be sleeping: on sidewalks, under bridges, or in parks. The effort has seen medical professionals join forces with the Boston Healthcare for the Homeless Program, the city’s largest homeless services provider, to aid those living with mental illness on the street.
Proponents argue street encounters aren’t an act of charity, but a clinical necessity.
The drive for more street-based care comes as the Trump administration pushes for an opposite approach, encouraging local governments to step up civil commitment of mentally ill and homeless individuals who pose a danger to others or are unable to care for themselves.
Several states, including California and New York, have expanded laws that make it easier to mandate psychiatric care, while cities including Portland, Ore., and Denver have increased police-led encampment clearings in the name of public safety.
Koh, who also teaches at Harvard Medical School, and Dr. Eileen Reilly, a psychiatrist at Cambridge-based nonprofit Vinfen Corp., documented what they see as the benefits of their work in a research paper they published in December. They argue that with homelessness near record highs nationwide, the field must be recognized, trained, and funded as a legitimate subspecialty of medicine.
