BRATTLEBORO — One evening at dinner, a Morningside Shelter resident turned toward Mac Newman, a therapist with the Brattleboro Retreat's Starting Now program.
“You're just like a regular person,” she told him.
Newman's supervisor, Director of Ambulatory Services Kurt White, smiles as he relates the story.
For White, that small moment symbolizes Newman's powerful work at southeastern Vermont's only year-round homeless shelter.
According to White, Newman, a clinical mental-health counselor and apprentice addiction professional, is normalizing the interactions he has with residents. The hope is that, over time, residents will feel comfortable seeking Newman's help.
“You meet people where they are at,” White said - preferably with services and in environments that make them comfortable.
Newman offers onsite clinical mental health services to residents two days a week.
It is part of a pilot program launched in March by the Retreat and Morningside to provide therapeutic services to residents.
The Mental Health Clinical Collaborative aims to prevent crisis and improve the mental health of residents by removing both treatment location and structure as potential barriers to mental health care.
“Mac is a fantastic fit for this program,” said White. “His interest in trauma-informed therapy is a great fit because we're talking about people who have experienced a lot of hardship and who tend to be extremely vulnerable.”
The Vermont Community Foundation's Innovations and Collaborations program provided $20,000 for the project. This funding will last through 2015.
According to a press release from the Retreat, the program was recently nominated for an Innovation Award from the Philadelphia-based Scattergood Foundation, which funds projects that advance behavioral health.
A program to bridge the gap
Morningside's Executive Director Joshua Davis appreciates the residents' opportunity to work with Newman.
The shelter has experienced an influx of clients needing support around mental health and substance issues, he said.
Davis also appreciates the collaboration with the Retreat. Morningside staff, generalists who focus on housing, serve residents who have greater needs - like medication or treatment for mental-health issues - than many staff members can meet.
Despite the fact that “all residents of Morningside Shelter are experiencing some form of crisis,” said Davis, the organization can't afford to keep a mental-health clinician on staff.
“Offering therapy onsite at Morningside will bridge that gap and truly provide a pathway to mental health and stability,” he added. “This program will keep valuable supports and connections to the Retreat's services available, even as residents transition out of the Shelter into long-term housing.”
Thanks to its grant funding, the clinical collaborative operates outside the traditional medical billing system, which is a strength in Davis's opinion.
An organization like Morningside must stay “loose and fast” to respond to residents' shifting needs, he said. Such a dynamic environment challenges the traditional health-care billing structure.
Davis hopes that as health-care delivery changes to a more “community health-care system,” collaborations like this one will stand at the forefront of innovation.
A visit from Philadelphia-based Deborah Luepnitz, Ph.D., last year sparked the conversations that resulted in the Mental Health Clinical Collaboration. Luepnitz participated in “Dreams of Home,” a community dialogue hosted by the Retreat.
She shared the work of the Philadelphia program Project HOME, which seeks to break the cycle of homelessness.
“We know that mental-health care is difficult for many people to access for a range of reasons, from transportation to stigma to uneasiness with accessing mental-health supports at all,” said Retreat CEO Rob Simpson. “Homelessness exacerbates some of these barriers and also creates additional challenges to accessing treatment.”
In a press release, the Retreat noted that such a program offers cost savings by possibly preventing a mental-health crisis.
According to White, it costs approximately $40 per day for a resident to stay at Morningside. Yet, if that same resident experiences a psychiatric crisis, one day of inpatient psychiatric hospitalization can cost upwards of $1,000 - roughly the equivalent of one month of shelter services.
A great deal of trauma
Like most of the clinicians under White's supervision, Newman practices “trauma informed” care.
This type of care operates in a vein similar to most counseling sessions, with added attention given to the vulnerabilities and painful areas of a person's life touched by a traumatic incident.
Successful counseling depends on the clinician and client building a trusting working relationship, but people who have experienced trauma might not engage easily with a clinician.
And those who have experienced trauma might have lacked stable relationships, said White.
“So many people have a lot of trauma in the rest of their lives,” said White.
According to White, trauma differs from other difficult experiences.
“Human beings are very resilient creatures,” he said.
A traumatic experience, however, overwhelms a person's natural coping system. The experience can leave a lasting imprint and impede a person's ability to get his or her needs met in the wider world, White continued.
“Unfortunately, traumatic experiences are not that uncommon,” he said.
Morningside Shelter staff estimate that up to 80 percent of incoming adult residents are struggling with acute mental-health and/or addiction challenges.
“People struggling with homelessness often have a lot of complicated needs,” White said.
It's a good bet that many of the people staying at Morningside have experienced trauma and chaos. The upheaval experienced by people whose lives are in transition can impinge practically and emotionally on making decisions or interfere with their attending appointments.
Long-term problems
White said that the American medical system excels at solving acute problems like broken bones or heart attacks, but chronic issues and health management can prove tricky for the system.
Many mental-health issues are long-term problems that a person might struggle with over a lifetime, he said. The costs of untreated mental-health issues are incredibly high on individuals and their loved ones.
He estimates that 90 percent of people with a diagnosable substance-abuse problem never receive treatment.
Facilities like the Retreat “can help those who come in, but can't help those who don't come in,” he said. So the mental health community must discover how to help the whole community and not just those individuals who knock at the door.
White has many hopes for the new program.
He hopes the program will create an environment where people engage with the services they need when they need them.
He also hopes that through working with Newman, residents will gain the tools needed to help them transition to permanent housing.
White commented that society-at-large often misunderstands homelessness and poverty.
At a recent dinner, a family friend made a facile observation that a homeless person just “does not work hard enough.”
White disputes this characterization.
Trauma, mental health issues, addictions are “real illnesses of the brain that are treatable and that people can recover from with help and support,” said White.
And people struggling with enormous obstacles need help and compassion, he said.