Psychiatry interventions for the homeless

Street psychiatrists

Homeless people who need psychiatric care are left to themselves in the streets of Montreal without getting any real medical attention. They go back and forth from the street to the hospital without medical follow-up. This "revolving door" is what inspired the clinic for the homeless that opened its doors in Montreal on November 12.

"More than 50% of suffer from serious and are not treated. With the clinic, we want to take care of these people and improve the effectiveness of care for the homeless," said Dr. Paul Lespérance, head of the Department of Psychiatry at the Centre hospitalier de l'Université de Montréal (CHUM), professor at the Faculty of Medicine at the Université de Montréal, and one of the main initiators of the project.

Located inside the Old Brewery Mission in downtown Montreal, the clinic includes a waiting room, an examination room, and two consultation rooms. Currently, six beds are available for patients with mental health problems and those needing longer-term care. The clinic has a social worker paid by the Agence de la santé et des services sociaux de (ASSSM), who is supported by clinical teams from the Centre de santé et de services sociaux Jeanne Mance and the Department of Psychiatry of the CHUM. Finally, three psychiatrists from the CHUM will take turns being present at the clinic.

This social approach to psychiatry is demanding but essential in the eyes of the doctors working with Dr. Lespérance. This vulnerable clientele requires a special clinical approach that is adapted to their needs; however, they also have the right to quality care.

In 2011, Dr. Lespérance and his team submitted an ambitious project in specialized care for the homeless to the ASSSM. The proposal, estimated at $8 million per year, was refused. "I couldn't drop the project either for those who conceived it or for the homeless," he said. In collaboration with the ASSSM and the Old Brewery Mission, Dr. Lespérance's team decided to focus on a single element of the project: the clinic.

"For now, it is a one-year pilot project," said the psychiatrist. "We want to prove this approach works. By taking the clinic directly to them, we hope to better monitor our homeless patients."

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